수평마비사시 치료에서 근융합술에 대한 장기 임상결과
Long-term Outcome of a Muscle Union Procedure in Patients with Horizontal Paralytic Strabismus
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목적: 마비사시에 대하여 근융합술을 시행 받은 환자를 대상으로 장기 임상성적을 알아보고자 하였다. 대상과 방법: 2010년 9월부터 2018년 3월까지 마비사시로 근융합술을 시행 받은 환자를 대상으로 의무기록을 후향적으로 조사하여 임상 결과를 분석하였다. 외향신경마비, 동안신경마비, 그리고 부비동 내시경수술 후 발생한 내직근파열로 수술을 받은 경우로 환자군을 나누어 수술 후 1년의 결과를 비교하였다. 결과: 술 후 평균 추적관찰기간은 42 ± 20개월(12-79개월)이었으며, 수술 시 평균 연령은 40 ± 19세(7-65세)였다. 11명은 외향신경마비, 6명은 동안신경마비, 3명은 부비동 내시경수술 후 발생한 내직근파열환자들이었다. 평균 수평사시각은 수술 전 58 ± 19프리즘디옵터였으며, 술 후 최종 내원 시 14 ± 17프리즘디옵터였다. 수술의 성공은 최종 내원 시 사시각이 제일눈위치에서 10프리즘디옵터이하인 경우로 정의하였고 성공률은 60%였다. 술 후 1년째 평균 수평사시각은 외향신경마비군에서 4 ± 9프리즘디옵터, 동안신경마비군에서 26 ± 16프리즘디옵터, 그리고 내직근파열군에서 12 ± 11프리즘디옵터로 외향신경마비군과 동안신경마비군 간 비교에서 동안신경마비군이 유의하게 컸다(p=0.002). 성공률은 1년째 외향신경마비군에서 91%, 동안신경마비군 및 내직근파열군에서 33%로 외향신경마비군과 동안신경마비군 간 비교에서 외향신경마비군이 유의하게 높았다(p=0.028). 결론: 마비사시, 특히 외향신경마비환자에서 근융합술은 좋은 장기 임상 결과를 보였다. 반면, 동안신경마비나 내직근파열의 경우 제한적인 효과를 보였다.
Abstract
Purpose: To report the long-term surgical outcomes of a muscle union procedure in patients with paralytic strabismus. Methods: We retrospectively reviewed the medical records of 20 patients who underwent muscle union procedure for paralytic strabismus from September 2010 to March 2018. We analyzed the clinical results before and at the final visit after surgery. We also compared the outcomes of the first year after surgery between patients with sixth cranial nerve palsy, with third cranial nerve palsy and with medial rectus muscle rupture after endoscopic sinus surgery. Results: The mean follow-up duration was 42 ± 20 months (12-79 months). The mean age at surgery was 40 ± 19 years (7-65 years). Eleven patients underwent surgery for sixth cranial nerve palsy, six patients underwent surgery for third cranial nerve palsy, and three patients underwent surgery for medial rectus rupture after endoscopic sinus surgery. The mean horizontal deviation at the primary eye position was 58 ± 19 prism diopters before surgery and decreased to 14 ± 17 prism diopters at the final visit. The success rate at the last visit was 60%. The mean horizontal deviation at postoperative 1 year was 4 ± 9 prism diopters in the sixth nerve palsy group and 26 ± 16 prism diopters in the third nerve palsy group (p = 0.002). The success rate was 91% in the sixth nerve palsy group and 33% in the third nerve palsy group at postoperative 1 year (p = 0.017). There were no complications during surgery or anterior segment ischemia for any of the patients. Conclusions: A muscle union procedure had good long-term surgical outcomes in patients with paralytic strabismus, especially in patients with sixth cranial nerve palsy. However, in the case of third cranial nerve palsy or rupture of the medial rectus muscle, the effects were limited.
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