상급종합병원으로 내원한 근시굴절부등약시 환아의 임상 특징
Clinical Features of Amblyopic Children with Myopic Anisometropia at a Tertiary Center
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 상급종합병원으로 내원한 한 눈 근시굴절부등약시에서 굴절부등정도에 따른 임상 양상 차이를 알아보고자 하였다. 대상과 방법: 두 눈 구면렌즈대응치 차이가 1.00디옵터(D) 이상인 근시굴절부등으로 처음 안경을 착용한 환아 중 1년 이상 관찰한 102명을 대상으로 하였다. 굴절부등이 3.00D 이상인 군과 미만인 군으로 나누어, 약시 빈도와 가림치료 결과, 굴절부등 변화, 굴절이상을 제외한 안과질환이나 전신질환 빈도를 조사하였다. 안경 착용 후 4개월, 1년, 최종관찰시기에 측정한 시력과 굴절검사 결과로 분석하였으며 두 눈의 시력 차이가 1줄 이내일 때 약시치료 성공으로 정의하였다. 결과: 경도굴절부등군 61명, 고도굴절부등군 41명은 평균 5.2세에 안경을 착용하였고, 평균 34.6개월 관찰하였다. 4개월 뒤 경도굴절부등군 82.0%, 고도굴절부등군 92.7%가 한 눈 약시였으나, 최종관찰시기에 경도굴절부등군 45.9%, 고도굴절부등군 87.8%가 한 눈 약시로 경도굴절부등군의 치료 결과가 의미 있게 좋았다(p<0.001). 굴절부등 정도는 경도굴절부등군은 1.42 ± 0.66D, 고도굴절부등군은 5.47 ± 2.09D였고, 관찰 기간동안 경도굴절부등군은 0.78D 굴절부등이 증가하고, 고도굴절부등군은 0.02D 감소하여 평균적으로 0.42D 굴절부등이 증가하였으나 통계적으로 의미 있는 변화는 아니었다(p=0.437). 경도굴절부등군 57.4%, 고도굴절부등군 53.7%에서 동반질환이 있었다. 결론: 상급종합병원으로 내원한 고도굴절부등인 근시 약시는 제한적인 약시 호전을 보였고, 굴절부등 정도는 변하지 않았다.
Abstract
Purpose: To evaluate the clinical features of unilateral amblyopia with myopic anisometropia at a tertiary center. Methods: The medical records of 102 children wearing spectacles due to myopic anisometropia with an interocular difference in spherical equivalent (SE) ≥ 1.00 diopters (D) with a follow-up ≥ 1 year were reviewed. Patients were classified into mild or severe groups according to an interocular SE difference ≥ 3.00D. The frequency of amblyopia (interocular difference ≥ two lines of visual acuity [VA]) and response to patching, the magnitude of anisometropia, and the frequency of combined ocular or systemic disorders except refractive errors were compared between the two groups. The VA and refractive errors were measured four months and one year after spectacle correction and at the last follow-up. Results: In all, 61 patients with mild myopic anisometropia and 41 patients with severe myopic anisometropia started to wear spectacles at a mean age of 5.2 years old and were followed-up during a mean period of 34.6 months. The frequency of amblyopia decreased more prominently in the mild group: 82.0% in the mild group vs. 92.7% in the severe group four months after spectacle correction and 45.9% in the mild group vs. 87.8% in the severe group at the last follow-up. At baseline, the mild group had anisometropia of 1.42 ± 0.66D, while the severe group had anisometropia of 5.47 ± 2.09D. The magnitude of anisometropia tended to increase by 0.42D but not significantly: +0.78D in the mild group and -0.02D in the severe group. More than half of the patients had combined disorders: 57.4% in the mild group and 53.7% in the severe group. Conclusions: Severe myopic anisometropic amblyopia at a tertiary center showed little improvement and the magnitude of anisometropia did not change.
참고문헌 (26)
- Barrett BT, "The relationship between anisometropia and amblyopia", Prog Retin Eye Res, 36, pp.120~158 (2013)
- Vincent SJ, "Myopic anisometropia : ocular characteristics and aetiological considerations", Clin Exp Optom, 97, pp.291~307 (2014)
- 김준범, "굴절부등에 동반된 약시 및 사시", 대한안과학회지, 48(3), pp.411~417 (2007), 대한안과학회
- Pang Y, "A prospective pilot study of treatment outcomes for amblyopia associated with myopic anisometropia", Arch Ophthalmol, 130, pp.579~584 (2012)
- Rosenthal AR, "Clinical findings and therapy in unilateral high myopia associated with amblyopia", Am J Ophthalmol, 71, pp.873~879 (1971)
- Priestley BS, "Amblyopia secondary to unilateral high myopia; results of pleoptic therapy", Am J Ophthalmol, 56, pp.926~932 (1963)
- Curtin BJ, "Unilateral high myopia in childhood : clinical characteristics and treatment", Am Orthopt J, 26, pp.65~68 (1976)
- Kutschke PJ, "Anisometropic amblyopia", Ophthalmology, 98, pp.258~263 (1991)
- Pang Y, "A prospective study of macular thickness in amblyopic children with unilateral high myopia", Invest Ophthalmol Vis Sci, 52, pp.2444~2449 (2011)
- Vincent SJ, "Interocular symmetry in myopic anisometropia", Optom Vis Sci, 88, pp.1454~1462 (2011)
- Linke SJ, "Association between ocular dominance and spherical", astigmatic anisometropia, age, and sex : analysis of 10, 264 myopic individuals, 2011, pp.52, 9166~9173
- Yang JW, "Correlation between myopic ametropia and stereoacuity in school-aged children in Taiwan", Jpn J Ophthalmol, 57, pp.316~319 (2013)
- 김연희, "한 눈의 시력이 0.1 이하인 순수 굴절부등약시의 임상 분석", 대한안과학회지, 49(6), pp.973~978 (2008), 대한안과학회
- 이병주, "소아의 단안 고도 근시성 부등시 눈에서 콘택트렌즈 착용과 약시 치료", 대한안과학회지, 51(1), pp.88~94 (2010), 대한안과학회
- 최덕규, "굴절부등약시에서 약시치료 전 안경착용의 효과", 대한안과학회지, 52(5), pp.550~556 (2011), 대한안과학회
- Cotter SA, "Treatment of anisomtropic amblyopia in children with refractive correction", Ophthalmology, 113, pp.895~903 (2006)
- Wallace D, "Amblyopia, preferred practice pattern", American Academy of Ophthalmology, pp.110~133 (2017)
- Sen DK, "Results of treatment in amblyopia associated with unilateral high myopia without strabismus", Br J Ophthalmol, 68, pp.681~685 (1984)
- Pang Y, "Effect of amblyopia treatment on macular thickness in eyes with myopic anisometropic amblyopia", Invest Ophthalmol Vis Sci, 56, pp.2677~2683 (2015)
- Tychsen L, "Phakic intraocular collamer lens(Visian ICL)implantation for correction of myopia in spectacleaversive special needs children", Am J Ophthalmol, 175, pp.77~86 (2017)
- Holmes JM, "Effect of age on response to amblyopia treatment in children", Arch Ophthalmol, 129, pp.1451~1457 (2011)
- Pärssinen O, "Anisometropia of spherical equivalent and astigmatism among myopes : a 23-year follow-up study of prevalence and changes from childhood to adulthood", Acta Ophthalmol, 95, pp.518~524 (2017)
- Lok JY, "Visual outcome and refractive status in first 3 years of age in preterm infants suffered from laser-treated type 1 retinopathy of prematurity(ROP) : a 6-year retrospective review in a tertiary centre in Hong Kong", Int Ophthalmol, 38, pp.163~169 (2018)
- Lyu IJ, "The association between menarche and myopia : findings from the Korean national health and nutrition examination, 2008-2012", Invest Ophthalmol Vis Sci, 56, pp.4712~4718 (2015)
- Shin KH, "The impact of intermittent exotropia and surgery for intermittent exotropia on myopic progression among early school-aged children with myopia", Br J Ophthalmol, 98, pp.1250~1254 (2014)
- Tsiaras WG, "Amblyopia and visual acuity in children with Down's syndrome", Br J Ophthalmol, 83, pp.1112~1114 (1999)