양안 외직근후전술 후 발생한 속발내사시수술 시 적절한 수술량의 결정
Decision for Proper Surgical Amount in Consecutive Esotropia Following Bilateral Lateral Rectus Recession
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목적: 간헐외사시 환자 중 양안외직근후전술 후 수술 전 외편위량과 비슷한 정도의 속발내사시가 발생하여, 이에 대한 교정수술 시 적절한 수술목표량의 결정에 대해 알아보고자 하였다. 대상과 방법: 1998년부터 2013년까지 간헐외사시로 양안 외직근후전술 후 발생한 속발내사시로 이에 대한 교정수술 후 24개월 이상 경과관찰한 환자들을 후향적으로 분석하였다. 대상이 되었던 환자는 속발 내편위량이 수술 전 외편위량과 5프리즘디옵터 이내로 유사했던 환자로 속발내사시각을 전부 교정했던 전량교정군(A) 13명과 속발내사시각을 부족 교정했던 감량교정군(B) 16명으로 나누어 수술 후 눈위치 및 입체시를 비교하였다. 결과: 속발내사시 29명의 환자 중 A군 13명, B군 16명이었다. 속발내사시 교정수술 후 24개월 이상 경과한 최종관찰 시점의 만족교정은 A군 23.1%, B군 62.5%로 B군에서 유의하게 높았으며(p=0.039), 과교정으로 인한 외사시 발생은 A군 76.9%, B군 37.5%로 A군에서 유의하게 높았다(p=0.039). 수술 후 6개월간 최종관찰 시 과교정 비율이 A군 30.8%에서 76.9%로(p=0.034), B군 12.5%에서 37.5%로 두 군 모두 증가되어 수술 후 시간경과에 따라 외편위로의 과교정 비율이 높아졌다(p=0.046). 결론: 간헐외사시 수술 전 외사시 양과 비슷한 크기의 속발내사시의 교정수술 시에는 일반적인 일차내사시 수술량에 비해 내사시 양 전부를 교정하기보다는 교정목표량을 줄이는 감량수술이 수술 후 시간경과에 따른 외편위 이행을 막을 수 있을 것이다.
Abstract
Purpose: To determine the amount of additional surgery required for patients with consecutive esotropia, who had an esodeviation angle similar to their pre-operative exodeviation angle, following bilateral lateral rectus recession surgery for intermittent exotropia. Methods: The medical records of 29 patients who underwent surgery for intermittent exotropia from 1998 through 2013 were reviewed. These patients had consecutive esotropia with an unchanged postoperative esodeviation angle. Thirteen patients underwent esotropia surgery with the aim of full correction (Group A), while 16 patients underwent esotropia surgery with the aim of partial correction (Group B). The postoperative ocular alignment and stereopsis of both groups were compared. Results: A total of 29 patients were evaluated including 13 patients in Group A and 16 patients in Group B. At the final follow-up visit, at least 24 months post procedure, Group B had a significantly greater success rate than Group A (62.5% vs. 23.1%, p = 0.039). Over-correction rates were higher in Group A than Group B (76.9% vs. 37.5%, p = 0.039). The changes during the follow- up period (6 months to their last follow-up) showed that the over-correction rate had increased from 30.8% to 76.9% in Group A (p = 0.034) and from 12.5% to 37.5% in Group B (p = 0.046). Conclusions: Consecutive esotropia surgery with the aim of partial correction showed favorable motor and sensory outcomes in patients who had a postoperative esodeviation angle similar to that of their pre-operative exodeviation. This strategy may also be helpful in preventing long-term postoperative over-correction in patients presenting with consecutive esotropia.
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