재발로 인해 3회 이상 수술을 시행한 간헐외사시 환자군의 임상분석
A Clinical Analysis of Intermittent Exotropia Patients Requiring More than Three Reoperations
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 3회 이상 재수술을 시행한 간헐외사시 환자들의 임상양상을 분석하여 3회 이상 재수술에 이르게 하는 요인에 대하여 알아보고자 한다. 대상과 방법: 간헐외사시로 2차 수술 후 재발되어 3차 이상의 수술을 시행 받은 13명과 2차 수술 후 1년 이상 경과 관찰을 통하여 수술의 성공을 판단할 수 있었던 29명을 대상으로 후향적으로 분석하였다. 다중 로지스틱 회귀분석을 사용하여 증상 발생 시 나이, 1차, 2차, 3차, 4차 수술 시 나이, 각 수술 전후의 입체시, 각 수술 전후의 원거리 및 근거리 사시각, 각 수술 시 항상성 유무 등이 2차 수술 후의 수술 결과에 미치는 영향을 분석하였다. 결과: 3회 이상의 수술군에서는 2회 수술군에 비하여 1세 이전에 증상이 발생한 경우가 많았고(p=0.011), 1차 수술 전 사시각이 30PD 이상으로 크며(p=0.003), 항상성인 경우가 많았다(p=0.023). 또한 3회 이상 수술군에서는 1차 수술 후 1일째 내편위를 보인 경우가 적었으며(p=0.003), 2차 수술 후 성공적인 입체시 회복을 보인 경우가 유의하게 적었다(p=0.043). 이들 요인 중 다중 로지스틱 회귀분석을 통하여 2차 수술 후 재수술과 성공에 영향을 주는 가장 중요한 요인은 술 후 성공적인 입체시의 회복 여부였다(odds ratio [OR]=50.00, 95% confidence interval [CI]=4.392-569.224, p=0.002). 결론: 본 연구에서는 사시가 1세 이전에 발생한 경우, 첫 수술 시 큰 각의 항상성 외사시인 경우, 술 후 초기 과교정이 안 된 경우에 재발로 인해 3회 이상의 수술이 필요할 수 있었고, 술 후 입체시 회복 여부가 2차 수술 후 결과의 가장 중요한 예측 인자였다.
Abstract
Purpose: To evaluate the clinical analysis of intermittent exotropia patients who required more than three reoperations and to investigate the factors leading to situations that require more than three reoperations. Methods: We retrospectively analyzed the results of 13 patients who underwent more than three reoperations for recurrence after the second operation, as well as for 29 patients who had successful results for operation at least 1 year after the second operation. We investigated the factors associated with surgical outcomes of the second operation using multiple logistic regression analysis, which included; onset of symptom, primary, secondary, tertiary, and fourth ages of surgery, stereopsis before and after surgery, distance and near deviation before and after surgery, and constancy of exotropia. Results: There were more cases in which symptoms occurred before 1 year of age (p = 0.011) and which had constant exotropia (p = 0.023), with a large deviation at first operation (p = 0.003) after more than three operations compared to patients who only had two operations. There were less cases that achieved initial overcorrection after first operation (p = 0.003) and successful postoperative stereopsis after second operation (p = 0.043) in the three operations group than in the two operations group. Among these factors, the most important factor affecting reoperation and success after second operation was related to successful recovery of stereopsis using multiple regression analysis (odds ratio [OR] = 50.00, 95% confidence interval [CI] = 4.392-569.224, p = 0.002). Conclusions: In cases of intermittent exotropia occurring before 1 year of age, constant exotropia with a large deviation at first operation, and insufficient initial overcorrection after operation, it may be necessary for patients to receive more than three operations because of recurrence. Further, recovery of postoperative stereopsis after the second operation was the most important predictor for postoperative results.
참고문헌 (24)
- Friedmann L, "Screening for refractive errors, strabismus and other ocular anomalies from ages 6 months to 3 years", J Pediatr Ophthalmol Strabismus, 17, pp.315~317 (1980)
- Friedman Z, "Ophthalmic screening of 38,000 children, age 1 to 2 1", 2 years, in child welfare clinics, 1980, pp.17, 261~267
- Preslan MW, "Baltimore vision screening project", Ophthalmology, 103, pp.105~109 (1996)
- Rah SH, "An epidemiologic survey of strabismus among school-children in Korea", J Korean Ophthalmol Soc, 38, pp.2195~2199 (1997)
- Yu YS, "Preschool vision screening in Korea: preliminary study", J Korean Ophthalmol Soc, 32, pp.1092~1096 (1991)
- Park JY, "Is the nonsurgical treatment effective on intermittent exotropia in children school-age?", J Korean Ophthalmol Soc, 36, pp.1561~1567 (1995)
- Oh JY, "Survival analysis of 365 patients with exotropia after surgery", Eye (Lond), 20, pp.1268~1272 (2006)
- Scott WE, "The postoperative results and stability of exodeviations", Arch Ophthalmol, 99, pp.1814~1818 (1981)
- Koi Chun, "The Comparision of Outcomes Between Lateral Rectus Muscles Rerecession and Medial Rectus Muscles Resection in Recurrent Exotropia", Korean Journal of Ophthalmology, 22(2), pp.111~114 (2008), 대한안과학회
- Yang HK, "Bilateral vs unilateral medial rectus resection for recurrent exotropia after bilateral lateral rectus recession", Am J Ophthalmol, 148, pp.459~465 (2009)
- Jampolsky A, "Treatment of exodeviations", Trans New Orleans Acad Ophthalmol, 34, pp.201~234 (1986)
- Yam JC, "Long-term ocular alignment after bilateral lateral rectus recession in children with infantile and intermittent exotropia", J AAPOS, 16, pp.274~279 (2012)
- Gezer A, "Factors influencing the outcome of strabismus surgery in patients with exotropia", JAAPOS, 8, pp.56~60 (2004)
- Beneish R, "The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia", Can J Ophthalmol, 29, pp.119~124 (1994)
- Choi YM, "Comparison of clinical features between two different types of exotropia before 12 months of age based on stereopsis outcome", Ophthalmology, 120, pp.3~7 (2013)
- Hunter DG, "Long-term outcome of uncomplicated infantile exotropia", J AAPOS, 5, pp.352~356 (2001)
- Wu H, "Binocular status after surgery for constant and intermittent exotropia", Am J Ophthalmol, 142, pp.822~826 (2006)
- Abroms AD, "Timely surgery in intermittent and constant exotropia for superior sensory outcome", Am J Ophthalmol, 131, pp.111~116 (2001)
- Pratt-Johnson JA, "Early surgery for intermittent exotropia", Am J Ophthalmol, 84, pp.689~694 (1977)
- Edelman PM, "Consecutive esodeviation… then what?", Am Orthopt J, 38, pp.111~116 (1988)
- Raab EL, "Recession of the lateral recti. Early and late postoperative alignments", Arch Ophthalmol, 82, pp.203~208 (1969)
- Hahm IR, "The clinical course of recurrent exotropia after reoperation for exodeviation", Korean J Ophthalmol, 19, pp.140~144 (2005)
- Gill MK, "Indications and outcomes of strabismus repair in visually mature patients", Can J Ophthalmol, 32, pp.436~440 (1997)
- Yeo SI, "Surgical results according to sensory function tests in intermittent exotropia", J Korean Ophthalmol Soc, 40, pp.3174~3179 (1999)