간헐외사시에서 수술 당일 측정한 수술 전 사시각의 변동성
Variability of Preoperative Angle of Deviation Measured on the Day of Surgery in Intermittent Exotropia
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목적: 간헐외사시 환아에서 수술 당일 측정한 수술 전 사시각의 변동성을 평가하고, 그 변동에 따른 수술 결과의 차이를 알아보고자하였다. 대상과 방법: 간헐외사시로 두 눈 외직근후전술을 받은 323명을 대상으로, 수술 전 3개월 이내 측정된 최대 사시각과 수술 당일 측정한 사시각을 비교하였다. 수술 당일 사시각이 8프리즘디옵터(PD) 이상 증가, 감소 혹은 동일하였던 군으로 나누어, 각 군의 빈도와임상양상, 수술 결과를 조사하였다. 수술량은 수술 전 3개월 이내 측정된 최대 원거리 사시각을 기준으로 정하였다. 결과: 수술 당일 원거리 사시각은 5명(1.5%)에서 증가하고, 6명(1.9%)에서 감소하였으며, 근거리 사시각은 19명(5.9%)에서 증가하고, 22명(6.8%)에서 감소하였다. 원거리 사시각에 변동이 있었던 군은 동일군보다 원거리 사시각이 컸고, 굴절부등이 있는 경우가 많았다. 근거리 사시각 감소군은 동일군에 비해 나이가 많았으며, 특히 취학 아동의 비율이 81.8%로 높았다. 수술 당일 사시각에 변동이 있었던 군은 수술 전 최대 사시각에 비해 사시각의 원근 차이가 감소하였다. 최종 경과관찰에서 근거리 사시각 감소군에서는 10PD 이상과교정된 경우가 13.6%로, 유의하게 많았다(p=0.039). 결론: 일부 간헐외사시 환아에서는 수술 당일 사시각에 변동이 있을 수 있으며, 근거리 사시각이 감소하는 경우 수술 후 과교정되는빈도가 상대적으로 높았다.
Abstract
Purpose: To evaluate the characteristics and surgical outcomes of children with intermittent exotropia whose preoperative angle of deviation changed on the day of surgery. Methods: The medical records of 323 children with intermittent exotropia who underwent lateral rectus recession in both eyes were reviewed. The records were classified according to the difference of 8 prism diopters (PD) or more between the largest angle of deviation measured within 3 months prior to the operation and that on the day of surgery into the increased, same, or decreased groups. The frequency, characteristics, and surgical outcomes of each group were analyzed. The surgical amount was determined based on the largest angle of deviation measured at distance within 3 months before surgery. Results: The angle of deviation at distance on the day of surgery was increased in 5 patients (1.5%) and decreased in 6 (1.9%). The near angle was increased in 19 (5.9%) and decreased in 22 (6.8%) patients. The groups in which distant deviation was changed had a greater distant angle and more patients with anisometropia. The group in which near deviation decreased was older than the same group and 81.8% of the patients were school-aged. In the group with changes in either distant or near deviation, the angle on the day of surgery changed toward decreasing disparity of near-distant deviation. On the last follow-up, the rate of overcorrection of 10 PD or more was 13.6% in the decreased near deviation group, which was significantly high (p = 0.039). Conclusions: The angle of deviation on the day of surgery could be different compared to the largest preoperative angle in some patients with intermittent exotropia. In patients with decreased near deviation, the rate of postoperative overcorrection might be high.
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