근원거리 사시각이 차이 나는 감각 외사시의 수술 결과
Surgical Outcome of Sensory Exotropia with Distant-Near Disparity
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목적: 근원거리 사시각이 차이 나는 감각 외사시의 수술 결과를 분석하고, 내직근 절제 감량 여부에 따라 수술 결과의 차이를 비교하고자 하였다. 대상과 방법: 6개월 이상 경과관찰한 감각 외사시 환자들의 의무기록을 후향적으로 조사하였다. 근, 원거리 사시각 차이가 없는 경우를 기본 감각 외사시(basic sensory exotropia, B-XT), 10 prism diopter (PD) 이상 차이 나는 경우를 불일치 감각 외사시(distant-near disparity sensory exotropia, DND-XT)라고 이름하였다. 두 군의 임상 자료를 비교 분석하였고, 내직근 수술량의 감량여부에 따라 전통 술식군과 감량 절제군으로 나누어 수술 결과 및 수술성공률을 비교하였다. 수술성공 기준은 근, 원거리 모두에서10 PD 미만의 편위를 유지하고 있는 경우로 정의하였다. 결과: B-XT군은 58명, DND-XT군은 33명이었다. 두 군 간 임상적 특징의 유의한 차이는 없었으나, 나쁜 눈의 시력은 DND-XT군에서B-XT군보다 유의하게 좋았다. DND-XT군의 평균 원거리 외사시각은 46.55PD, 근거리 외사시각은 14.93PD 로 그 차이는 29.83PD 였다. 이들은 모두 단안 내직근 절제 및 외직근 후전술을 받았고, 33명 수술 환자 중 전통 술식 수술군은 16명, 내직근 감량 수술군은17명이었다. 전통적 수술군 중 9명이 최종 관찰시점에서 수술 실패 기준에 해당하였고, 감량 수술군 중 수술 실패 환자는 단지 1명으로유의하게 수술 실패율이 낮았다. 결론: 전통적 수술량에 따라 원거리 사시각을 수술하였을 때 과교정이 많았으며 내직근 절제 수술량을 감량하였을 때 상대적으로더 높은 수술 성공률을 얻을 수 있었다.
Abstract
Purpose: To assess clinical features of sensory exotropia with distant-near disparity, surgical outcome, and compare according to amount of medical rectus resection. Methods: Authors retrospectively reviewed medical records of patients of sensory exotropia with follow-up over 6 months. We defined patients with over 10 prism diopter (PD) disparity as distant-near disparity sensory exotropia (DND-XT) and without disparity as basic sensory exotropia (B-XT). First, we analyzed and compared data of visual acuity, cause and age of visual loss, amount of deviation. Second, Surgical failure was analyzed with dividing DND-XT into conventional surgery group as Parks’ formula and reduced medial rectus resection group in accordance with disparity. Surgical success was defined as less than 10 PD deviation in distant, near fixation. Results: B-XT consisted of 58 patients (40 males) and DND-XT of 33 patient (13 males). There was no significant difference between 2 groups in onset and cause of visual loss, deviation at distant fixation. But, log MAR visual acuity of worse eye was better in DND-XT than B-XT (1.74 ± 0.78, vs. 2.10 ± 0.74, p = 0.039). Average deviation in distant fixation in DND-XT was 46.55 ± 16.59 PD in distant and 14.93 ± 8.91 PD in near fixation. All patients underwent surgery of medial rectus resection and lateral rectus recession and average deviation was 6.83 ± 7.71 PD at distant fixation, 3.02 ± 0.69 PD at near fixation at last follow-up. Among 33 patients, 16 patients underwent conventional amount of surgery and 17 patients with reduced medial rectus resection. In patient with conventional surgery, 9 patients were surgical failure (8 patients of over-, 1 patient of under-correction) but in patient with reduced amount of resection, only 1 patient was under-correction. Conclusions: As a result of medial rectus resection and lateral rectus recession in DND-XT, more surgical failures due to over-correction were observed with conventional resection and higher surgical success was attained in consideration of disparity.
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