첫 원시교정안경 착용 후 내사시가 교정되기까지 오래 걸린 굴절조절내사시의 임상양상
Refractive Accommodative Esotropia: Duration between Wearing Hyperopic Glasses and Control of Esotropia within 8 PD
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목적: 원시교정안경을 생애 처음으로 착용 후 내사시가 교정되기 시작한 기간에 따른 굴절조절내사시 환아들의 임상양상에 대해 보고하고자 한다. 대상과 방법: 굴절조절내사시 환자 75명의 의무기록을 분석하였고, 최소 2년 이상 관찰한 경우만 포함하였다. 굴절검사결과, 내사시각, 약시 유무, 안경착용 2개월 안에 8 PD 이내로 교정된 군과 오랜 경과관찰이 필요했던 군을 비교하였다. 결과: 첫 안경 착용 나이는 평균 4.74 ± 2.34세, 경과관찰 기간 50.17 ± 14.18개월, 안경교정 전 내사시는 원거리 25.42 ± 10.07 PD, 근거리 27.72 ± 11.45 PD였다. 조절마비굴절검사 우안 +4.86 ± 2.41D, 좌안 +5.05 ± 1.06D, 8명(10.67%)은 +2D 이하였다. 안경착용 후 8 PD 이내로 교정되기까지 2개월 이내 61명(81.3%), 2-6개월 6명(8%), 6-12개월 4명(5.3%), 12개월 이후 4명(5.3%)이었다. 2개월보다 더 오랜 경과관찰이 필요했던 14명(18.7%)에서 원시는 더 적었고(+4.02D vs. +5.17D), 내사시는 원거리, 근거리 모두유의하게 심했으며(원거리 30.79 ± 10.79 PD vs. 24.17 ± 9.56 PD, p=0.03, 근거리 34.00 ± 14.20 PD vs. 26.25 ± 10.31 PD, p=0.02), 약시의 빈도가 더 높았다(71.4% vs. 47.5%). 결론: 2개월 이후에도 내사시가 8 PD 이내로 교정되지 않더라도, 환아의 사시각, 원시의 정도 등을 고려하여 긴 기간 동안 경과관찰이필요한 경우가 있다.
Abstract
Purpose: To report clinical aspects of children diagnosed with refractive accommodative esotropia after wearing their first glasses to correct hyperopia accompanied with esodeviation. Methods: The present study included 75 children followed up for at least 24 months. Age, spherical equivalent of refractive error, angle of deviation and presence of amblyopia were analyzed according to the duration between first wearing glasses and control of esotropia within 8 PD (≤2 months vs. >2 months). Results: The mean age was 4.48 ± 2.08 years and mean follow-up was 50.17 months. Initial deviation angle without glasses was 25.43 ± 10.07 PD at far, 27.72 ± 11.45 PD at near, spherical equivalent was +4.86 ± 2.41 D in right eyes, +5.05 ± 1.06 D in left eyes and 8 of 75 patients (10.67%) had ≤2 D of hyperopia. Esotropia was controlled within 8 PD with hyperopic glasses in 61 of 75 children (81.3%) within 2 months, 6 (8%) within 3-6 months, 4 (5.3%) within 6-12 months and 4 (5.3%) after 12 months. In comparison, esotropia was controlled ≤2 months in 61 of 75 children (81.3%); 14 of 75 children (18.7%) requiring >2 months had less hyperopia (+4.02 D vs. 5.17 D), more severe esodeviation both at far (30.79 ± 10.79 PD vs. 24.17 ± 9.56 PD, p = 0.03) and at near distance (34.00 ± 14.20 PD vs. 26.25 ± 10.31 PD, p = 0.02) and higher initial amblyopia prevalence rates (71.5% vs. 47.5%). Conclusions: Several patients needed longer follow-up until esotropia was controlled within 8 PD after wearing hyperopic glasses considering the amount of hyperopia and angle of esodeviation.
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