약시에 대한 매일 가림치료와 격일 가림치료의 효과 비교
Comparison of Results after Daily Patching and Alternate-Day Patching to Treat Amblyopia
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목적: 약시에 대한 매일과 격일 가림치료의 효과가 차이 있는지를 알아보기 위해 두 방법을 전향적으로 비교하였다. 대상과 방법: 초진 후 두 눈 시력이 2줄 이상 차이 나는 경우, 조절마비굴절검사 결과에 따라 안경을 처방하였다. 4개월 후 최대교정시력 기준으로 약시로 확진된 45명 환아를 무작위로 매일과 격일 가림치료군으로 나누었다. 매일 가림치료군 24명은 매일, 격일 가림치료군 21명은 격일로 나쁜 눈의 시력에 따라 2-6시간 동안 좋은 눈을 가리도록 하였고, 달력에 가린 날을 표시하도록 하였다. 치료후 1, 3, 6, 9개월째 시력 및 치료 순응도를 조사하였고, 두 눈 시력이 한 줄 이하로 차이 나는 경우를 치료 성공으로 정의해 최종성공률을 분석하였다. 결과: 치료 시작 시 매일과 격일 가림치료군 간에 나이, 약시안 최대교정시력, 약시 원인, 그리고 총 치료기간은 유의한 차이 없었다. 두 군 모두 치료 후 1개월부터 치료 시작 시에 비해 시력이 유의하게 호전되었다. 최종 내원 시 두 군 간 시력이 호전된 줄 수(3.8줄:3.7줄, p=0.754), 성공률(50.0%:81.0%, p=0.060) 및 순응도(94.5%:96.3%, p=0.803)에 유의한 차이 없었으나, 최종 약시안 시력은 격일가림군에서 유의하게 좋았다(0.2 logMAR:0.1 logMAR, p=0.042). 결론: 약시의 가림치료 방법으로 매일과 격일 가림 간에 최종 시력은 격일 가림치료군이 좋았고, 치료의 순응도, 시력이 호전된 줄수 및 성공률은 유의한 차이 없었다. 따라서, 약시에 대한 가림치료의 한 방법으로 격일 가림을 고려할 수 있겠다.
Abstract
Purpose: We compared the results of daily patching and alternate-day patching to treat amblyopia. Methods: Patients with difference in the visual acuity (VA) between the eyes of at least two lines were prescribed spectacles accordingto the result of cycloplegic refraction. After 4 months, 45 patients with confirmed amblyopia were randomly assigned todaily patching or alternate-day patching group. Patients were patched daily in the daily patching group (n = 24), and patched everyother day in another group. The patching time was 2-6 hours according to the VA of the amblyopic eye. The parents wereasked to mark on a calendar whether their child performed occlusion or not. The main outcome measure was the mean VA ofamblyopic eye and compliance of occlusion after 1, 3, 6 and 9 months. The success of treatment was defined if difference of VAbetween the eyes was less than or equal to 1 line. Results: There was no significant difference between the two groups in age, type of amblyopia, VA of the amblyopic eye and totaltreatment duration. VA of the amblyopic eye was significantly improved at 1 month after occlusion in both groups. At the final visitin both groups, the number of improved VA lines in the amblyopic eye (3.8 lines:3.7 lines, p = 0.754), the final success rate(50.0%:81.0%, p = 0.060) and the compliance of occlusion (94.5%:96.3%, p = 0.803) were not different significantly, but VA ofthe amblyopic eye (0.2 log MAR:0.1 log MAR, p = 0.042) was better in the alternate-day patching group than that in another group. Conclusions: There was no difference in the number of improved VA lines in the amblyopic eye, nor were there differences insuccess rate and compliance of occlusion between the two groups. The final VA was better in the alternate-day patching groupthan another group. Therefore, the alternate-day patching method is another possible option for the treatment of amblyopia.
참고문헌 (32)
- Lowe RF., "Atropine treatment for amblyopia ex anopsia", Br Orthopt J, 22, pp.35~42 (1965)
- Bangerter A., "Die okklusion in der pleoptik und orthoptik", Klin Monbl Augenheilkd, 136, pp.305~331 (1960)
- Campbell FW., "Preliminary results of a physiologically based treatment of amblyopia", Br J Ophthalmol, 62, pp.748~755 (1978)
- Lee JH., "Effect of levodopa on visual function in amblyopia", J Korean Ophthalmol Soc, 37, pp.1354~1359 (1996)
- Repka MX., "Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children", Arch Ophthalmol, 123, pp.149~157 (2005)
- Pediatric Eye Disease Investigator Group., "A randomized trial of atropine vs patching for treatment of moderate amblyopia : follow-up at age 10 years", Arch Ophthalmol, 126, pp.1039~1044 (2008)
- 김연희, "약시에서 간헐적 아트로핀 처벌치료와 부분 가림치료 효과의 전향적 비교", 대한안과학회지, 49(6), pp.958~966 (2008), 대한안과학회
- 이경숙, "학동기 약시 환아에서 부분 가림치료와 간헐적 아트로핀 처벌치료의 비교", 대한안과학회지, 51(2), pp.259~265 (2010), 대한안과학회
- Simons K., "Preschool vision screening : rationale, methodology and outcome", Surv Ophthalmol, 41, pp.3~30 (1996)
- Oliver M., "Compliance and results of treatment for amblyopia in children more than 8 years old", Am J Ophthalmol, 102, pp.340~345 (1986)
- Searle A., "Psychosocial and clinical determinants of compliance with occlusion therapy for amblyopic children", Eye(Lond), 16, pp.150~155 (2002)
- Woodruff G., "Factors affecting the outcome of children treated for amblyopia", Eye (Lond), 8(Pt 6), pp.627~631 (1994)
- Beardsell R., "Outcome of occlusion treatment for amblyopia", J Pediatr Ophthalmol Strabismus, 36, pp.19~24 (1999)
- Holmes JM., "A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children", Ophthalmology, 110, pp.2075~2087 (2003)
- Repka MX., "A randomized trial of patching regimens for treatment of moderate amblyopia in children", Arch Ophthalmol, 121, pp.603~611 (2003)
- 안진환, "한눈약시 환자에서 2시간, 6시간, 종일 가림치료의 비교", 대한안과학회지, 50(11), pp.1724~1729 (2009), 대한안과학회
- Agervi P., "Two-year follow-up of a randomized trial of spectacles plus alternate-day patching to treat strabismic amblyopia", Acta Ophthalmol, 91, pp.678~684 (2013)
- Mintz-Hittner HA., "Successful amblyopia therapy initiated after age 7 years : compliance cures", Arch Ophthalmol, 118, pp.1535~1541 (2000)
- Foley-Nolan A., "Atropine penalisation versus occlusion as the primary treatment for amblyopia", Br J Ophthalmol, 81, pp.54~57 (1997)
- Cotter SA., "Treatment of anisometropic amblyopia in children with refractive correction", Ophthalmology, 113, pp.895~903 (2006)
- Steele AL., "Successful treatment of anisometropic amblyopia with spectacles alone", J AAPOS, 10, pp.37~43 (2006)
- Chen PL., "Anisometropic amblyopia treated with spectacle correction alone : possible factors predicting success and time to start patching", Am J Ophthalmol, 143, pp.54~60 (2007)
- Flynn JT, "The therapy of amblyopia : an analysis of the results of amblyopia therapy utilizing the pooled data of published studies", Trans Am Ophthalmol Soc, 96, pp.431~450 (1998)
- Cleary M., "Efficacy of occlusion for strabismic amblyopia : can an optimal duration be identified?", Br J Ophthalmol, 84, pp.572~578 (2000)
- 이철승, "약시 환자의 가림치료 결과에 영향을 주는 인자 분석", 대한안과학회지, 42(12), pp.1740~1746 (2001), 대한안과학회
- Hiscox F., "Occlusion for amblyopia: a comprehensive survey of outcome", Eye (Lond), 6(Pt 3), pp.300~304 (1992)
- 오동은, "약시의 종류와 정도 및 치료 시작 시기에 따른 가림 치료 효과", 대한안과학회지, 44(12), pp.20~2856 (2003), 대한안과학회
- Romano PE., "Stereoacuity development in children with normal binocular single vision", Am J Ophthalmol, 79, pp.966~971 (1975)
- Flynn JT., "The therapy of amblyopia: an analysis comparing the results of amblyopia therapy utilizing two pooled data sets", Trans Am Ophthalmol Soc, 97, pp.373~390 (1999)
- Scott WE., "Full-time occlusion therapy for amblyopia", Am Orthopt J, 30, pp.125~130 (1980)
- Freeman RS., "The use of part-time occlusion for early onset unilateral exotropia", J Pediatr Ophthalmol Strabismus, 26, pp.94~96 (1989)
- Parks MM., "Treatment of eccentric fixation in children under four years of age", Am J Ophthalmol, 61, pp.395~399 (1966)