미숙아 병력을 가진 외사시 환아의 임상양상 및 수술 결과
The Clinical Features and Surgical Outcome of Premature Children with Exotropia
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목적: 미숙아 병력을 가진 외사시 환자의 임상양상과 수술 성공률을 알아보고자 하였다. 대상과 방법: 외사시로 수술 받은 후 6개월 이상 관찰한 환아 중 재태기간 37주 미만 또는 출생체중 2,000 g 미만의 미숙아 병력이있는 22명을 대상으로 하였다. 이들의 재태기간, 출생체중, 초진 및 수술 시 나이, 수술 전 시력, 초진 시 및 수술 전 최대 외사시각,동반된 사시, 수술 후 결과를 분석하였다. 최종 내원 시 사시각이 10 PD 이내인 경우를 성공으로 정의한 후, 성공군과 실패군으로분류하여 비교하였다. 결과: 수술 전 외사시각은 원거리에서 28.4 ± 8.2 PD, 근거리에서 28.5 ± 8.3 PD이었고 최종 내원 시 원거리에서 8.0 ± 14.2 PD,근거리에서 9.1 ± 14.8 PD의 외사시를 보였다. 수술 성공률은 최종 내원 시 59.1%였으며, 재발이 8명(36.4%)으로 실패의 주 원인이었다. 성공군(13명)에 비하여 실패군(9명)에서 초진 및 수술 전 최대 사시각이 통계적으로 유의하게 컸다. 수술 전 또는 수술 후에 상사시가 동반된 경우는 총 10명(45.6%)이었으며, 실패군과 성공군 사이에 차이는 없었다. 결론: 미숙아 병력이 있는 외사시 환아에서는 수술 성공률은 비교적 낮았으며, 수술 실패의 주원인은 외사시의 재발이었다. 초진 시외사시각의 정도와 수술 전 최대 외사시각의 정도가 수술 결과에 영향을 주는 요인이었다.
Abstract
Purpose: We intended to investigate the clinical features and success rates of surgery in premature children with exotropia. Methods: Twenty-two exotropia children with a gestational age of less than 37 weeks, or a birth weight of less than 2,000 g wereincluded. The children had also been clinically observed for at least six months after surgery for exotropia. This study analyzedthe results of their surgery in terms of gestational age, birth weight, ages at the first examination, and surgery, visual acuity, theangle of exodeviation at the first examination and the maximum angle of exodeviation before surgery, the frequency of accompaniedstrabismus, and surgical results. Surgical success was defined as postoperative angle of deviation less than 10 PD. Thepatients were divided into success and failure groups, and a comparative analysis was performed between the 2 groups. Results: The mean maximum angle of exodeviation before surgery was 28.4 ± 8.2 PD at far distance and 28.5 ± 8.3 PD at neardistance. The mean angle of exodeviation at last visit after surgery was decreased to 8.0 ± 14.2 PD at far distance and 9.1 ± 14.8PD at near distance. The success rate of surgery was measured to be 59.1% at the last visit. Recurrence was a major cause offailure, which occurred in eight cases (36.4%). The angle of exodeviation at the first examination and the maximum angle of exodeviationin the failure group were higher than in the success group with statistical significance. The incidence of vertical strabismusbefore or after the surgery was 45.6% (10 cases) and there was no statistically significant difference between the 2groups. Conclusions: The premature children with exotropia had a relatively low surgical success rate and the major cause of the surgicalfailure was the recurrence of exotropia. The degree of the angle of deviation at the first examination and the maximum angle ofexodeviation before surgery was an influential factor on the surgical results.
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