발달장애아에서 안과질환의 임상양상
A Study of Ocular Disease and Treatment in Patients with Developmental Disability
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목적: 발달장애아에서 안과질환의 구성과 경과, 그리고 발달장애아에서 시행한 약시치료와 사시수술의 결과에 대해 알아 보고자 하였다. 대상과 방법: 소아과 및 재활의학과에서 발달장애아로 진단받고 안과에 의뢰되어 검사를 시행한 43명의 의무기록을 후향적으로 조사하였다. 결과: 총 43명 중 41명(95.35%)에서 사시가 발견되었다. 구성은 외사시 20명(46.51%), 내사시 15명(34.88%), 해리수직편위 10명(23.26%),운동장애성사시 4명(9.30%)이었다. 이 중 4명은 치료 없이 저절로 호전되었고 21명에서 수술을 시행하였으며 수술 후 최종사시각은외사시에서 5.33 ± 5.93 PD의 외사시, 내사시에서 5.75 ± 4.65 PD의 내사시로 양호하였다. 굴절이상은 33명(88.4%)에서 발견되었고26명(60.5%)에서 단안약시를 보였으며 이 중 17명(65.38%)이 치료 후 시력개선을 보였다. 결론: 발달장애아에서 높은 빈도의 사시와 굴절이상이 관찰되었고 약시치료와 사시수술을 시행하여 좋은 결과를 얻을 수 있었다. 발달장애가 사시수술 결과에 미치는 영향은 없는 것으로 보이나 운동장애성사시, 자발적 호전이나 외편위로의 진행 등이 관찰되므로 수술전 충분한 기간동안 신중한 검사가 필요하다.
Abstract
Purpose: To evaluate ocular abnormalities in children with developmental disability and to find out whether any correlationexists between developmental disability and surgical outcome. Methods: Totally 43 patients with the diagnosis of developmental disability were enrolled in this retrospective study. Results: Mean follow-up was 4.54 ± 2.35 year. 20 patients had exodeviation, 15 patients had esodeviation, 10 patients haddissociated vertical deviation and 4 patients had dyskinetic strabismus. 21 patients had surgery and the mean deviationangle was decreased from 36.67 ± 15.70 PD to 5.33 ± 5.93 PD in exotropia and 56.25 ± 8.54 PD to 5.75 ± 4.65 PD inesotropia. Refractive error was found in 33 patients (88.4%). 26 patients (60.5%) had monocular amblyopia and 17 patients(65.38%) showed improvement of visual acuity after treatment. Conclusions: Exotropia is the most common type strabismus in patients with developmental disability and dyskinetic strabismusis found in cerebral palsy. Strabismus Surgery for patients with stable angle deviation and amblyopia treatment iseffective in children with developmental disability. However decision for surgery should be made after a long follow upperiod.
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