듀안안구후퇴증후군의 얼굴돌림과 내전시 과도한 상하전에 대한 수술적 치료
Surgical Treatment of Face Turn, and Up and Down Shoot in Duane Retraction Syndrome
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목적: 얼굴돌림이나 내전시 심한 상하전으로 수술이 필요하였던 듀안안구후퇴증후군 환자에서 임상양상에 따른 수술방법과 결과를알아보고자 하였다. 대상과 방법: 듀안안구후퇴증후군 환자 34명(34안)에서 수술 후의 사시각과 이상두위, 상하전의 호전을 후향적으로 분석하였다. 수평사시와 얼굴돌림이 있으면 수평근후전술을(1군, 15명), 내전시 심한 상하전과 외사시가 있으면 외직근후전과 함께 Y형분리술(외직근Y형분리후전술)을(2군, 16명), 제일눈위치에서 정위이면서 내전시 심한 상하전이 있으면 외직근Y형분리후전술과 내직근후전술을 동시에시행하였다(3군, 3명). 결과: 수술 후 1군에서 사시각은 18.5 ± 6.5프리즘디옵터(PD)에서 4.6 ± 5.8PD, 2군은 14.4 ± 5.5PD에서 1.6 ± 2.8PD로 감소하였고3군에서는 내전시 심한 상하전과 안구후퇴가 호전되었다. 외직근Y형분리후전술시 4 mm의 후전은 사시각에 영향을 미치지 않았고7 mm는 약 12.8PD의 교정을 보였다. 결론: 임상양상에 따라 수술방법을 결정하고, 외직근Y형분리후전술과 내직근후전술을 함께할 때는 외직근의 후전효과가 약간 작은 것을 고려해 내직근의 후전량을 정해야 하겠다.
Abstract
Purpose: To present the results of patients undergoing surgical treatment and determine clinical guidelines for the face turn, and up and down shoot in Duane retraction syndrome (DRS). Methods: Thirty-four patients with DRS were treated with single horizontal rectus muscle recession, lateral rectus (LR)recession with Y-splitting, or LR recession with Y-splitting combined with medial rectus (MR) recession. The different treatment approaches were based on the angle of deviation in the primary position, versions, and ductions. In all patients,ocular alignment, face turn and up and down shoot were assessed preoperatively and postoperatively. Results: The average standard deviation reduced from 18.5 ± 6.5 prism diopters (PD) to 4.6 ± 5.8 PD in horizontal rectus muscle recession and 14.4 ± 5.5 PD to 1.6 ± 2.8 PD in LR recession with Y-splitting. LR recession with Y-splitting combined with MR recession was effective in reducing globe retraction. Postoperative 4-mm LR recession with Y-splitting did not change ocular alignment; 7-mm LR recession with Y-splitting showed an average correction of 12.8 PD. Postoperatively,all patients presented a reduction in face turn; however, there was no statistically significant difference between the 2 procedures (Mann-Whitney U test, p = 0.620). Conclusions: Decisions regarding surgical approaches in DRS should be based on the amount of deviation in primary eye position, the expression of up and down shoot, and the degree of face turn. Surgeons planning Y-splitting of LR with MR recession must consider modifying the MR recession amount due to the smaller LR recession effect of Y-splitting compared with conventional LR recession.
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