간헐성 외사시에서 수술시기에 따른 수술결과 비교
Surgical Outcomes of Intermittent Exotropia According to the Constancy
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목적: 간헐외사시에서 간헐성 시기와 항상성 시기에서의 수술결과를 비교하여 간헐성 여부가 수술 결과에 영향을 미치는지 알아보고자한다. 대상과 방법: 외사시로 수술을 시행 받은 간헐외사시의 과거력을 가지는 항상외사시군 16명과 간헐외사시군 44명을 후향적으로 분석하였다. 다중 로지스틱 회귀분석을 사용하여 간헐성 유무, 수술 시 나이, 사시이환기간, 술전 입체시, 술전 원거리사시각, 술전 원거리융합 유무 등이 수술결과에 미치는 영향을 분석하였다. 결과: 수술 후 성공적인 안구정렬을 보인 비율은 두 군 사이에 차이가 없었으나(p=0.121) 술후 두눈중심오목융합의 비율은 간헐외사시군이(70.5%) 항상외사시군(12.5%)에 비하여 유의하게 높았다(p=0.000). 단변량 로지스틱 회귀분석에서는 간헐성 유무(p=0.001) 및 술전 원거리융합 유무(p=0.025)가, 다중 로지스틱 회귀분석 결과 간헐성 유무만이 술후 감각회복에 영향을 주었다(p=0.008). 결론: 간헐성 시기에 사시 수술을 시행 받은 경우가 간헐성을 거친 항상성 시기에 비하여 술후 감각회복이 좋았으며 수술 시 나이나사시이환기간, 술전 입체시, 술전 사시각 및 원거리융합 유무는 영향을 주지 않았다.
Abstract
Purpose: To investigate how the constancy of intermittent exotropia affects postoperative motor and sensory outcomes. Methods: A retrospective analysis was conducted of 44 patients with intermittent exotropia (IXT group) and 16 patients with constant exotropia with a previous history of intermittent exotropia (CXT group). All patients were followed up for more than 1 year postoperatively. Successful postoperative motor alignment was defined as within 8 prism diopters of exo- or esotropia at 6 meters and 33 centimeters. Successful sensory outcome (bifixation) was considered as stereoacuity ≤60 seconds of arc. The influence of constancy, age at surgery, duration of strabismus, preoperative gross stereopsis, preoperative distant deviation, and preoperative distant fusion to surgical outcomes were evaluated using logistic regression analysis. Results: Mean age at surgery and follow-up periods was 9.34 years and 37.8 months in the IXT group, and 10.19 years and 45.7 months in the CXT group. Successful motor alignment rates of the IXT and CXT groups were 65.9% and 48.3%,respectively. Postoperative bifixation rates of the IXT and CXT groups were 70.5% and 12.5%, respectively. The IXT group showed significantly better successful sensory outcome (p = 0.000), but no significant difference in motor outcome (p =0.121). Constancy and preoperative distant fusion were associated with post-operative bifixation in univariate regression analysis (p = 0.001, 0.025, respectively). However, only the constancy was strongly associated with successful sensory outcome in multivariate regression analysis with an odds ratio of 20.138 (p = 0.008). Conclusions: Surgical correction of intermittent exotropia during the intermittent period showed better sensory outcome than in constant deviation period.
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