간헐외사시에서 해리수직편위의 유무에 따른 임상양상과 수술성적
Clinical Manifestations and Surgical Outcomes of Intermittent Exotropia with or without Dissociated Vertical Deviation
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 해리수직편위(dissociated vertical deviation, DVD)의 동반유무에 따른 간헐외사시의 임상양상과 수술성적을 비교하고자 하였다. 대상과 방법: 간헐외사시로 진단받고 수술을 시행 받았던 환자를 대상으로 DVD의 동반유무에 따라 두 군으로 나누어 후향적으로 비교분석하였다(DVD군 66명, 외사시군 81명). 수술 성적은 원거리 사시각이 10프리즘디옵터(PD) 이하의 과교정이거나 5PD 이하의 부족교정일 때 성공으로 정의하였다. 결과: DVD군의 사시 시작시기는 외사시군보다 빨랐으며 눈떨림과 하사근기능항진, 상사근기능항진, A-V형 사시가 외사시군보다 많았으나 머리기울임과 약시, 첫 번째 수술시기는 차이가 없었다. DVD군의 외사시각은 외사시군보다 작았으나 티트무스검사에서 입체시는 유의하게 나빴다. 간헐외사시의 수술성공률은 수술 후 1개월에 외사시군이 더 높았으며 수술 후 6개월과 12개월에는 두 군간에유의한 차이가 없었다. DVD를 수술하였을 때 DVD는 90.0%에서 10PD 이내로, 우수한 결과를 보였다. 결론: DVD가 동반된 간헐외사시는 외사시각은 작았으나 입체시는 더 나빴다. 그러나 DVD의 동반여부에 따른 간헐외사시의 수술성적은 유의한 차이가 없었다.
Abstract
Purpose: Clinical manifestations and surgical outcomes of intermittent exotropia with or without dissociated vertical deviation (DVD) were evaluated. Methods: Patients who were diagnosed with intermittent exotropia following surgical correction were divided into 2 groups:66 patients with DVD (DVD group) and 81 patients without DVD (XT group). The postoperative deviation between exodeviation of 10 prism diopters (PD) and esotropia of 5 PD was considered surgically successful. Results: The onset of strabismus occurred at an earlier age in the DVD group. There were more cases of nystagmus, inferior oblique muscle overaction, superior oblique muscle overaction, and AV pattern in the DVD group than in the XT group, but there were no differences between the 2 groups in terms of head tilt, amblyopia, and age at first operation. While exodeviation in the DVD group was smaller than in the XT group, stereopsis in the DVD group was statistically worse than in the XT group in the Titmus test. At postoperative 1 month, the XT group had better surgical outcome, but at postoperative 6 and 12 months, there were no differences in the surgical outcomes of intermittent exotropia between the 2groups. Regarding DVD surgery, a postoperative DVD angle less than 10 PD accounted for 90.0% of the cases. Conclusions: Intermittent exotropia combined with DVD had worse stereoacuity and lesser exodeviation. There was no statistically significant difference in the surgical outcomes of intermittent exotropia with or without DVD.
참고문헌 (36)
- Moore S, "A panoramic view of exotropias", Am Orthopt J, 27, pp.70~79 (1977)
- Santiago AP, "Intermittent exotropia, In Clinical Strabismus Management: Principles and Surgical Techniques" (1999), Saunders
- Von Noorden GK, "Exodeviations, In Binocular Vision and Ocular Motility: Theory and Management of Strabismus, 6th ed" (2002), Mosby
- Von Noorden GK., "Cyclovertical deviations, In Binocular Vision and Ocular Motility : Theory and Management of Strabismus, 6th ed" (2002), Mosby
- Kutluk S, "The prevalence of dissociated vertical deviation in patients with sensory heterotropia", Am J Ophthalmol, 119, pp.744~747 (1995)
- Sidikaro Y, "Observations in sensory heterotropia", J Pediatr Ophthalmol Strabismus, 19, pp.12~19 (1982)
- Duncan LB, "Surgical results in dissociated vertical deviations", J Pediatr Ophthalmol Strabismus, 21, pp.25~27 (1984)
- Lim HT, "Dissociated vertical deviation in patients with intermittent exotropia", J AAPOS, 12, pp.390~395 (2008)
- 오주연, "외사시와 동반된 해리수직편위의 임상적인 특징", 대한안과학회지, 43(5), pp.23~148 (2002), 대한안과학회
- Mehta A., "Chief complaint, history and physical examination, In Clinical Strabismus Management: Principles and Surgical Technique" (1999), Saunders
- Braverman DE, "Surgical correction of dissociated vertical deviations", J Pediatr Ophthalmol, 14, pp.337~342 (1977)
- FINK WH., "Oblique muscle surgery from the anatomic viewpoint", Am J Ophthalmol, 34, pp.261~281 (1951)
- Parks MM, "Atlas of strabismus surgery", pp.167~ (1983), Harper & Row
- Apt L, "Inferior oblique muscle recession", Am J Ophthalmol, 85, pp.95~100 (1978)
- Snir M, "Combined resection and anterior transposition of the inferior oblique muscle for asymmetric double dissociated vertical deviation", Ophthalmology, 106, pp.2372~2376 (1999)
- Scott WE, "Superior rectus recessions for dissociated vertical deviation", Ophthalmology, 89, pp.317~322 (1982)
- Clarke WN, "Surgical results in intermittent exotropia", Can J Ophthalmol, 16, pp.66~69 (1981)
- Jampolsky A., "Management of vertical strabismus", Trans New Orleans Acad Ophthalmol, 34, pp.141~171 (1986)
- Santiago AP, "Dissociated vertical deviation, In Clinical Strabismus Management: Principles and Surgical Techniques" (1999), Saunders
- Anderson JR., "Ocular Vertical Deviations and the Treatment of Nystagmus, 2nd ed", pp.15~16 (1959), British Medical Association
- 노인호, "하사근기능항진 정도에 따른 하사근절제술의 효과", 대한안과학회지, 47(3), pp.437~15 (2006), 대한안과학회
- Cho YA, "Evaluation of criteria of stereoacuity for Titmus, Randot & TNO stereotests", J Korean Ophthalmol Soc, 40, pp.532~537 (1999)
- 정유리, "사시환자에서 입체시의 양상", 대한안과학회지, 49(8), pp.1309~1316 (2008), 대한안과학회
- 이세엽, "정상 소아와 간헐외사시 소아의 원거리 및 근거리 입체시 비교", 대한안과학회지, 42(4), pp.624~629 (2001), 대한안과학회
- Rosenbaum AL, "Subjective and objective criteria for recommending surgery in intermittent exotropia", Am Orthopt J, 42, pp.46~51 (1992)
- Stathacopoulos RA, "Distance stereoacuity. Assessing control in intermittent exotropia", Ophthalmology, 100, pp.495~500 (1993)
- McCall LC, "Incomitant dissociated vertical deviation and superior oblique overaction", Ophthalmology, 98, pp.911~917 (1991)
- 허남홍, "양안시기능과 간헐외사시 수술결과와의 관계", 대한안과학회지, 42(11), pp.1588~1593 (2001), 대한안과학회
- Ko KH, "Factors related to surgical results of intermittent exotropia", J Korean Ophthalmol Soc, 37, pp.179~184 (1996)
- Koo NK, "Clinical study for the undercorrection factor in intermittent exotropia", Korean J Ophthalmol, 20, pp.182~187 (2006)
- Richard JM, "Intermittent exotropia. Surgical results in different age groups", Ophthalmology, 90, pp.1172~1177 (1983)
- Hunter DG, "Long-term outcome of uncomplicated infantile exotropia", J AAPOS, 5, pp.352~356 (2001)
- Taira Y, "Clinical features of comitant strabismus related to family history of strabismus or abnormalities in pregnancy and delivery", Jpn J Ophthalmol, 47, pp.208~213 (2003)
- Elliott RL, "Anterior transposition of the inferior oblique", J Pediatr Ophthalmol Strabismus, 18, pp.35~38 (1981)
- Stager DR, "Anterior transposition of the inferior oblique. Anatomic assessment of the neurovascular bundle", Arch Ophthalmol, 110, pp.360~362 (1992)
- Risović D., "Surgical treatment of combined vertical tropias: dissociated vertical deviation and primary hyperfunction of the inferior oblique ocular muscles", Acta Chir Iugosl, 50, pp.55~60 (2003)