V형 아형 간헐외사시의 수술적 치료
Treatment of Sub-V Pattern Intermittent Exotropia
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목적: V형 아형 간헐외사시 환자에서 수술 방법에 따른 치료결과를 비교하고자 한다. 대상과 방법: 간헐외사시 환자 중 상방주시 사시각이 하방주시에 비해 8PD 이상, 15PD 미만으로 큰 경우를 V형 아형이라 정의하고,환자 65명을 대상으로 수평근수술군(I군), 하사근약화술 동시시행군(II군), 수평근 수직전이술 동시시행군(III군)으로 나눠 6개월 경과관찰을 시행하였다. 결과: 수술성공은 술 후 6개월에 수직불일치가 5PD 이하인 경우로 하였고, I군에서는 92% (23/25), II군 88.8% (16/18), III군 86.4%(19/22)의 성공률을 보였다. 술 후 6개월 수직불일치가 5PD 이하인 경우에 수평사시성공률은 87.9% (51/58), 수직불일치가 6PD 이상인 경우, 42.9% (3/7)이었으며 술 후 수직불일치 감소와 수평사시성공률은 유의한 상관관계를 보였다(p=0.01). 결론: V형 아형 간헐외사시에서 수직전이술과 사근약화술의 시행여부와 상관없이 수평근 수술 후 수직불일치가 감소하였고 술 후 수직불일치감소와 수평사시성공률은 유의한 상관관계를 보였다.
Abstract
Purpose: To compare the surgical methods for the treatment of sub-V pattern intermittent exotropia. Methods: Sub-V pattern intermittent exotropia is defined as 8-15 prism diopters (PD) less horizontal deviation in downgaze than in upgaze. The present study included 65 patients who underwent a standard recession procedure of the lateral rectus muscle (group I), oblique muscle surgery (group II) or vertical transposition of the horizontal rectus muscle (group III)and who were followed up for six months after the surgery. Results: Surgical success was defined as vertical incomitance ≤5 PD; the success rate was 92% (23/25) in group I, 88.8%(16/18) in group II and 86.4% (19/22) in group III. Surgical success of the horizontal strabismus was defined as horizontal deviation ≤10 PD at primary position; the success rate was 87.9% (51/58) in the patients with vertical incomitance less than 5 PD, and 42.9% (3/7) in the patients with vertical incomitance greater than 6 PD. There was statistical significance in the success rate of horizontal strabismus according to the decrease in vertical incomitance (p=0.01). Conclusions: There was no statistical significance of the difference in success rates of horizontal strabismus surgery regardless of vertical transposition of the horizontal rectus muscle or oblique muscle surgery. There was statistical significance in the difference in success rates of horizontal strabismus according to the reduction in vertical incomitance.
참고문헌 (32)
- Urrets-Zavalia A, "Paralisis bilateral congenita del musculo oblicuo inferior", Arch Oftalmol B Aires, 23, pp.172~ (1948)
- Urist MJ, "Horizontal squint with secondary vertical deviations", AMA Arch Ophthalmol, 46, pp.245~267 (1951)
- Albert DG, "Personal communication", Arch Ophthalmol, 58, pp.152~ (1957)
- Costenbader FD, "Symposium: The A and V patterns in strabismus. Introduction", Trans Am Acad Ophthalmol Otolaryngol, 68, pp.354~355 (1964)
- 장우석, "한국인 A-V형 사시의 임상적 고찰", 대한안과학회지, 49(12), pp.1974~1980 (2008), 대한안과학회
- Von Noorden GK, "Diagnosis and surgical management of vertically incomitant horizontal strabismus", Am J Ophthalmol, 60, pp.434~442 (1965)
- Burian HM, "The A and V patterns in strabismus", Trans Am Acad Ophthalmol Otolaryngol, 68, pp.375~384 (1964)
- Urist MJ, "Recession and upward displacement of the medial rectus muscles in a pattern esotropia", Am J Ophthalmol, 65, pp.769~773 (1968)
- Goldstein JH, "Monocular vertical displacement of the horizontal rectus muscles in the A and V patterns", Am J Ophthalmol, 64, pp.265~267 (1967)
- Metz HS, "The treatment of A and V patterns by monocular surgery", Arch Ophthalmol, 95, pp.251~253 (1977)
- Pullman MD, "Effect of monocular vertical displacement on the deviation in primary position", Arch Ophthalmol, 98, pp.2001~2003 (1980)
- Kim SJ, "A clinical study on A and V patterns", J Korean Ophthalmol Soc, 28, pp.1329~1338 (1987)
- Miller JE, "Vertical recti transplantation in the A and V syndromes", Arch Ophthalmol, 64, pp.175~179 (1960)
- von Noorden GK, "Temporal transplantation of the inferior rectus muscle in V-esotropia", Am J Ophthalmol, 56, pp.919~922 (1963)
- Parks MM, "Concomitant exodeviations", pp.1~11 (1991), Harper & Row
- Breinin GM, "New aspects of ophthalmoneurologic diagnosis", AMA Arch Ophthalmol, 58, pp.375~388 (1957)
- Brown HW, "vertical deviations", Trans Am Acad Ophthalmol Otolaryngol, 57, pp.157~162 (1953)
- Jampolsky A, "Oblique muscle surgery of the A-V patterns", J Pediatr Ophthalmol, 2, pp.31~36 (1965)
- Scott AB, "A and V patterns in exotropia. An electromyographic study of horizontal rectus muscles", Am J Ophthalmol, 65, pp.12~19 (1968)
- Kushner BJ, "The role of ocular torsion on the etiology of A and V patterns", J Pediatr Ophthalmol Strabismus, 22, pp.171~179 (1985)
- Miller M, "Strabismus associated with craniofacial anomalies", Am Orthopt J, 25, pp.27~37 (1975)
- Demer JL, "Heterotopy of extraocular muscle pulleys causes incomitant strabismus", pp.91~ (1999), Aeolus Press
- Postic G, "Etiopathogénie des syndromes A et V", Bull Mem Soc Fr Ophtalmol, 78, pp.240~252 (1965)
- Monteiro de Carvalho KM, "Quantification (grading) of inferior oblique muscle recession for V-pattern strabismus", Binocul Vis Strabismus Q, 13, pp.181~184 (1998)
- Polati M, "Recession and measured, graded anterior transposition of the inferior oblique muscles for V-pattern strabismus", Binocul Vis Strabismus Q, 17, pp.89~94 (2002)
- Woo KI, "Treatment of AV syndrome", J Korean Ophthalmol Soc, 34, pp.331~336 (1993)
- Dunlap EA, "Vertical displacement of horizontal recti", pp.307~329 (1971), Mosby
- Manley DR, "Surgical management of a pattern esotropia", Ann Ophthalmol, 3, pp.1067~1068 (1971)
- Scott WE, "Vertical offsets of horizontal recti muscles in the management of A and V pattern strabismus", Aust N Z J Ophthalmol, 17, pp.281~288 (1989)
- Burckley EG, "Strabismus and Glaucoma", pp.16~33 (1995), Mosby
- Chang HR, "Effect of vertical displacement of bilateral horizontal muscles in AV syndrome", J Korean Ophthalmol Soc, 41, pp.506~510 (2000)
- Stager DR, "Arch Ophthalmol", Arch Ophthalmol, 90, pp.15~16 (1973)