선천 백내장에서 백내장 제거술 및 일차 인공수정체 삽입술 후의 사시 발생에 영향을 주는 인자 비교
Factors Associated with Strabismus after Cataract Extraction and Primary Intraocular Lense Implantation in Congenital Cataracts
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목적: 선천백내장으로 백내장 제거술 및 일차 인공수정체삽입술 후 사시 발생에 영향을 미치는 요인을 분석하고자 한다. 대상과 방법: 1993년 3월부터 2008년 3월까지 선천 백내장으로 생후 6개월에서 21세 사이에 백내장 제거술 및 일차 인공수정체삽입술 을 시행받은 80명 125안을 대상으로 술 전 사시가 있던 9명 11안을 제외한 양안 백내장 43명, 단안 백내장 28명으로 나누어 백내장 수술 시 나이, 수술 전후 시력, 수술 전후 양안 시력차이, 수술 전 후 눈떨림의 유무, 수술방법(후낭 보존 유무), 동반 안이상, 후발성 백내장이 사시 발생과 연관이 있는지를 후향적으로 조사하였다. 결과: 양안 선천백내장에서는 술 전 후 눈떨림이 있을 때, 단안 선천 백내장에서는 술 후 양안 시력 차이가 0.3보다 클 때 사시 발생이 유의하게 증가하였다. 또한 백내장의 양측성에 관계없이 술 후 평균 시력이 0.2 이하일 때, 후낭을 보존하였을 때 사시 발생이 유의하 게 증가하였다. 결론: 선천백내장 환자들에서 술 후 평균 시력이 나쁘거나 눈떨림이 있는 경우, 술 후 양안시력차이가 큰 경우, 후낭을 보존한 경우에는 백내장 제거술 및 인공수정체 삽입술 후에도 사시에 대한 주의 깊은 경과 관찰이 필요하다.
Abstract
Purpose: To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation. Methods: Medical records of 80 patients who had undergone cataract extraction with primary intraocular lens implantation between 6 months and 21 years of age from March 1993 to March 2008 were reviewed. Nine patients (11 eyes) with strabismus before cataract surgery were excluded. Patients were divided into 2 groups; patients with congenital bilateral cataracts (43 patients, 86 eyes) or patients with unilateral cataracts (28 patients, 28 eyes). Data were collected on age at cataract surgery, pre and post-cataract extraction visual acuity, interocular visual acuity differences, nystagmus, operation method, and the existence of associated other ocular diseases to evaluate the association of the onset of strabismus and after cataract. Results: Factors statistically significantly associated with the development of strabismus include presence of nystagmus in bilateral cataracts and postoperative visual acuity differences > 0.3 in unilateral cataracts. A post-cataract extraction mean visual acuity ≤ 0.2 and preservation of posterior capsule were significant factors in both groups. Conclusions: Children with congenital cataracts should be monitored carefully after cataract surgery for the development of strabismus especially when they have poor postoperative visual acuity, nystagmus, large postoperative interocular visual acuity differences, or preservation of posterior capsule.
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