한 눈 선천상사근마비 환자에서 단계적하사근후전술의 결과
The Outcome of Graded Inferior Oblique Recession in the Congenital Unilateral Superior Oblique Palsy
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목적: 한 눈 선천상사근마비 환자에서 단계적 하사근후전술 시행 후 수직사시각의 변화와 머리기울임의 호전, 반대쪽 눈의 하사근기능항진 발생이나 가면상사근마비가 나타나는 빈도에 대해 알아보고자 하였다. 대상과 방법: 한 눈 상사근마비 환자에서 단계적 하사근후전술을 시행 받은 후 1년 이상 추적관찰이 가능하였던 65명의 환자를 대상으로 의무기록을 후향적으로 조사하였다. 남은 수직사시각이 3프리즘디옵터(prism diopters, PD) 이하일 때 매우 좋음(excellent), 4-7 PD 일 때 좋음(good), 8 PD 이상일 때 불량(poor)으로 분류하였다. 반대쪽 눈의 하사근기능항진은 +2 이상일 때 있는 것으로 간주하였다. 결과: 수술 후 매우 좋은 결과를 얻은 경우는 45명(69.2%)이었고 67.3%에서 머리기울임이 호전되었다. 수술 후 9명(13.8%)에서 반대쪽눈에 +2 이상의 하사근기능항진이 나타났고, 1명(1.5%)에서 반대쪽 눈에 상사근마비가 발견되었다. 결론: 한 눈 상사근마비 환자에서 시행한 단계적 하사근후전술은 수직사시각과 머리기울임을 효과적으로 치료할 수 있었으나 약 15.3%에서 반대쪽 눈에 하사근기능항진이나 가면상사근마비가 나타났다.
Abstract
Purpose: To examine changes in vertical deviation and improvement in head tilt after graded inferior oblique (IO) recession surgery in patients with congenital unilateral superior oblique palsy (SOP). Frequency of inferior oblique overaction (IOOA)or bilateral SOP in the contralateral eye after surgery was also investigated. Methods: We retrospectively reviewed medical records of 65 patients who had undergone graded IO recession surgery in unilateral congenital SOP with at least 1 year of postoperative follow-up. Postoperative vertical deviation was classified as excellent (under 3 prism diopters, PD), good (4-7 PD) or poor (over 8 PD). The occurrence of IOOA was considered if more than 2 IOOAs were observed in the contralateral eye after surgery. Results: Forty-five of the 65 patients (69%) obtained excellent results and 67.3% had improvement in head tilt after surgery. IOOA in the contralateral eye was not observed in any patients before surgery. Postoperative IOOA in the contralateral eye occurred in 9 patients (13.8%) and a diagnosis of masked bilateral SOP was made in 1 patient (1.5%). Conclusions: The graded IO recession procedures are considered to be an effective surgical method for the treatment of unilateral congenital SOP. However, IOOA or masked bilateral SOP occurring in the contralateral eye was observed in 15.3% of the patients undergoing surgery.
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