갑상샘눈병증에 동반된 위눈꺼풀뒤당김 환자에서 눈꺼풀올림근후전술의 치료 효과
The Effect of Levator Recession for Upper Eyelid Retraction in Patients with Thyroid-associated Ophthalmopathy
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목적: 갑상샘눈병증이 동반된 위눈꺼풀뒤당김 환자에서 눈꺼풀올림근후전술 시행 후 수술의 효과 및 결과에 영향을 미치는 인자에 대해 분석한다. 대상과 방법: 갑상샘눈병증을 진단받은 환자들 중 2010년 2월부터 2018년 9월까지 눈꺼풀뒤당김으로 눈꺼풀올림근후전술을 시행받은 환자 24명(36안)을 대상으로 의무기록을 이용한 후향적 분석을 시행하였다. 의무기록상의 수술 전과 수술 6개월 후의 marginal reflex distance (MRD)1, 2, 위아래 눈꺼풀의 길이와 면적을 눈꺼풀 분석 소프트웨어로 측정하여 비교하였다. 또한 수술 전후 MRD1의 차이에 영향을 미치는 인자를 다변량 선형 회귀 분석을 이용하여 분석하였다. 결과: 24명의 환자가 연구에 포함되었다. 수술 전과 수술 후 6개월째에서 MRD1은 5.12 ± 1.26 mm에서 3.48 ± 1.08 mm (p<0.001)로 유의하게 감소하였다. 이외 모든 위눈꺼풀 변수인 위눈꺼풀길이(p<0.001), 위안쪽 눈꺼풀틈새넓이(p<0.001), 위중간 눈꺼풀틈새넓이(p=0.004), 위바깥쪽 눈꺼풀틈새넓이(p<0.001)가 수술 전후 유의하게 감소하였고, 아래눈꺼풀 변수 중에는 유의하게 감소한 변수는없었다. 다변량 로지스틱 회귀분석을 시행하였을 때, 수술 전 MRD1이 작을수록 수술의 성공과 유의하게 관련되었다(교차비 0.31, 신뢰구간 0.09-1.01). 결론: 갑상샘눈병증에 동반된 위눈꺼풀뒤당김 환자에서 눈꺼풀올림근후전술은 위눈꺼풀뒤당김을 교정할 수 있는 객관적으로 증명된 효율적인 수술 방법이며, 수술 전 MRD1이 작을수록 성공할 확률이 높다.
Abstract
Purpose: We analyzed factors that affect the outcome of levator recession surgery for upper eyelid retraction in patients with thyroid- associated ophthalmopathy. Methods: Retrospective analysis was performed based on the medical records of 24 patients with thyroid-associated ophthalmopathy who underwent upper eyelid levator recession surgery between February 10, 2010, and September 18, 2018. The margin to reflex distance (MRD), length and area of the upper and lower eyelids were measured and compared with the eyelid analysis software before and after 6 months of surgery on medical records. In addition, factors affecting the difference in MRD1 before and after surgery were examined by multivariate linear regression analysis. Results: Twenty-four patients were included in the study. The MRD1 decreased significantly from 5.12 ± 1.26 mm before surgery to 3.48 ± 1.08 mm at 6 months after surgery (p < 0.001). All upper eyelid measurements, i.e., UEL (p < 0.001), UMA (p < 0.001), UCA (p = 0.004), and ULA (p < 0.001), were significantly decreased after surgery, while none of the lower eyelid measurements showed significant changes. Multivariate logistic regression analysis indicated that lower preoperative MRD1 was associated with the success of the surgery (odds ratio, 0.31; 95% confidence interval, 0.09-1.01). Conclusions: Levator recession surgery is an efficient surgical method that can correct the upper eyelid retraction associated with thyroid-associated ophthalmopathy.
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