만 16세 이후에 처음 진단된 간헐외사시
Long-Standing Intermittent Exotropia Diagnosed in Patients Older than 16 Years of Age
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목적: 만 16세 이후에 처음으로 진단된 간헐외사시의 임상 양상과 양안시 기능을 알아보고자 한다. 대상과 방법: 2001년부터 2010년까지 본원에 내원한 만 16세 이상 환자 중 10년 이상 진단이나 치료를 받지 않고 방치된 외사시 환자73명을 대상으로 하였다. 결과: 평균 연령은 29.47 ± 12.13세이었고 남자가 42명(57.5%)으로 더 많았다. 평균 사시각은 40.68 ± 17.75프리즘디옵터(PD)이고,26%가 55PD 이상, 46.58%가 30PD 이상 50PD 이하의 외사시로 편위각이 매우 컸다. 64명의 간헐외사시 중 17명은 근거리만 융합이가능하였다. 감각 기능검사에서 원거리 억제, 복시, 파노라마시기능, 이상망막대응 등의 이상이 있었다. 53명에서 소아와 동일한 근육량으로 수술을 시행하였고, 술 후 근거리 입체시는 59.09%, 원거리 억제는 78.57%에서 호전되었다. 결론: 소아 간헐외사시를 간과할 경우 사시각 증가나, 양안시 기능 부전을 겪을 수 있으므로 적절한 시기에 수술을 하는 것이 좋을것으로 생각한다. 또한 양안시 기능 부전은 술 후 호전될 가능성이 있으므로 성인 외사시의 적극적인 수술이 필요할 것으로 생각한다.
Abstract
Purpose: To evaluate clinical features and binocular function of long-standing intermittent exotropia detected for the first time in patients older than 16 years of age. Methods: We retrospectively evaluated adult exotropic patients older than 16 years of age who were first diagnosed between March 2001 and February 2010. A total of 73 patients with exotropia who had not undergone ophthalmologic management for at least 10 years were included in the present study. Results: The mean age was 29.47 ± 12.13 years and 42 (57.5%) patients were male. The mean angle of deviation was 40.68 ± 17.75 prism diopter (PD); 46.58% of patients were between 30 to 50 PD and 26% were over 55 PD. Out Of 64 the intermittent exotropic patients, 17 patients had poor fusion at distance. Abnormal findings in binocular function such as poor stereoacuity, suppression at distance, reduced binocular visual acuity at distance, diplopia, panoramic vision, anomalous retinal correspondence, and accommodative spasms were observed. All 20 patients received surgery. Postoperatively,59.90% of the patients showed improvement in near stereoacuity, and 78.57% improved in suppression at distance. Conclusions: According to the present study, exotropia may cause subjective and objective deteriorations in motor/sensory function without appropriate medical or surgical intervention during childhood. In addition, the potential for improvement in binocular function after surgery was demonstrated even in adults. Therefore, we recommend surgical treatment for untreated, long-standing exotropia in adults.
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