간헐외사시에서 단순화한 프리즘적응검사를 이용한 증량수술의 결과
Outcomes of Augmented Surgery Performed after Simplified Prism Adaptation Testing in Patients with Intermittent Exotropia
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목적: 간헐외사시환자에서 프리즘적응검사로 측정한 사시각이 교대프리즘가림검사로 측정한 사시각에 비해 증가하는지 확인하고, 프리즘적응검사를 기준으로 시행한 수술의 결과를 분석해 보고자 하였다. 대상과 방법: 2013년 1월부터 2017년 12월까지 간헐외사시에서 수술 전 교대프리즘가림검사와 프리즘적응검사로 사시각을 측정하고 프리즘적응검사 후 사시각이 5PD 이상 증가한 경우에는 늘어난 사시각을 기준으로 수술을 시행하였으며, 수술 후 1년 이상 경과 관찰이 가능했던 환자들의 결과를 후향적으로 분석하였다. 결과: 전체 대상 환자 100명 중 프리즘적응검사로 측정한 사시각이 5PD 이상 증가한 경우는 76명(76.0%)이었고, 사시각의 평균 증가는 근거리에서 9.8 ± 6.3PD, 원거리에서 3.6 ± 3.5PD였다. 수술 후 1년 시점에서 성공군은 57명, 저교정군은 42명, 과교정군은 1명이었다. 수술의 성공률은 프리즘적응검사 후 사시각의 증가가 없었던 비반응군(n=24)에서는 62.5%, 증가한 사시각 전체를 반영하여 수술 목표를 늘렸던 완전증량군(n=45)에서는 68.9%, 증가한 사시각의 50%만을 반영하여 수술 목표를 조정한 부분증량군(n=31)에서는 35.5%로 다른 군에 비해 부분증량군의 성공률이 낮았다(one-way analysis of variance, p=0.01). 결론: 간헐외사시환자에서 프리즘적응검사를 통해 사시각의 증가를 확인하고, 그 결과를 반영하여 수술 목표를 조정하는 것은 장기적인 수술 성공률을 높이는 데에 도움이 될 수 있을 것으로 생각된다.
Abstract
Purpose: We explored whether the deviation angle in patients with intermittent exotropia was greater when the prism adaptation test was used rather than the prism cover test. Methods: From January 2013 to December 2017, we performed the prism cover and adaptation tests on patients with intermittent exotropia. If the deviation angle increased by more than 5 PD after the prism adaptation test, surgery was performed. The outcomes of patients followed-up for more than 1 year after surgery were analyzed retrospectively. Results: In total, 76 of 100 patients (76.0%) exhibited deviation angle increases of over 5 PD, the mean increase was 9.8 ± 6.3 prism diopters (PD) for near vision and 3.6 ± 3.5 PD for distance vision. Satisfactory motor alignment was achieved in 57 patients; 42 were undercorrected and 1 was overcorrected. The success rate was 62.5% in the non-responder group (n = 24, patients in whom the deviation angle did not increase after prism adaptation) and 68.9% in the full augmentation group (n = 45, in whom the deviation angle was increased). In the partial augmentation group (n = 31), where the surgical target was a 50% increase in the deviation angle, the success rate was lower than in the other groups. Conclusions: The preoperative prism adaptation test can be used to determine the angle of deviation and improves the surgical outcomes of patients with intermittent exotropia.
참고문헌 (19)
- Figueira EC, "Intermittent exotropia : comparison of treatments", Clin Exp Ophthalmol, 34, pp.245~251 (2006)
- Rah SH, "An epidemiologic survey of strabismus among school-children in Korea", J Korean Ophthalmol Soc, 38, pp.2195~2199 (1997)
- Scott WE, "The postoperative results and stability of exodeviations", Arch Ophthalmol, 99, pp.1814~1818 (1981)
- Kim MM, "Long-term surgical results of intermittent exotropia", J Korean Ophthalmol Soc, 35, pp.1321~1326 (1994)
- 백성욱, "간헐외사시 수술의 장기적인 결과", 대한안과학회지, 54(7), pp.1079~1085 (2013), 대한안과학회
- Kushner B, "Diagnostic occlusion in strabismus management", J Ocul Ther Surg, 2, pp.194~200 (1983)
- Ohtsuki H, "Comparison of surgical results of responders and non-responders to the prism adaptation test in intermittent exotropia", Acta Ophthalnol Scand, 75, pp.528~531 (1997)
- Kushner BJ, "The distance angle to target in surgery for intermittent exotropia", Arch Ophthalmol, 116, pp.189~194 (1998)
- Prism adaptation study research group, "Efficacy of prism adaptation in the surgical management of acquired esotropia", Arch Ophthalmol, 108, pp.1248~1256 (1990)
- Scott WE, "Preoperative prism adaptation in acquired esotropia", Ophthalmologica, 189, pp.49~53 (1984)
- Ohtsuki H, "Prism adaptation response is useful for predicting surgical outcome in selected types of intermittent exotropia", Am J Ophthalmol, 131, pp.117~122 (2001)
- Dadeya S, "Usefulness of the preoperative prism adaptation test in patients with intermittent exotropia", J Pediatr Ophthalmol Strabismus, 40, pp.85~89 (2003)
- Shippman S, "Prisms in the pre-operative diagnosis of intermittent exotropia", Am Orthopt J, 38, pp.101~106 (1998)
- Kiyak Yilmaz A, "The impact of prism adaptation test on surgical outcomes in patients with primary exotropia", Clin Exp Optom, 98, pp.224~227 (2015)
- Burian HM, "The surgical management of exodeviation", Am J Ophthalmol, 59, pp.603~620 (1965)
- 김성훈, "간헐외사시에서 단안차폐 후 측정한 사시각의 변화", 대한안과학회지, 46(7), pp.1175~1182 (2005), 대한안과학회
- 고병우, "간헐외사시 수술 후 조기 재발한 환자와 장기간 정위를 유지한 환자들의 임상양상", 대한안과학회지, 49(7), pp.1108~1113 (2008), 대한안과학회
- Jung EH, "Factors associated with surgical success in adult patients with exotropia", J AAPOS, 20, pp.511~514 (2016)
- Cooper J., "Major review: intermittent exotropia. Basic and divergence excess type", Binoc Vis Eye Muscle Surg, 8, pp.185~216 (1993)