일차하사근기능항진 환자에서 외회선의 임상적 평가

Abstract

Purpose: To evaluate the amount of excyclotorsion according to degree of inferior oblique overaction (IOOA) in patients with primary IOOA. Methods: Fifty-nine primary IOOA patients who underwent inferior oblique muscle surgery were evaluated. Visual acuity, ocular movement test, prism cover test, Bielschowsky head tilt test, fundus photograph and photographic examination for excyclotorsion were performed. The correlation analysis was performed for the excyclotorsion according to the amount of IOOA (Control group; IOOA < 1, Group 1; 1 ≤ IOOA < 2, Group 2; 2 ≤ IOOA < 3, Group 3; 3 ≤ IOOA < 4, Group 4; IOOA = 4). Results: Excyclotorsion was 7.37 ± 2.36° in the Control group, 9.29 ± 3.79° in Group 1, 10.04 ± 4.39° in Group 2, 17.98 ±4.62° in Group 3, and 24.70 ± 4.61° in Group 4. The amount of IOOA and excyclotorsion showed a positive correlation (Pearson’s correlation coefficient r = 0.675). Asymmetric IOOA was observed in 35 patients (59.3%) and symmetric IOOA was observed in 24 patients (40.7%). Asymmetric IOOA combined with hypertropia was presented in 9 patients (37.5%) and symmetric IOOA combined with hypertropia was presented in 3 patients (8.6%). Therefore, patients with asymmetric IOOA have a higher incidence of vertical diplopia. The amounts of IOOA and excyclotorsion were greater in primary IOOA with esotropia than in subjects with exotropia (p = 0.001). Conclusions: The excyclotorsion was proportional to the amount of IOOA in Group 3 and Group 4. The aspect of excyclotorsion was widely distributed in Group 1 and Group 2 compared to that in the Control group.

목적: 일차하사근기능항진 환자의 하사근기능항진 정도에 따른 외회선 양상을 알아보았다. 대상과 방법: 일차하사근기능항진 환자 59명을 대상으로 양안운동검사로 하사근기능항진, 안저사진으로 회선량을 평가하여 하사근기능항진 정도(대조군; IOOA＜1, 1군; 1≤IOOA＜2, 2군; 2≤IOOA＜3, 3군; 3≤IOOA＜4, 4군; IOOA=4)에 따른 외회선과의 상관관계를 조사하였다. 결과: 외회선은 대조군; 7.37 ± 2.36°, 1군; 9.29 ± 3.79°, 2군; 10.04 ± 4.39°, 3군; 17.98 ± 4.62°, 4군; 24.70 ± 4.61°로 하사근기능항진 정도와 외회선은 양의 상관관계를 보였다(Pearson’s 상관계수 r=0.675). 비대칭하사근기능항진에서 상사시의 빈도가 더 높았다. 외사시를 동반하는 경우보다 내사시를 동반한 경우가 하사근기능항진과 외회선 정도가 더 크게 나타났다(p=0.001). 결론: +3 이상의 하사근기능항진에서는 하사근 기능항진 정도에 비례해서 외회선이 증가하며 1군, 2군에서는 대조군에 비해 외회선이 크게 증가하지는 않았으나 넓게 분포하였다.