간헐외사시로 양안 외직근후전술을 받은 후 발생한 속발내사시에서 단안 외직근전진술의 효과

Abstract

Purpose: To investigate the clinical outcomes of unilateral lateral rectus muscle advancement in patients with consecutive esotropia after bilateral lateral rectus muscle recession. Methods: We investigated the results of 13 patients who underwent unilateral lateral rectus muscle advancement for consecutive esotropia after bilateral lateral rectus muscle recession. We evaluated the amount of deviation, changes of angle deviation, corrected amount/mm, and sensory status after each surgery. Results: The average angle deviation of exotropia was 30.42±5.41PD, and the average amount of bilateral lateral rectus muscle recession was 6.73±0.59 mm. The average angle deviation of esotropia one day after the surgery was 13.17±5.15PD. Occlusion treatment was performed during follow-up. The surgery for consecutive esotropia was performed after an average of 12.0±7.25 months of follow-up. In Worth-4-dot tests, 12 patients showed diplopia, and 1 patient showed suppression after the surgery for exotropia. Nine patients showed diplopia, and 4 patients showed suppression just before the surgery for consecutive esotropia. One patient showed mild limitation of motion of the lateral rectus muscle (-1 degree). The average angle deviation before the surgery for consecutive esotropia was 19.42±4.20PD. An average of 6.73±0.79 mm of unilateral lateral rectus muscle advancement was performed. After surgery, the average angle deviation was 1.25±2.73PD esodeviation, and 1.42±4.44PD exodeviation after 6 months. In Worth-4-dot tests, 6 patients showed fusion, 2 patients showed diplopia, and 5 patients showed suppression after surgery for consecutive esotropia. Conclusions: Unilateral lateral rectus muscle advancement was an effective procedure for patients with consecutive esotropia under 25PD who did not show any limitation of motion after bilateral lateral rectus recession.

목적: 양안 외직근후전술을 받은 후 발생한 속발내사시 환자에서 단안 외직근전진술의 결과를 알아보았다. 대상과 방법: 대상 환자 13명에서 외사시수술과 속발내사시수술 전후의 초기 사시각과 사시각의 변화, 수술량, 감각상태를 각각 비교하였다. 결과: 외사시수술 전의 사시각은 30.42±5.41PD, 외직근의 후전량은 6.73±0.59 mm였다. 외사시수술 후 1병일째 13.17±5.15PD의 내사시를 보여 교대가림을 하면서 경과관찰하였다. 워트4등 검사에서 외사시수술 직후 복시 12명, 억제 1명을 보였고 속발내사시수술 직전에는 복시 9명, 억제 4명을 보였다. 1명에서는 -1정도의 경한 외전장애가 발생하여 지속되었다. 속발내사시수술 전 19.42±4.20PD의 속발내사시를 보여 단안 외직근전진을 6.73±0.79 mm 시행하였고 수술 후 사시각은 1.25±2.73PD의 내편위를, 수술 후 6개월에는 1.42±4.44PD의 외편위를 보였다. 속발내사시수술 후 워트4등 검사에서는 융합 6명, 복시 2명, 억제 5명을 보였다. 결론: 외사시수술 후 발생한 25PD 이내의 속발내사시 환자들에서 안구운동의 제한이 없는 상태에서도 단안 외직근전 진술은 유용한 수술방법이었다.