간헐외사시와 동반된 상사근마비의 임상특징

Abstract

Purpose: The goal of this study was to determine the clinical characteristics of patients with intermittent exotropia (IXT) associated with hypertropia. Methods: This study recruited 268 hospital patients with IXT associated with hypertropia. After taking history, measuring the angle of deviation, conducting an ocular motor examination, performing a Bielschowsky head tilt test and taking a fundus photograph, the clinical characteristics of 23 patients diagnosed with superior oblique palsy (SOP) were investigated. Results: Twenty-three patients (8.6%) of the 268 subjects with IXT associated with hypertropia were diagnosed with SOP. The average angle of exodeviation was 17.1±3.8PD and the angle of hypertropia at primary position was 12.9±5.9PD. Excyclotorsion of an eyeball was observed in 19 patients (82.6%), the Bielschowsky head tilt test was positive in all patients, and head tilt or face turn was found in 12 (52.2%) patients. All subjects had inferior oblique overaction, and 20 (86.9%) had superior oblique underaction. Operations to weaken the inferior oblique muscle of the paralytic eye and for horizontal muscles were conducted at the same time. The angle of exodeviation and the angle of hypertropia were, on average, 1.8±3.6PD and 2.4±2.2PD, respectively, 6 months after the operation. Conclusions: When patients with intermittent exotropia have hypertropia, the possibility of SOP should be considered. SOP can be detected by determining a history of head tilt and conducting a Bielschowsky head tilt test. Surgical treatment for SOP is advised.

목적: 간헐외사시로 내원한 환자 중 상사시가 동반된 환자에서의 임상적 특징을 알고자 하였다. 대상과 방법: 간헐외사시에 수직사시가 동반된 환자 268명의 병력청취, 사시각측정, 안구운동검사, 빌쇼스키머리기울임검사, 안저촬영검사 후 상사근 마비로 진단된 환자 23명의 임상적 특징을 조사하였다. 결과: 간헐외사시에 상사시가 동반된 268명 중 23명(8.6%)이 상사근마비로 진단되었다. 평균 외사시각은 17.1±3.8PD였고, 제일안위에서 상사시각은 12.9±5.9PD였다. 안구의 외회선은 19명(82.6%)에서 관찰되었으며, 빌쇼스키머리기울임검사는 모든 환자에서 양성이였고, 머리기울임은 12명(52.2%)에서 관찰되었다. 모든 환자에서 하사근기능항진이 양성이었다. 수술은 모든 환자에게 마비안의 하사근약화술과 함께 수평근에 대한 수술도 동시에 시행하였다. 술 후 6개월에 평균 1.8±3.6PD의 외사시각, 2.4±2.2PD의 상사시각을 보였다. 결론: 간헐외사시 환자에서 수직사시가 동반되는 경우에는 머리기울임의 병력청취와 함께 빌쇼스키머리기울임검사를 통하여 상사근마비가 있는지를 알아보고 이에 대한 적절한 수술적 치료가 필요할 것으로 사료된다.