단안 상사근마비환자에서 시행한 상사근접치기수술의 효과

The Clinical Course of Superior Oblique Tuck Surgery in Patients with Unilateral Superior Oblique Palsy

목적: 단안 상사근마비환자에서 첫 수술로 단안 상사근접치기수술 후 경과 관찰시점에 따른 수술 효과의 변화를 알아보고자 하였다. 대상과 방법: 단안의 상사근접치기수술 후 3개월 이상 경과 관찰한 16명의 의무기록을 후향적으로 분석하여 술 후 3, 6, 12개월, 마지막 경과 관찰 시 수직사시각, 머리기울임, 상사근기능저하, 하사근기능항진의 호전 여부를 조사하고 안저사진에서 시신경유두 망막중심오목각을 측정하여 안구회선의 변화를 알아보았다. 결과: 술 후 평균 경과 관찰기간은 24.9 ± 21.9개월, 평균 접침양은 11.4 ± 4.0 mm였다. 제일눈위치의 수직 편위각이 7프리즘디옵터 이하인 경우는 술 후 3개월에 53.9%, 6개월에 50.0%, 12개월에 83.3%, 마지막 경과 관찰 시 62.5%였고, 경과 관찰시점에 따른 유의한 차이는 없었다(p=0.55). 머리기울임이 호전된 경우 및 외회선이 감소한 경우는 술 후 3, 6, 12개월, 마지막 경과 관찰 시 각각 66.7%, 71.4%, 50%, 80% 및 37.5%, 66.7%, 75%, 80.0%였고, 관찰시점에 따른 유의한 차이는 없었다(p=0.73, p=0.11). 상사근기능저하 및 하사근기능항진이 호전된 경우는 술 후 3, 6, 12개월, 마지막 경과 관찰 시 각각 100%, 77.8%, 60%, 75% 및 100%, 88.9%, 85.7%, 81.25%였다. 결론: 단안 상사근마비환자에서 상사근접치기수술 시행 후 호전된 상태가 수술 후 3, 6, 12개월 이후까지 유지되었고, 경과 관찰시점에 따른 유의한 차이를 보이지 않았다.

Purpose: To evaluate the effects of surgery depending on the follow-up duration after superior oblique tuck was performed as the first surgery in unilateral superior oblique palsy patients. Methods: Sixteen patients who were followed-up for a minimum of 3 months were retrospectively evaluated. The vertical deviation, abnormal head posture, superior oblique underaction, and inferior oblique overaction were evaluated before and at 3, 6, and 12 months after the surgery and at the last follow-up. The angle between the center of the optic disc and fovea (disc-fovea angle) was measured using fundus photography to investigate changes in ocular torsion. Results: The mean follow-up period was 24.9 ± 21.9 months and the mean tuck was 11.4 ± 4.0 mm. Vertical deviation <7 prism diopters in the primary position was observed in 53.9% of patients at 3 months postoperatively, 50.0% at 6 months, 83.3% at 12 months, and 62.5% at the last follow-up (p = 0.55). Head posture was improved in 66.7% of patients at 3 months, 71.4% at 6 months, 50% at 12 months, and 80% at the last follow-up after surgery (p = 0.73). Ocular torsion was decreased in 37.5% of patients at 3 months postoperatively, 66.7% at 6 months, 75% at 12 months, and 80.0% at the last follow-up (p = 0.11). Superior oblique underaction was improved in 100%, 77.8%, 60%, and 75% of the patients and inferior oblique overaction was improved in 100%, 88.9%, 85.7%, and 81.3% of the patients at postoperative month 3, 6, and 12, and at the last follow-up, respectively. Conclusions: Superior oblique tuck resulted in the maintenance of an improved condition of patients at 3, 6, and 12 months postoperatively, and there was no significant difference in motor measurements between the follow-up periods.