간헐외사시에서 측정 거리와 한 눈 가림에 따른 사시각의 변화

Changes in Angle of Exodeviation According to Distance after Monocular Occlusion in Intermittent Exotropia

목적: 간헐외사시 환자에서 측정 거리에 따른 사시각의 변화와 한 눈 가림 후 사시각이 증가하는 환자군의 특징을 알아보고자 하였다. 대상과 방법: 102명의 기본형 간헐외사시 환자들이 포함되었으며 33 cm, 3 m, 6 m, 12 m, 거울을 이용한 6 m에서 사시각을 측정한후, 1시간 동안 비우세안을 가린 후에 33 cm와 3 m에서 사시각을 측정하였다. 가림 후 근거리사시각이 증가한 그룹을 ‘increased group’, 그렇지 않은 그룹을 ‘stationary group’으로 나누어 분석하였다. 결과: 남녀 비율은 46:56, 수술 시 평균 나이 9.23세였다. 3 m, 6 m, 12 m, 거울을 이용한 6 m의 사시각은 서로 유의미한 차이를보이지 않았다. 33 cm에서 측정한 사시각은 가림 후 유의미하게 증가하였다(p<0.01). 근거리 입체시 평균 log값은 ‘increased group’ 의 경우 1.96 ± 0.35였으며, ‘stationary group’의 경우 2.16 ± 0.41이었다. ‘Increased group’에서 근거리 입체시가 유의미하게 좋았고(p=0.01), 근거리 W4D 검사에서 ‘good’ 항목이 유의미하게 많았다(p=0.03). 결론: 융합 상태가 좋은 기본형 간헐외사시 환자에서 1시간 단안차폐 후 사시각을 측정하는 것은 잠재되어 있는 사시각을 찾아주어수술 성공률을 높이는 데 도움이 될 것으로 생각된다.

Purpose: This study investigated changes in the angle of exodeviation at different distances and the characteristics of a group that showed an increased angle following monocular occlusion in intermittent exotropia. Methods: In all, 102 patients diagnosed with basic intermittent exotropia were enrolled. The deviation angle was measured using a mirror at 33 cm, 3 m, 6 m, 12 m, and 6 m. Moreover, the deviation was measured at 33 cm and 3 m after patching the non-dominant eye for 1 hour. Patients with a higher deviation angle at 33 cm after occlusion were categorized as the ‘increased group’, whereas those with lower deviation angles were classified as the ‘stationary group’. Results: There was a male-to-female ratio of 46:56 and an average age at surgery of 9.23 years. No significant differences were observed in deviation measurements taken at 3, 6, 12, and 6 m using a mirror. However, after occlusion, there was a significant increase in deviation at 33 cm (p < 0.01). The average log value of near stereoacuity was 1.96 ± 0.35 in the increased group and 2.16 ± 0.41 in the stationary group. The group with an increased near deviation after occlusion demonstrated a significantly improved near stereoacuity (p = 0.01) and an increased proportion of good results in the near Worth 4 dot test (p = 0.03). Conclusions: Preoperative measurement of maximum deviation after 1 hour of monocular occlusion can help reduce recurrence and insufficient correction, particularly in patients with good fusional ability.