단독 안와하벽골절 환자의 안와 전산화단층촬영 소견에 따른 복시 양상 및 수술 후 복시 경과

김명진(Myungjin Kim),이승현(Seunghyun Lee),유혜린(Helen Lew) 대한안과학회 2021 대한안과학회지 Vol.62 No.10

목적: 단독 안와하벽골절 환자에서 발생한 복시를 안와 전산화단층촬영 소견에 따라 분류하고 수술 후 경과 및 복시 양상에 영향을 미치는 요인들을 알아본다. 대상과 방법: 2001년 3월부터 2020년 12월까지 단독 안와하벽골절 발생 후 본원에서 수술적 치료를 받은 200명의 의무기록을 후향적으로 조사하였다. 복시는 문진 및 동적 자동시야계를 이용하여 주변부, 중심부, 전방향으로 분석하였고, 수술 전과 수술 후 1일, 1주, 6주, 6개월 경과 관찰 시 복시의 임상경과를 조사하였다. 수술 전 CT 영상에서는 골절 크기(소, 중, 대), 위치(앞, 중간, 뒤), 외안근 두께(부종, 변형), 외안근 위치(끼임, 탈출), 외안근 형태(당김 유무)로 나누어 분석하였다. 결과: 수술 전 복시는 전체 200명 중 144명(72.0%)으로, 주변부 복시 57명(39.6%), 중심부 복시 46명(24.3%), 전방향 복시 20명(13.9%) 순이었다. 수술 전 복시는 수술 전 안구운동제한 여부(p<0.001)와 외안근의 위치(p=0.022)에 따라, 수술 전 복시 양상은 안구운동제한의 방향에 따라 차이가 있었다(p=0.018). 또한 외안근의 두께가 복시 양상에 영향을 주는 것으로 나타났다(p=0.020). 수술 6개월 후 복시가 지속된 환자는 33명(16.5%)으로, 주변부 복시 회복 속도가 가장 빨랐다. 결론: 단독 안와하벽골절 환자에서 수술 전 안구운동제한 양상과 안와 전산화단층촬영 소견에 따라서 복시의 경과를 예측하는 데 참고할 수 있다. Purpose: To investigate the postoperative changes in diplopia and evaluate factors that affect diplopia after isolated inferior orbital wall fracture. Methods: A retrospective study was conducted on 200 patients who underwent reconstruction surgery for isolated inferior orbital wall fracture between March 2001 and December 2020. Diplopia was categorized into peripheral, central, and full-degree types based on the history and binocular single vision. The natural course of diplopia was analyzed pre-operatively and at 1 day, 6 weeks, and 6 months postoperatively. We analyzed the orbital computed tomography images to determine fracture size (small, medium, or large), fracture site (anterior, middle, posterior, or mixed), extraocular muscle (EOM) size (swelling or deformity), EOM site (incarcerated or prolapsed), and EOM tenting. Results: Diplopia was seen in 144 out of 200 patients (72.0%) before surgery; peripheral diplopia was seen in 57 patients (39.6%), central diplopia in 46 (24.3%), and full-degree diplopia in 20 (13.9%). Pre-operative diplopia differed according to the pre-operative limitation of range of motion (LOM) (p < 0.001) and EOM site (p = 0.022). Pre-operative diplopia type differed according to the LOM direction (p = 0.018) and EOM size (p = 0.020). Diplopia persisted in 33 patients (16.5%) 6 months after the surgery. Recovery was faster in patients with peripheral diplopia compared to those with central or full-degree diplopia. Conclusions: The presence of diplopia was associated with the pre-operative LOM and EOM site but the type of diplopia was associated with LOM direction and EOM size. These factors can be used to predict the progression of diplopia in patients with isolated inferior orbital wall fracture. J Korean Ophthalmol Soc 2021;62(10):1324-1332

단독 안와하벽골절복원술 후 회복되지 않는 고착화된 복시와 관련된 인자

김요셉,강성모 대한안과학회 2019 대한안과학회지 Vol.60 No.2

Purpose: To investigate factors affecting persistent diplopia after surgical repair of isolated inferior orbital wall fractures. Methods: Thirty-three patients who underwent surgical repair of isolated inferior orbital wall fractures in Inha University Hospital Ophthalmology Department from 2014 to 2017 were enrolled in this study. The authors examined facial computed tomography, diplopia, extraocular muscle movement, and Hertel’s exophthalmometer before and 6 months after surgery. The diplopia which was not recovered even at 6 months postoperatively was defined as persistent diplopia. Multivariable logistic regression analyses were performed on parameters that were found to be related to persistent diplopia using univariable logistic regression analyses. Results: Univariable regression analysis showed that preoperative ocular motility limitation, preoperative diplopia, the type of fracture, the number of contacts with the fracture site and extraocular muscle (EOM), and EOM tenting were associated with persistent postoperative diplopia. Multivariable regression analysis using the previously mentioned five parameters showed 28.3- fold and 17.4-fold greater probabilities of diplopia after surgery in preoperative diplopia and EOM tenting, respectively (p = 0.023). Conclusions: Preoperative diplopia and EOM tenting were associated with persistent postoperative diplopia. These parameters were predictors of persistent diplopia in eyes with isolated inferior orbital wall fractures. 목적: 단독 안와하벽골절복원술 시행 후 고착화된 복시와 관련된 인자를 알아보고자 하였다. 대상과 방법: 2014년부터 2017년까지 인하대학교병원 안과에서 단독 안와하벽골절을 진단받고 결막접근 안와골절복원술을 시행한 33명의 환자를 대상으로 수술 전후 얼굴 전산화단층촬영, 안구운동검사, 복시검사, 안구돌출계 검사를 시행하였다. 수술 후 6개월 이상 경과 관찰 후에도 회복되지 않는 복시를 고착화된 복시로 정의하였다. 단변수 로지스틱 회귀분석을 시행하여 수술 후 고착화된복시와 관련성이 있는 것으로 확인된 변수들을 평가한 후 다변수 로지스틱 회귀분석 시행하였다. 결과: 단변수 회귀분석에서 수술 전 안구운동제한, 수술 전 복시, 골절 유형, 골절부위와 외안근의 접촉 횟수, 외안근텐팅이 수술 후 고착화된 복시와 연관된 것으로 확인되었다. 다섯 가지 변수를 반영한 다변수 회귀분석에서 술 전 복시가 28.3배, 외안근텐팅이 17.4배 높은 고착화된 복시의 위험성이 있는 것으로 확인되었다(p=0.023). 결론: 본 연구에서는 수술 전 복시와 얼굴 전산화단층촬영 영상을 통해 분석한 외안근텐딩이 수술 후 고착화된 복시와 연관성이 높은 것으로 확인되었다. 향후 고착화된 복시의 예측인자로 고려할 수 있을 것으로 판단된다.

복시가 동반된 안와골절 환자의 임상양상

강효정,하명숙 대한안과학회 2009 대한안과학회지 Vol.50 No.7

conservative treatment group. Methods: The study comprised of 109 eyes of 109 patients with orbital wall fracture and diplopia. The patients were divided into two groups: the surgical treatment group (59 cases) and the conservative treatment group (50 cases). The groups were analyzed retrospectively according to age, gender, cause, CT, the period and severity of diplopia, and enophthalmos with time. Results: In the conservative treatment group, 38 cases (64.4%) had medial wall fracture, and the average fracture size was 26% of the inferior wall and 33% of the medial wall. In addition, at the first visit, the patients showed diplopia within 45.5 degrees, and diplopia disappeared completely within 17 days on average (57 cases, 96.6%). In the group that underwent the reconstruction of orbital wall fracture, 27 cases (54.0%) had inferior wall fracture, and the average fracture size was 41% of the inferior wall and 35% of the medial wall. Additionally, in the first visit, the patients showed diplopia within 20.3 degrees. The muscle incarceration occurred in 12 cases (24%). In the surgical treatment group, diplopia disappeared completely within 30 days on average (45 cases, 90.0%). Conclusion: In the group of conservative treatment, they showed diplopia within 45.5 degrees at the first visit. Diplopia disappeared completely within 17 days on average (57 cases, 96.6%). In the group of surgical treatment, they showed diplopia within 20.3 degrees at the first visit. Diplopia disappeared completely within 30 days on average (45 cases, 90.0%). 목적: 복시가 동반된 안와골절 환자에서의 수술적 치료와 보존적 치료를 시행한 경우의 임상양상을 각각 분석하고자 한다. 대상과 방법: 복시가 동반된 안와골절 환자 중 보존적 치료를 시행한 59명 59안과 수술적 치료를 시행한 50명 50안에 대해 나이, 성별, 발생원인, 전산화단층촬영 소견 및 시간에 따른 복시의 변화를 후향적으로 각각 분석하였다. 결과: 보존치료군은 내벽골절이 38명(64.4%)이고 평균 하벽의 26%, 내벽의 33% 크기의 골절을 보였고 초진 시 평균 45.5도의 복시를 보였으며 57명(96.6%)에서 평균 17일 이내 복시의 완전소실을 보였다. 수술치료군은 하벽골절이 27명(54.0%)이었으며 하벽의 41%, 내벽의 35% 크기의 골절을 보였고 초진 시 평균 20.3도의 복시를 보였다. 외안근 감돈은 12명(24%)이었고 45명(90%)의 환자에서 평균 30일 후 복시의 완전소실을 보였다. 결론: 보존치료군의 초기 복시각은 45.5도, 복시의 소실시기는 17일, 6개월 후 96.6%의 환자에서 복시의 회복을 보였고 수술치료군은 초기 복시각 35.0도, 복시의 소실시기 30일, 6개월 후 90%에서 복시가 회복되었다.

복시환자의 임상양상

김민석,최진,김정훈,김재석,이주화,Min Seok Kim,Jin Choi,Jung Hoon Kim,Jae Suk Kim,Joo Hwa Lee 대한안과학회 2013 대한안과학회지 Vol.54 No.11

Purpose: To evaluate the clinical features, causes and outcomes of patients with diplopia. Methods: All patients presenting with diplopia from October 2010 to March 2012 and followed up for more than 3 months were retrospectively investigated. Results: During the study period, 59 patients with diplopia were identified. There were 42 males and 17 females with an average age of 50 years. Binocular diplopia accounted for 54 cases (92%) and 5 cases (8%) had monocular diplopia. Cranial nerve palsies were the most common cause of binocular diplopia (28 cases, 52%). Within the cranial nerve palsies group, 14 cases (50%) were accompanied by hypertension or diabetes mellitus. Binocular diplopia spontaneously resolved in 35 cases (65%) by 3 months rising to 41 cases (76%) by 7 months. Thirteen (93%) out of 14 cases of cranial nerve palsies with hypertension or diabetes resolved spontaneously by 3 months. Conclusions: Binocular diplopia was caused most commonly by cranial nerve palsy and resolved after 3 months in 65% of patients. A spontaneous recovery from diplopia was observed after 3 months in 93% of patients with cranial nerve palsies and microvascular disease such as hypertension or diabetes. Therefore, the initial observation without additional treatment would be sufficient in these patients. J Korean Ophthalmol Soc 2013;54(11):1772-1777

열공성 망막박리 환자에서 공막돌륭술 시행 후 발생한 안구운동장애

이경주,선해정,최경식,이성진,김현아 대한안과학회 2023 대한안과학회지 Vol.64 No.12

목적: 양안 복시는 열공성 망막박리에서 시행하는 공막돌륭술 후 발생할 수 있는 중요한 합병증이다. 본 연구에서는 공막돌륭술 이후양안 복시의 발생률과 그 위험인자를 밝히고, 복시가 발생한 환자를 대상으로 시행한 사시수술의 수술 성공률에 대해 알아보고자하였다. 대상과 방법: 2017년 1월부터 2022년 6월까지 열공성 망막박리로 공막돌륭술을 시행한 417명 환자들의 의무기록을 후향적으로 분석하였으며, 6개월 이상 지속된 양안 복시를 복시 발생군으로 정의하였다. 결과: 총 22명(5.3%)에서 수술 후 6개월 이상 지속되는 양안 복시가 발생하였다. 공막누름조각에 영향을 받은 근육의 개수, 냉동유착술, 망막하액배액술, 가스 또는 오일 주입술의 시행 여부와 복시 유병률 간 의미 있는 상관관계는 없었다. 복시 발생군 중 3명(13.6%) 은 프리즘 치료 후 양안 단일시를 획득하였으며, 10명(45.5%)은 사시수술을 시행하였고, 1명(4.5%)은 공막누름조각 제거술을 시행하였다. 사시수술을 시행한 모든 환자에서 공막누름조각과 외안근 사이의 유착이 발견되었으며 수술 후 6명(60%)은 복시가 해소되었다. 결론: 공막돌륭술 후 안구운동장애와 복시가 생기는 위험 요인은 명확히 규정할 수 없으며, 프리즘을 이용한 보존적 치료에도 복시가지속될 경우 사시수술의 시행이 복시 호전에 도움을 줄 수 있다. Purpose: Binocular diplopia is a primary complication that may arise after scleral buckling surgery in patients with rhegmatogenous retinal detachment. This study examined the incidence of and risk factors for binocular diplopia after scleral buckling surgery; it also evaluated the rate of strabismus surgery success in patients with diplopia. Methods: Medical records of 417 patients who underwent scleral buckling surgery for rhegmatogenous retinal detachment at a single institution from January 2017 to June 2022 were retrospectively reviewed. Patients who experienced binocular diplopia for > 6 months were included in the diplopia group. Results: After surgery, 22 patients (5.3%) developed binocular diplopia. There were no significant correlations of diplopia onset with buckle position (i.e., the affected muscle), cryophotocoagulation, subretinal fluid drainage, and the use of gas or oil injections. Prism therapy restored binocular single vision in three patients. Ten patients chose to undergo strabismus surgery, and one patient underwent encircling band removal. All strabismus surgery patients displayed adhesion between the buckle and extraocular muscle. After surgery, 60% of these patients regained binocular single vision. Conclusions: Clear risk factors leading to ocular movement disorders and diplopia after scleral buckling remain undefined. If diplopia persists despite prism-based conservative treatment, strabismus surgery may offer relief.

복시(複視)(Diplopia)를 호소하는 Guillain-Barre Syndrome(GBS) 환자 치험 1례 증례보고

강성욱,문미현,홍석훈,황충연,강정란,박준영,Kang, Sung-Wook,Moon, Mi-Hyun,Hong, Suk-Hoon,Hwang, Chung-Yeon,Kang, Jeong-Ran,Park, Joon-Young 대한한방안이비인후피부과학회 2005 한방안이비인후피부과학회지 Vol.18 No.3

Guillain-Barre Syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. It is disorder in which the body's immune system, attacks parts of the peripheral nervous system. It is characterized by the rapid onset of weakness, paralysis of the legs, arms, breathing muscles and face. But the analysis of CSF and electrical tests on nerve and muscle function can be performed to confirm the diagnosis. Most cases occur shortly after a viral infection. This is a clinical ease report on Cuillain-Barre Syndrome with diplopia. The patient, a 52-year-old man had a weakness in both legs and diplopia. His weakness and diplopia improved after oriental medical treatment, so this is reported as a potential treatment. Objective: This study was designed to evaluate the effects on oriental medicine therapy on Guillain-Barre Syndrome with diplopia. Methods & Result: The Clinical data was analyzed on a patient with Cuillain-Barre Syndrome whose main symptoms were diplopia. The patient was treated by acupuncture and oriental medicine. As a result, symptoms was improved remarkably. Conclusion: The patient showed weakness and diplopia. After acupuncture and oriental medicine treatment, weakness and diplopia was improved in 4weeks after visit to clinic. The study suggests that oriental medicine treatment is effective on Cuillain-Barre Syndrome.

Prevalence of Diplopia and Extraocular Movement Limitation according to the Location of Isolated Pure Blowout Fractures

Min Seok Park,Young Joon Kim,김훈,Sang Hyun Nam,최영웅 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.3

Background Isolated pure blowout fractures are clinically important because they are the main cause of serious complications such as diplopia and limitation of extraocular movement. Many reports have described the incidence of blowout fractures associated with diplopia and limitation of extraocular movement; however, no studies have statistically analyzed this relationship. The purpose of this study was to demonstrate the correlation between the location of isolated pure blowout fractures and orbital symptoms such as diplopia and limitation of extraocular movement. /Methods We enrolled a total of 354 patients who had been diagnosed with isolated pure blowout fractures, based on computed tomography, from June 2008 to November 2011. Medical records were reviewed, and the prevalence of extraocular movement limitations and diplopia were determined. /Results There were 14 patients with extraocular movement limitation and 58 patients complained of diplopia. Extraocular movement limitation was associated with the following findings, in decreasing order of frequency: floor fracture (7.1%), extended fracture (3.6%),and medial wall (1.7%). However, there was no significant difference among the types of fractures (P=0.60). Diplopia was more commonly associated with floor fractures (21.4%)and extended type fractures (23.6%) than medial wall fractures (10.4%). The difference was statistically significant (Bonferroni-corrected chi-squared test P<0.016). /Conclusions Data indicate that extended type fractures and orbital floor fractures tend to cause diplopia more commonly than medial wall fractures. However, extraocular movement limitation was not found to be dependent on the location of the orbital wall fracture.

Prevalence of Diplopia and Extraocular Movement Limitation according to the Location of Isolated Pure Blowout Fractures

Park, Min-Seok,Kim, Young-Joon,Kim, Hoon,Nam, Sang-Hyun,Choi, Young-Woong Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.3

Background : Isolated pure blowout fractures are clinically important because they are the main cause of serious complications such as diplopia and limitation of extraocular movement. Many reports have described the incidence of blowout fractures associated with diplopia and limitation of extraocular movement; however, no studies have statistically analyzed this relationship. The purpose of this study was to demonstrate the correlation between the location of isolated pure blowout fractures and orbital symptoms such as diplopia and limitation of extraocular movement. Methods : We enrolled a total of 354 patients who had been diagnosed with isolated pure blowout fractures, based on computed tomography, from June 2008 to November 2011. Medical records were reviewed, and the prevalence of extraocular movement limitations and diplopia were determined. Results : There were 14 patients with extraocular movement limitation and 58 patients complained of diplopia. Extraocular movement limitation was associated with the following findings, in decreasing order of frequency: floor fracture (7.1%), extended fracture (3.6%), and medial wall (1.7%). However, there was no significant difference among the types of fractures (P=0.60). Diplopia was more commonly associated with floor fractures (21.4%) and extended type fractures (23.6%) than medial wall fractures (10.4%). The difference was statistically significant (Bonferroni-corrected chi-squared test P<0.016). Conclusions : Data indicate that extended type fractures and orbital floor fractures tend to cause diplopia more commonly than medial wall fractures. However, extraocular movement limitation was not found to be dependent on the location of the orbital wall fracture.

갑상선기능항진과 갑상선눈병증의 첫 증상으로서 후천사시와 복시

정승민(Seung Min Chung),김원제(Won Jae Kim) 대한안과학회 2020 대한안과학회지 Vol.61 No.3

목적: 후천사시와 복시가 갑상선눈병증과 갑상선기능항진의 첫 임상증상이었던 환자들의 임상양상을 분석하고자 한다. 대상과 방법: 2017년 1월부터 2018년 12월까지 후천사시와 복시로 내원한 환자들의 의무기록을 후향적으로 분석하였다. 이들 중 복시의 원인감별을 위해 시행한 검사에서 갑상선눈병증과 갑상선기능항진을 진단받은 환자들이 연구에 포함되었다. 결과: 연구기간 동안 410명의 환자가 후천사시와 복시로 안과에 의뢰되었고, 이 중 12명이 연구에 포함되었다(2.9%, 12/410). 복시가 발생한 평균 나이는 54.7년이었다(범위, 18-78년). 이 중 9명(75%, 9/12)이 남성이었다. 6명의 남성이 흡연자였다. 하사시가 가장 흔한 형태의 사시였다(83.3%, 10/12). 평균 하사시각은 17.5PD였다(범위, 4-40PD). 한 명은 외사시와 하사시를 보였고, 1명은 내사시와 양안 상측 운동제한을 보였다. 경과 관찰 중 4명의 남성이 사시수술을 시행 받았으며, 이들은 모두 흡연자였다. 한 명의 여성이 안와감압술을 시행받았다. 결론: 후천사시와 복시로 갑상선눈병증과 갑상선기능항진을 진단받은 경우는 남성에서 더 많았다. 하사시가 가장 흔한 형태의 사시였으며, 흡연하는 남성에서 여성보다 더 심한 임상경과로 진행할 가능성이 많았다. Purpose: We evaluated the clinical characteristics of patients who recently acquired strabismus and diplopia as the initial presentations of hyperthyroidism and thyroid eye disease (TED). Methods: The medical records of patients with acquired strabismus and diplopia who visited our clinic for evaluation between January 2017 and December 2018 were retrospectively reviewed; patients diagnosed initially with hyperthyroidism and TED were included in this study. Results: A total of 410 patients were referred to our clinic for the evaluation and treatment of diplopia. Among these patients, 12(2.9%, 12/410) showed acquired strabismus and diplopia as the initial presentation signs of hyperthyroidism and TED. The mean age of onset of diplopia was 54.7 years (range, 18-78 years). Nine patients (75%, 9/12) were male. Six male patients were active smokers at the initial presentation. Hypotropia was the most common type of strabismus (83.3%, 10/12). The mean angle of hypodeviation was 17.5 prism diopters (PD) (range, 4-40 PD). One patient showed exotropia with hypotropia and one patient showed esotropia with a bilateral up gaze limitation. Four male patients (all active smokers) underwent strabismus surgery, and one female patient underwent orbital decompression surgery. Conclusions: The incidence of acquired strabismus and diplopia as the initial presentation sign of hyperthyroidism was predominant in male patients. Hypotropia was the most common type of strabismus. Male patients who smoked were more likely to show progression to a severe clinical course than female patients.

복시를 주소로 내원한 에드하임-체스터병 1예

김세은,김숙영,김근해,Se Eun Kim,Sook Young Kim,Keun Hae Kim 대한안과학회 2014 대한안과학회지 Vol.55 No.2

Purpose: We present a case of Erdheim-Chester disease (ECD) with diplopia. Case summary: A 56-year-old woman came to the hospital with a 6-week history of diplopia on left lateral gaze. The right eye showed mildly limited adduction. Humphrey automated perimetry demonstrated inferior bitemporal quadrantanopia. Orbital and brain magnetic resonance imaging revealed well-defined orbital masses in both intraconal orbits with homogenous enhancement, as well as multiple masses of homogenous signal intensity in the brain. Systemic evaluation showed involvement of the long bones, and retroperitoneum, but no involvement of the heart, or lungs. Incisional biopsy of the right orbital mass was performed. Histopathological examination showed numerous lipid-laden histiocytes and few multinucleated Touton giant cells. Immunohistochemical staining showed positivity for CD68, but negativity for CD1a, and ECD was therefore diagnosed. The patient received treatment with radiation therapy and interferon-α, but died due to sepsis secondary to urinary tract infection after 2 months. Conclusions: Except exophthalmos, diplopia may be the only initial symptom of an orbital mass. Although rare, the possibility of ECD should be considered in the differential diagnosis of both retrobulbar and orbital masses with diplopia. J Korean Ophthalmol Soc 2014;55(2):283-288