간헐외사시 재수술 후 다시 재발한 환자의 임상양상

김태진(Tae Jin Kim),김대현(Hyun Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.11

적: 간헐외사시 재수술 후 다시 재발된 간헐외사시 환자의 임상양상을 분석하고 위험인자 및 예후 등을 알아보았다. 대상과 방법: 간헐외사시 첫 수술 후 외사시가 재발하여 재수술을 시행 받은 39명의 환자에서 경과관찰 중 외사시가 다시 재발한 환자의 발생빈도, 위험인자, 치료방법, 예후 등을 분석하였다. 결과: 전체 환자 39명에서 24명(61.5%)이 간헐외사시가 다시 재발하였고 15명은 간헐외사시가 다시 재발하지 않았다. 재수술 전 나이, 사시각, 굴절력, 부등시, 바깥쪽불일치, 수직편위 유무는 간헐외사시가 다시 재발하는 데 영향이 없었다. 그러나 첫 수술로 두 눈 외직 근후전술을 시행한 후 재수술로 두 눈 내직근절제술이나 한 눈 내직근절제술을 시행한 경우가 첫 수술로 한 눈 외직근후전술과 내직 근절제술을 시행한 후 재수술로 반대쪽 눈 외직근후전술과 내직근절제술을 시행한 경우에 비해 간헐외사시가 다시 재발하는 경향을 보였다(p<0.05). 또한 술 후 1일째 10프리즘디옵터(prism diopter, PD) 미만의 내편위 또는 정위 및 외편위를 보이는 경우가 10프리즘 디옵터 이상의 내편위를 보이는 경우에 비해 다시 재발하는 경향을 보였다(p<0.05). 결론: 간헐외사시 재수술 후 재발에 영향을 미치는 인자는 수술방법 및 수술 후 과교정도 등이 수술적인 요인일 것으로 생각된다. Purpose: We reviewed the clinical features of intermittent exotropic patients who experienced recurrence after reoperation for intermittent exotropia, and identified the risk factors and prognoses. Methods: The incidences, risk factors, treatment modalities, and prognoses of patients with recurrent exotropia were analyzed in 39 patients who underwent reoperation due to a relapse of exotropia after the first intermittent exotropia. Results: Among 39 patients, 24 (61.5%) had recurrent intermittent exotropia and 15 patients had no recurrence with intermittent exotropia. There was no difference in the recurrence of intermittent exotropia with age, deviation, refraction, anisometropia, outward discrepancy, and the vertical deviation before the reoperation. However, when the first operation was performed with bilateral lateral rectus recession and the reoperation was performed with bilateral medial rectus resection or unilateral medial rectus resection, intermittent exotropia tended to recur more than when the first operation was performed with one eye with lateral rectus recession and medial rectus resection, followed by reoperation with the other lateral rectus recession and medial rectus resection (p < 0.05). In addition, an esodeviation <10 prism diopters, orthophoria, or exotropia on the first postoperative day showed a tendency to relapse more than an esodeviation >10 prism diopters (p < 0.05). Conclusions: The factors affecting recurrence after intermittent exotropia surgery involve surgical factors such as the surgical method and the postoperative overcorrection. J Korean Ophthalmol Soc 2017;58(11):1248-1253

기본형 간헐외사시수술 후 재발된 간헐외사시의 형태 변화

황성하,백혜정 대한안과학회 2018 대한안과학회지 Vol.59 No.8

Purpose: To report the surgical outcomes and changes in types of recurrent exotropia after surgical correction of basic type intermittent exotropia. Methods: We retrospectively analyzed the medical records of 91 patients who underwent reoperations for recurrent exotropia after primary surgical correction, and who visited our hospital for a period of at least one year after the reoperation. When distant deviation was >30 prism diopters (PD), we defined convergence insufficiency type (CI type) if the difference of the deviation angle was >10 PD and basic type exotropia if the difference was <10 PD. When distant deviation was <30 PD, we defined basic type exotropia if the difference of the deviation angle between at distant and near was <33% of the distant deviation angle, and CI type exotropia if the difference was >33% of the distant deviation angle. Results: The types of recurrent exotropia were similar to those of the preoperative condition in 68 patients (74.7%), and newly emergent CI type was observed in 23 patients (25.3%). With regard to the incidence of CI type, bilateral lateral rectus recession was more common than unilateral lateral rectus recession after primary surgery and medial rectus resection and unilateral lateral rectus recession, but the difference was not significant (p = 0.615). Recurrent CI type exotropia was observed 6 months after primary surgery (p < 0.001), but there was no significant difference in the timing of the reoperation between the two groups (p > 0.05). There was no significant difference in the success of reoperations between the two groups (p > 0.05). Conclusions: The types of recurrent exotropia after surgical correction of primary basic type intermittent exotropia differed from those of preoperative exotropia, which was not related to various factors before surgery. Recurrent exotropia was successfully treated by appropriately selected reoperations, regardless of the type of exotropia. 목적: 술 전 기본형 간헐외사시 환자 중 수술 후 외사시가 재발하여 이차로 재수술을 시행하여야 했던 경우를 대상으로 하여 수술 전후 간헐외사시의 형태 변화가 있는지를 알아보고, 변한 형태에 따라 재수술 성공률을 알아보고자 하였다. 대상과 방법: 기본형 간헐외사시 진단하에 사시수술을 시행받은 환자 중, 외사시가 재발하여 재수술을 시행하고 술 후 1년 이상 경과관찰이 가능했던 91명의 의무기록지를 후향 분석하였다. 원거리 사시각이 30프리즘디옵터 이상일 때, 근거리에서 원거리보다 10프리즘디옵터 이상 큰 경우 눈모음부족외사시 군으로 정의하였고, 그 미만은 기본외사시 군으로 정의하였다. 원거리사시각이 30프리즘디옵터 미만일 때는 원거리와 근거리 사시각의 차이가 원거리 사시각 기준 1/3 이상일 때 눈모음부족외사시 군으로 정의하였고, 그 미만은 기본외사시 군으로 정의하였다. 결과: 사시각검사상 재발 외사시의 형태는 술 전과 동일한 기본형 68명(74.7%), 눈모음부족형 23명(25.3%)으로 눈모음부족외사시가 발생하였다. 1차 수술로 양안 외직근후전술을 시행한 경우 15명(30%)에서 눈모음부족외사시가 발생하여, 단안 외직근후전술 및 내직근절제술을 시행한 경우 6명(20%), 단안 외직근후전술을 시행한 경우 2명(18.2%)에 비해 더 흔하게 발생하였으나 차이는 유의하지 않았다(p=0.615). 재발 눈모음부족외사시는 재발 기본형 외사시 군에 비해 특히 1차 수술 6개월 이후에 발생하는 양상을 보였으나(p<0.001) 재수술 시행 시기는 유의한 차이는 없었다(p>0.05). 재수술 후 1년 이상 추적관찰상 두 군의 수술 성공률은 유의한 차이는없었다(p>0.05). 결론: 기본형 간헐외사시 수술 후 재발한 외사시는 술 전과 비교해 기본형 외에 눈모음부족외사시가 새로이 발생하였으나 이는 일차수술 방법이나 술 전 여러 요소들과는 무관한 것으로 생각되었다. 또한 재발된 기본외사시와 눈모음부족외사시 모두 적절히 선택된재수술로 성공적으로 치료할 수 있었다.

The Effects of Nonsurgical Treatment in Intermittent Exotropia by Meta-Analysis

Yeon-Shik Oh,Kyu-Byung Lee,Ki-Choong Mah 대한시과학회 2017 대한시과학회지 Vol.19 No.4

목적: 간헐외사시의 비수술처치 효과에 관한 국내외 개별연구들을 대상으로 메타분석을 이용하여 현재까 지 연구 동향을 파악하고, 간헐외사시에 대한 비수술처치 효과의 방향과 크기를 바탕으로 임상적 및 이론적 의미를 제시하고자 하였다. 방법: 간헐외사시의 비수술처치 효과에 대한 논문들을 메타분석하기 위하여 1990년부터 2015년까지 발 표된 국내외 학위논문과 학술지를 대상으로 포함 및 배제 기준을 적용하여 15편을 선정하였다. 개별연구들 로부터 연구별 효과크기와 변량, 전체 효과크기를 산출하고 동질성을 검증한 후 처치변인별 하위요인의 효 과크기 차이를 검증하였다. 비수술처치에서 고려할 항목으로 치료 방법, 사시 유형, 연령 수준 등을 선정하 였으며, 각 항목이 간헐외사시의 치료에 미치는 효과를 구분하여 분석하였다. 결과: 간헐외사시의 치료를 위한 비수술처치 방법의 전체 효과크기는 -0.715이었다. 치료 방법의 효과크 기는 시기능훈련; -1.753, 혼합치료; -1.747, 굴절이상교정; -1.295, 마이너스렌즈 과교정; -0.500, 가림 치료; -0.281 순이었다. 사시 유형별 효과크기는 개산과다; -2.111, 폭주부족; -1.171, 기본형; -1.220 순 이었다. 연령별 효과크기는 13~19세; -2.029, 7~13세; -1.057, 4세 미만; -0.751, 및 4~7세; -0.379 순 이었다. 결론: 본 연구에서 제시된 효과크기들은 간헐외사시의 비수술처치에 의한 사시각 감소나 입체시 향상 등의 개선효과를 정량적으로 분석한 것이며, 이로부터 비수술처치의 객관적 타당성이 제시된 것으로 생각된다. Purpose: To understand research trends in domestic and foreign primary studies related to the effect of nonsurgical treatment of intermittent exotropia by meta-analysis, and to suggest clinical and theoretical implications based on the direction and magnitude of the nonsurgical treatment effect for intermittent exotropia. Methods: Of the thesis related to the effect of nonsurgical treatment of intermittent exotropia published in domestic and international journals and dissertations from 1990 to 2015, 15 papers selected from the inclusion and exclusion criteria were analyzed for meta-analysis. The effect size and variance of individual primary studies and overall effect size were calculated and then verified homogeneity. Also, the difference of effective size in different treatment methods by sub-group was verified. The treatment method, type of strabismus and age of treatment time were selected as variables to be considered for conducting the non-surgical treatment of intermittent exotropia, and the effect of each variable on treatment of intermittent exotropia were analyzed. Results: The overall effect size of non-surgical treatment of intermittent exotropia was -0.715. The order of effect size of the treatment method was orthoptics; -1.753, mixed treatment; -1.747, correction of refractive error; -1.295, minus lens overcorrection; -0.500 and then occlusion therapy; -0.281. The order of effect size of strabismus types was divergent excess; -2.111, convergence insufficiency; -1.171, and then basic; -1.220. The order of effect size of age groups was 13∼19 yrs.; -2.029, 7∼13 yrs.; -1.057, under 4 yrs.; -0.751 and then 4∼7 yrs.; -0.379. Conclusions: It is considered that the effect size in this study was analysed quantitatively the improving effect such as the decrease of deviation or the improvement of stereopsis and so on with the nonsurgical treatment in patients with intermittent exotropia, and the objective relevance of the nonsurgical treatment was suggested by these results.

간헐기를 거친 항상성 외사시의 임상특징

서영우,차덕선,조윤애,김승현.Young-Woo Suh. MD. PhD. Deoksun Cha. MD. Yoonae A. Cho. MD. PhD. Seung-Hyun Kim. MD. PhD 대한안과학회 2011 대한안과학회지 Vol.52 No.4

Purpose: To investigate clinical characteristics of constant exotropia patients with a previous history of intermittent exotropia. Methods: Constant exotropia patients (CXT) with a previous history of intermittency, and intermittent exotropia patients (X [T]) who had undergone surgery for exotropia were included in the present study. Patching therapy of the fixating eye was performed for all patients. Surgical results, the effect of patching, lateral incomitancy, and suppression were retrospectively reviewed and compared between the 2 groups. Results: The number of CXT was 51 and X (T) was 84. The angles of deviation at the initial visit and at surgery were significantly larger in CXT. After 3 months of patching therapy, there was no difference between the 2 groups in the reduction of distant angle of deviation. However, the reduction of near angle of deviation was 0.29 ± 5.44 in CXT and 4.42 ± 6.26 Δ in X (T), which was significantly different (p = 0.04). Lateral incomitancy was observed in 7.8% of CXT and 34.5% of X (T) (p < 0.001). The angles of deviation at the final visit and surgical success rate were not different between the groups. Preoperative suppression at distant was found in 100% of CXT and 88.7% of X (T), and postoperative suppression was in 17.6% and 18.3%, respectively. Conclusions: The surgical success rate and postoperative suppression were not different between constant exotropia and intermittent exotropia. However, the frequency of lateral incomitancy and the response to the patching therapy was lower in constant exotropia. J Korean Ophthalmol Soc 2011;52(4):462-465

항상 유아외사시와 간헐 유아외사시 환자에서 감각 및 운동 기능의 비교

황성수(),이수정() 대한안과학회 2016 대한안과학회지 Vol.57 No.11

목적: 항상과 간헐 원발 유아외사시 환자들의 임상양상을 파악함과 동시에 감각 및 운동기능에 차이가 있는지를 알아보고자 하였다. 대상과 방법: 2010년 3월부터 2015년 11월까지 원발 유아외사시로 진단 받은 환자 58명을 초진 시 사시 발현 빈도에 따라 항상(21명) 과 간헐(37명)로 나누어 두 군에서의 성별, 사시 가족력, 진단 나이, 구면렌즈대응치, 약시유무를 조사하였으며 사시 및 안구운동검사, 입체시 검사를 시행하여 비교하였다. 결과: 항상 유아외사시는 간헐 유아외사시에 비해 여아에서 더 흔하고(p=0.027), 우안에서 좀 더 근시 구면렌즈대응치(-0.99D)를 보였으나(p=0.023) 그 외 사시가족력 유무, 진단나이, 약시, 잠복 눈떨림과 입체시는 두 군 사이에 유의한 차이를 보이지는 않았다. 사시각의 크기도 근거리 주시시 및 원거리 주시시 모두 두 군의 차이가 없었고(p=0.598, p=0.518) 해리수직사시는 항상에서 2명, 간헐에 서 3명, 하사근기능항진은 항상에서 8명, 간헐에서 16명에서 동반되었으며 일치수직사시는 항상에서 1명, 간헐에서 3명에서 동반되었고 모두 유의한 차이를 보이지는 않았다. 결론: 원발 유아외사시 환자에서 외편위가 간헐적이라도 항상 유아외사시와 비슷한 임상양상을 보이므로 간헐 유아외사시 환자들도 항상 유아외사시 환자에서처럼 주의 깊은 관찰이 필요할 것으로 생각된다. <대한안과학회지 2016;57(11):1765-1769> Purpose: The aim of this study was to compare sensory and motor functions in patients with constant and intermittent primary infantile exotropia. Methods: From March 2010 to November 2015, 58 patients with primary infantile exotropia were divided into a constant group (21 patients) and an intermittent group (37 patients) according to frequency of exodeviation at the first visit. Sex, family history of strabismus, age at diagnosis, spherical equivalent, and presence of amblyopia were compared. Angle of deviation, ocular motor function, and stereopsis were measured. Results: Females were more prevalent (p = 0.027) and the spherical equivalent of the right eye was more myopic (-0.99 D) (p = 0.023) in the constant infantile exotropia group. However, there was no significant difference in family history of strabismus, age at diagnosis, amblyopia, latent nystagmus, or stereopsis between the two groups. There were no significant differences between the two groups in angle of deviation at near or distance (p = 0.598, p = 0.518). Dissociated vertical deviation was accompanied in 2 patients in the constant group and 3 in the intermittent group. Inferior oblique overaction was accompanied in 8 patients in the constant group and 16 in the intermittent group, while vertical deviation was accompanied in 1 patient in the constant group and 3 in the intermittent group. However, there were no significant differences between the groups for any of these findings. Conclusions: Constancy of exodeviation is insufficient to diagnose primary infantile exotropia. Compared to those in whom exodeviation was intermittent, the patients with constant infantile exotropia showed similar clinical features. Therefore, close observation is recommended in patients with intermittent and constant infantile exotropia. J Korean Ophthalmol Soc 2016;57(11):1765-1769

메타분석을 통한 간헐외사시의 비수술처치 효과

오연식,이규병,마기중 대한시과학회 2017 대한시과학회지 Vol.19 No.4

Purpose: To understand research trends in domestic and foreign primary studies related to the effect of nonsurgical treatment of intermittent exotropia by meta-analysis, and to suggest clinical and theoretical implications based on the direction and magnitude of the nonsurgical treatment effect for intermittent exotropia. Methods: Of the thesis related to the effect of nonsurgical treatment of intermittent exotropia published in domestic and international journals and dissertations from 1990 to 2015, 15 papers selected from the inclusion and exclusion criteria were analyzed for meta-analysis. The effect size and variance of individual primary studies and overall effect size were calculated and then verified homogeneity. Also, the difference of effective size in different treatment methods by sub-group was verified. The treatment method, type of strabismus and age of treatment time were selected as variables to be considered for conducting the non-surgical treatment of intermittent exotropia, and the effect of each variable on treatment of intermittent exotropia were analyzed. Results: The overall effect size of non-surgical treatment of intermittent exotropia was -0.715. The order of effect size of the treatment method was orthoptics; -1.753, mixed treatment; -1.747, correction of refractive error; -1.295, minus lens overcorrection; -0.500 and then occlusion therapy; -0.281. The order of effect size of strabismus types was divergent excess; -2.111, convergence insufficiency; -1.171, and then basic; -1.220. The order of effect size of age groups was 13∼19 yrs.; -2.029, 7∼13 yrs.; -1.057, under 4 yrs.; -0.751 and then 4∼7 yrs.; -0.379. Conclusions: It is considered that the effect size in this study was analysed quantitatively the improving effect such as the decrease of deviation or the improvement of stereopsis and so on with the nonsurgical treatment in patients with intermittent exotropia, and the objective relevance of the nonsurgical treatment was suggested by these results. 목적: 간헐외사시의 비수술처치 효과에 관한 국내외 개별연구들을 대상으로 메타분석을 이용하여 현재까지 연구 동향을 파악하고, 간헐외사시에 대한 비수술처치 효과의 방향과 크기를 바탕으로 임상적 및 이론적 의미를 제시하고자 하였다. 방법: 간헐외사시의 비수술처치 효과에 대한 논문들을 메타분석하기 위하여 1990년부터 2015년까지 발표된 국내외 학위논문과 학술지를 대상으로 포함 및 배제 기준을 적용하여 15편을 선정하였다. 개별연구들로부터 연구별 효과크기와 변량, 전체 효과크기를 산출하고 동질성을 검증한 후 처치변인별 하위요인의 효과크기 차이를 검증하였다. 비수술처치에서 고려할 항목으로 치료 방법, 사시 유형, 연령 수준 등을 선정하였으며, 각 항목이 간헐외사시의 치료에 미치는 효과를 구분하여 분석하였다. 결과: 간헐외사시의 치료를 위한 비수술처치 방법의 전체 효과크기는 -0.715이었다. 치료 방법의 효과크기는 시기능훈련; -1.753, 혼합치료; -1.747, 굴절이상교정; -1.295, 마이너스렌즈 과교정; -0.500, 가림치료; -0.281 순이었다. 사시 유형별 효과크기는 개산과다; -2.111, 폭주부족; -1.171, 기본형; -1.220 순이었다. 연령별 효과크기는 13~19세; -2.029, 7~13세; -1.057, 4세 미만; -0.751, 및 4~7세; -0.379 순이었다. 결론: 본 연구에서 제시된 효과크기들은 간헐외사시의 비수술처치에 의한 사시각 감소나 입체시 향상 등의 개선효과를 정량적으로 분석한 것이며, 이로부터 비수술처치의 객관적 타당성이 제시된 것으로 생각된다.

An Overview of the Korean Intermittent Exotropia Multicenter Study by the Korean Association for Pediatric Ophthalmology and Strabismus

Dae Hee Kim,Seung-Hee Baek,Hee-young Choi,Dong Gyu Choi,Dong Cheol Lee,Se-Youp Lee,Han Woong Lim,Hyun Taek Lim,Won Yeol Ryu,Hee Kyung Yang,Key Hwan Lim 대한안과학회 2021 Korean Journal of Ophthalmology Vol.35 No.5

The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.

재발로 인해 3회 이상 수술을 시행한 간헐외사시 환자군의 임상분석

김민재(Min Jae Kim),하석규(Suk Gyu Ha),김승현(Seung Hyun Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.11

목적: 3회 이상 재수술을 시행한 간헐외사시 환자들의 임상양상을 분석하여 3회 이상 재수술에 이르게 하는 요인에 대하여 알아보고자 한다. 대상과 방법: 간헐외사시로 2차 수술 후 재발되어 3차 이상의 수술을 시행 받은 13명과 2차 수술 후 1년 이상 경과 관찰을 통하여 수술의 성공을 판단할 수 있었던 29명을 대상으로 후향적으로 분석하였다. 다중 로지스틱 회귀분석을 사용하여 증상 발생 시 나이, 1차, 2차, 3차, 4차 수술 시 나이, 각 수술 전후의 입체시, 각 수술 전후의 원거리 및 근거리 사시각, 각 수술 시 항상성 유무 등이 2차 수술 후의 수술 결과에 미치는 영향을 분석하였다. 결과: 3회 이상의 수술군에서는 2회 수술군에 비하여 1세 이전에 증상이 발생한 경우가 많았고(p=0.011), 1차 수술 전 사시각이 30PD 이상으로 크며(p=0.003), 항상성인 경우가 많았다(p=0.023). 또한 3회 이상 수술군에서는 1차 수술 후 1일째 내편위를 보인 경우가 적었으며(p=0.003), 2차 수술 후 성공적인 입체시 회복을 보인 경우가 유의하게 적었다(p=0.043). 이들 요인 중 다중 로지스틱 회귀 분석을 통하여 2차 수술 후 재수술과 성공에 영향을 주는 가장 중요한 요인은 술 후 성공적인 입체시의 회복 여부였다(odds ratio [OR]=50.00, 95% confidence interval [CI]=4.392-569.224, p=0.002). 결론: 본 연구에서는 사시가 1세 이전에 발생한 경우, 첫 수술 시 큰 각의 항상성 외사시인 경우, 술 후 초기 과교정이 안 된 경우에 재발로 인해 3회 이상의 수술이 필요할 수 있었고, 술 후 입체시 회복 여부가 2차 수술 후 결과의 가장 중요한 예측 인자였다. Purpose: To evaluate the clinical analysis of intermittent exotropia patients who required more than three reoperations and to investigate the factors leading to situations that require more than three reoperations. Methods: We retrospectively analyzed the results of 13 patients who underwent more than three reoperations for recurrence after the second operation, as well as for 29 patients who had successful results for operation at least 1 year after the second operation. We investigated the factors associated with surgical outcomes of the second operation using multiple logistic regression analysis, which included; onset of symptom, primary, secondary, tertiary, and fourth ages of surgery, stereopsis before and after surgery, distance and near deviation before and after surgery, and constancy of exotropia. Results: There were more cases in which symptoms occurred before 1 year of age (p = 0.011) and which had constant exotropia (p = 0.023), with a large deviation at first operation (p = 0.003) after more than three operations compared to patients who only had two operations. There were less cases that achieved initial overcorrection after first operation (p = 0.003) and successful postoperative stereopsis after second operation (p = 0.043) in the three operations group than in the two operations group. Among these factors, the most important factor affecting reoperation and success after second operation was related to successful recovery of stereopsis using multiple regression analysis (odds ratio [OR] = 50.00, 95% confidence interval [CI] = 4.392-569.224, p = 0.002). Conclusions: In cases of intermittent exotropia occurring before 1 year of age, constant exotropia with a large deviation at first operation, and insufficient initial overcorrection after operation, it may be necessary for patients to receive more than three operations because of recurrence. Further, recovery of postoperative stereopsis after the second operation was the most important predictor for postoperative results. J Korean Ophthalmol Soc 2017;58(11):1269-1275

재발된 간헐외사시로 재수술한 환자의 임상분석

김상진,최동규,Sang Jin Kim,Dong Gyu Choi 대한안과학회 2007 대한안과학회지 Vol.48 No.2

Purpose: To analyze the clinical course and relationships between the factors and surgical outcomes after reoperation for recurrent intermittent exotropia. Methods: Surgical results were retrospectively investigated in 38 patients who had undergone reoperation at least 3 months after surgical correction. Recurrence was defined as an exodeviation of more than 10 prism diopters at the primary position. We investigated the recurrence rate according to the follow-up duration with survival analysis, and analyzed the relationships between the factors and surgical outcome. Results: The mean survival period was 22.7±20.2 months (range, 3 to 72 months). As the follow-up duration increased, the recurrence rate progressively increased. The hazard ratio for recurrence of a unilateral medial rectus resection as a reoperation was significantly higher than that for a unilateral lateral rectus recession and medial rectus resection (recession and resection)(p=0.021). After using unilateral recession and resection as the primary surgery, the hazard ratio for recurrence of unilateral recession and resection as a reoperation was not significantly different from that for unilateral lateral rectus recession (p=0.480). After a bilateral lateral rectus recession, the hazard ratio for recurrence of unilateral medial rectus resection was not significantly different from that for bilateral medial rectus resection (p=0.076). Conclusions: The surgical options for recurrent intermittent exotropia are contralateral recession and resection or contralateral lateral rectus recession. The procedure chosen depends on the operator`s preference after performing unilateral recession and resection as the primary surgery. After a bilateral lateral rectus recession, the hazard ratio for recurrence of unilateral medial rectus resection was not significantly higher than that for a bilateral medial rectus resection, but even so, a bilateral medial rectus resection may be more effective than unilateral medial rectus resection for recurrent intermittent exotropia.

사시환자에서 입체시의 양상

정유리,양홍석,유호민,이종복,장윤희,Yoo-Ri Chung,Hongseok Yang,Ho Min Lew,Jong Bok Lee,Yoon-Hee Chang 대한안과학회 2008 대한안과학회지 Vol.49 No.8

Purpose: To analyze stereoacuity in patients with strabismus using various stereotests. Methods: Stereoacuity was assessed in children who were diagnosed with intermittent exotropia or refractive accommodative esotropia using the Titmus stereotest, TNO stereotest, and the Lang II stereotest. Patients with amblyopia or previous ocular surgery were excluded. Results: Ninety-four patients with intermittent exotropia and 36 patients with refractive accommodative esotropia were included; the mean age was 7.2 years. The mean stereoacuity in intermittent exotropia was 143.1±207.9 seconds of arc with the Titmus stereotest, 130.2±103.7 seconds of arc with the TNO stereotest, and 200.0±0.0 seconds of arc with the Lang II stereotest. The mean stereoacuity in refractive accommodative esotropia was 430.3±288.6 seconds of arc, 232.5±90.0 seconds of arc, and 230.0±97.9 seconds of arc, respectively. The absence of stereoacuity was more frequent in patients with refractive accommodative esotropia than in patients with intermittent exotropia, and both groups of patients showed the largest proportion of absent stereopsis with the TNO stereotest. No factor was significant for stereopsis in patients with intermittent exotropia and patients with refractive accommodative esotropia. Conclusions: Stereoacuity showed various seconds of arc according to the type of stereotest in the same patient. Patients with refractive accommodative esotropia showed lower stereoacuity in all stereotests than patients with intermittent exotropia. TNO stereotests are sensitive enough to detect the absence of stereopsis in patients with strabismus. J Korean Ophthalmol Soc 49(8):1309-1316, 2008