Abstract
Purpose: To investigate the surgical outcome of both lateral rectus resection in the treatment of residual esotropia with previous both medial rectus recession Methods: The medical record of 30 patients who had underwent both lateral rectus resection from 1996 to 2001 for residual esotropia occurred after bilateral medial rectus recession and who had followed up for more than one year, were analysed retrospectively. Successful outcome was defined as esotropia $\leq$ 10PD, orthophoria and exotropia $\leq$ 5PD. Results: Mean age of patients was 8.6 years and ratio of male to female was 17:13. The mean interval between both medial rectus recession and reoperation was 49.5 months (10${\sim}$180 months). Mean preoperative deviation was 33.3PD (20${\sim}$75PD) and the mean amount of lateral rectus resection was 6.4 mm (4.5${\sim}$8.0 mm). Success rate, undercorrection rate and overcorrection rate at postoperative 1 year were 90.9% (n=20), 0% and 9.1% (n=2) in group with preoperative deviation less than 40PD (n=22). But in group with preoperative deviation over than 40PD (n=8), they were 37.5% (n=3), 62.5% (n=5) and 0% (p=0.045, 0.016, 0.730). Adduction limitation was not occurred in two groups. Postoperative angle of deviation in group I was changed from -1.6${\pm}$5.6PD at postoperative 1 day to 0.2${\pm}$4.2PD at postoperative 1 year (p>0.05), but it was not significant statistically. Postoperative angle of deviation in group II was increased from 8.1${\pm}$4.6PD at postoperative 1 day to 13.8${\pm}$7.9PD at postoperative 1 year (p<0.001). Conclusions: Both lateral rectus resection is an effective method in the treatment of residual esotropia less than 40 PD.
목적 : 양안 내직근 후전술 후 부족교정된 잔여내사시 환자에서 양안 외직근 절제술의 수술 효과와 안정성를 알아보고자 하였다. 대상과 방법 : 1996년에서 2001년까지 양안 내직근 후전술 후 발생한 잔여내사시로 인하여 양안 외직근 절제술을 시행하고 1년간 추적 관찰이 가능하였던 30명의 의무기록을 후향적으로 분석하였다. 수술 성공은 수술 후 편위각이 10프리즘 이하의 내사시 또는 5프리즘 이하의 외사시인 경우로 정의하였다. 결과 : 연령은 평균 8.6세이었고, 남녀비는 17:13이었다. 내직근 후전술후 평균 49.5개월 (10${\sim}$180개월)에 재수술을 시행하였다. 수술시 편위각은 평균 33.3 PD이었으며 외직근 절제량은 평균 6.3 mm(4.5${\sim}$8.0 mm)이었다. 수술 후 1년 째 수술 성공률, 부족 교정율, 과교정율은 수술 전 편위각이 40 PD미만인 군 (Group I, n=22)에서 각각 90.9% (n=20), 0%, 9.1%(n=2)이었다. 그러나 40 PD이상인 군(Group II, n=8)에서는 각각 37.5%(n=3), 62.5%(n=5), 0%이었다.(p=0.016, p=0.045, p=0.730), 두 군 모두 내전장애는 발생하지 않았다. Group I에서 수술 후 평균 편위각은 수술 후 1일째에 -1.6${\pm}$5.6 PD에서 1년째에 0.2${\pm}$4.2 PD로 변화하였으나 통계적으로 유의하지 않았으며(p>0.05) Group II에서는 수술 후 1일째에 8.1${\pm}$4.6 PD에서 수술 후 1년째에 13.8${\pm}$7.9 PD로 증가하였다.(p<0.001). 결론 : 부족 교정된 잔여내사시 환자에서 편위각이 40 PD미만인 경우 양안 외직근 절제술은 효과적인 수술방법으로 생각된다.