Clinical Manifestations and Surgical Outcomes of Intermittent Exotropia with or without Dissociated Vertical Deviation

Dae-Young Park, Myung-Mi Kim
2012 Journal of the Korean Ophthalmological Society  
이 논문의 요지는 2010년 대한안과학회 제103회 학술대회에서 구연으로 발표되었음. 간헐외사시(intermittent exotropia)는 눈부심, 두통, 흐 려보임, 복시, 안정피로 등의 증상을 가지며 국내에서 가장 흔한 사시이다. 간헐외사시는 평균 2.3세에 발현하거나 1 혹 은 35-40%에서 2세 이전에 나타난다고 하였으며 2 양안시 가 가능하고 좋은 입체시를 나타낸다. 3 해리수직편위(dissociated vertical deviation, DVD)는 환자가 피곤할 때나 한 눈을 가리면 비주시안의 상전과 외 회선, 외측편위 등으로 구성된 눈운동의 이상으로 정의되는 수직사시의 일종이다. 이는 단안 또는 양안에 나타나며 4 만 2-5세에 주로 진단되고 입체시기능이 나쁜 경우가 많다. DVD는 내사시, 외사시, 하사근기능항진, 눈떨림 등의 다른 이상을 동반할 수 있으며 5,6 외관상 문제가 될 경우에 수술 이 필요하다. 4,7 간헐외사시에서 동시에 DVD가 나타나는 경우가
more » ... 나 이에 대한 연구는 드문 편이다. Lim et al 8 은 간헐외사시와 DVD가 공존하는 경우 사시의 시작 시기가 더 빠르고 양안 시가 더 좋지 않았다고 하였으며 Oh et al 9 Purpose: Clinical manifestations and surgical outcomes of intermittent exotropia with or without dissociated vertical deviation (DVD) were evaluated. Methods: Patients who were diagnosed with intermittent exotropia following surgical correction were divided into 2 groups: 66 patients with DVD (DVD group) and 81 patients without DVD (XT group). The postoperative deviation between exodeviation of 10 prism diopters (PD) and esotropia of 5 PD was considered surgically successful. Results: The onset of strabismus occurred at an earlier age in the DVD group. There were more cases of nystagmus, inferior oblique muscle overaction, superior oblique muscle overaction, and AV pattern in the DVD group than in the XT group, but there were no differences between the 2 groups in terms of head tilt, amblyopia, and age at first operation. While exodeviation in the DVD group was smaller than in the XT group, stereopsis in the DVD group was statistically worse than in the XT group in the Titmus test. At postoperative 1 month, the XT group had better surgical outcome, but at postoperative 6 and 12 months, there were no differences in the surgical outcomes of intermittent exotropia between the 2 groups. Regarding DVD surgery, a postoperative DVD angle less than 10 PD accounted for 90.0% of the cases. Conclusions: Intermittent exotropia combined with DVD had worse stereoacuity and lesser exodeviation. There was no statistically significant difference in the surgical outcomes of intermittent exotropia with or without DVD.
doi:10.3341/jkos.2012.53.8.1131 fatcat:s35b6auiajarrbttb2guiatijy