Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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Evaluation and Treatment of True Ptosis in Double Elevator Palsy

두눈올림근마비 환자의 눈꺼풀처짐에 대한 평가 및 치료

Kim, Eun-Ah;Lee, Sang-Hyeok;Kim, Myung-Mi;Chung, Wha-Sun
김은아;이상혁;김명미;정화선

  • Published : 20050300
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Abstract

Purpose: To estimate the predictable factors of postoperative true ptosis remaining after squint surgery in patients with double elevator palsy (DEP), and to analyze the factors that must be considered before the correction of true ptosis. Methods: We retrospectively reviewed the medical records of 6 patients who had undergone strabismus surgery for DEP at the Department of Ophthalmology, Yeungnam University College of Medicine, between 1989 and 2003. The MRD (margin reflex distance) of paretic and nonparetic eye with each eye fixation, palpebral aperture, levator function, and Bell's phenomenon were analyzed before and after squint surgery. Results: True ptosis was noted in 3 patients, one of whom underwent external levator resection. Postoperative Bell's phenomenon improved in 2 patients who had poor Bell's phenomenon preoperatively. Scleral show remained in 2 patients who underwent inferior rectus recession, and was taken into account before the correction of ptosis. Conclusions: Upper lid drooping in DEP patients is expected to be improved after squint surgery if preoperative MRD of paretic eye with paretic eye fixation has the same measured amount as that of non-paretic eye. MRD, Bell's phenomenon and the amount of scleral show after the squint surgery should be carefully examined and assessed before the correction of residual ptosis.

목적 : 두눈올림근마비 환자들을 대상으로 사시수술 후 남을 수 있는 진성눈꺼풀처짐을 예측할 수 있는 요소와 눈꺼풀 처짐에 대한 수술이 필요할 때 고려할 점에 대해 알아보았다. 대상과 방법 : 영남대학교 의과대학 부속병원 안과를 방문한 환자 중 1989년부터 2003년까지 두눈올림근마비로 사시 수술을 시행받은 6명을 대상으로 후향적으로 분석하였다. 사시수술전 후 건안과 마비안으로 각각 주시하였을 때 눈꺼풀각막반사간거리(margin reflex distance, MRD), 눈꺼풀틈새의 길이, 올림근 기능, 벨현상을 측정하여 비교, 평가하였다. 결과 : 진성눈꺼풀처짐은 6명 중 3명에서 관찰되었는데, 그 중 1명은 눈꺼풀올림근절제술을 시행받았다. 사시수술 전벨현상이 불량했던 2명은 수술 후 호전되었고, 하직근후전술을 시행받은 2명에서는 1 mm의 공막비침이 남아 눈꺼풀처짐을 교정할 때 이를 고려하여 적정량을 교정하였다. 결론 : 두눈올림근마비에서 눈꺼풀처짐은 마비안으로 주시 시 동측의 MRD가 반대편과 같아지거나 올림근 기능이 좋은 경우 수직사시 교정 후 호전되는 경우가 많고, 만약 술 후 눈꺼풀처짐이 남아 수술이 필요한 경우 건안과 마비안의 MRD, 벨현상 등을 재평가해 교정량을 정해야 한다.

Keywords

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