현성굴절검사로 추적관찰한 조절내사시 환자에서의 성공적인 안경약화 예측인자

Abstract

현성굴절검사로 추적관찰한 조절내사시 환자에서 성공적인 안경약화를 예측할 수 있는 인자에 대해 알아보고자 하였다. 현성굴절검사로 추적관찰한 조절내사시 환자 41명에서 초진 시 연령, 굴절력, 원거리 및 근거리 사시각과 최종검사 시 굴절력, 발병연령, 안경착용 시작연령, 연령별 굴절력, 굴절력의 변화율, 약시 동반 여부 등을 후향적으로 조사하였으며, 이 중 안경을 벗게 된 환자들과 안경유지가 필요했던 환자들을 두 군으로 나누어 비교 분석하였다. 마지막 경과 관찰 시 안경을 벗게 된 환자는 총 14명이었다. 안경을 벗게 된 환자군의 조절내사시의 발생연령은 39.3±15.6개월, 안경착용 시작연령은 57.6±26.2개월이었다. 초진 시 평균 굴절력은 3.91±1.13D, 원거리 평균 사시각은 22.7±10.2PD이었으며, 안경을 벗게 될 때의 평균 굴절력은 1.62±1.01D, 평균 연령은 146.9±28.3개월이었다. 초진 시 연령, 평균 굴절력과 원거리 사시각, 내사시 발병연령, 안경착용 시작연령, 연령별 굴절력, 굴절력의 변화율의 각 평균값을 비교했을 때 안경을 벗은 환자군과 안경을 유지 중인 환자군 간의 유의한 차이는 없었으며, 최종 내원 시 굴절력만이 안경을 벗은 군에서 통계적으로 유의하게 낮았다. 또한 내사시 발병 연령이 3세 이상인 경우에서 안경을 벗을 수 있는 확률이 높았으며 이는 통계적으로 유의하였다. 현성굴절검사를 우선적으로 시행하는 것은 조절내사시 환자를 추적관찰 하는 하나의 방법이 될 수 있으며, 조절내사시의 발생 연령이 3세 이상일 경우 안경을 벗을 수 있는 확률이 높았다.;The purpose of this study was to investigate the predictive factors of successfully weaning children out of glasses in accommodative esotropia who were monitored with manifest refraction on follow up visits. A retrospective review of 41 patients with accommodative esotropia was performed. The patients were initially prescribed their full hyperopic correction. Weaning was accomplished by monitoring patients with manifest refraction on follow up visits. The patients were divided into 2 groups who were weaned successfully from glasses and still needed glasses at their final visit. Comparative analysis on the multiple clinical characteristics between two groups was done. Among the 41 patients, 14 patients were weaned successfully from glasses. The age of onset in patients who were weaned successfully from glasses was 39.3±15.6months and the age when glasses were first prescribed was 57.6±26.2months. The initial refractive error was 3.91 ±1.13D and the initial distance esodeviation was 22.7±10.2PD. The patients were weaned successfully from glasses at a mean age of 146.9± 28.3months and at the last visit the refractive error was 1.62±1.01D. Final refractive error was significantly lower in the patients who were weaned successfully from glasses. Other parameters such as age at first visit, age of onset, initial refractive error, initial distance esodeviation, age at which glasses were prescribed, mean refractive error at each age, annual rate of refractive change were not significantly different between 2 groups. The patients with onset of accommodative esotropia after 3 years of age were more likely to be weaned from glasses at their final visit and it was statistically significant. In conclusion, monitoring with manifest refraction could be another method of weaning from glasses in children with accommodative esotropia and age of onset appears to be the useful predictor of successful weaning in children who can finally be weaned from glasses.