퇴행성 눈꺼풀속말림의 수술방법에 따른 치료결과 분석 (Clinical Results of Different Surgical Procedures in Correcting Involutional Entropion)

서지정보

· 발행기관 : 대한안과학회
· 수록지 정보 : 대한안과학회지 / 49권 / 12호 / 1877 ~ 1887페이지
· 저자명 : 윤재문, 김선아, 노주헌

초록

목적: 퇴행성 눈꺼풀속말림 환자에게 눈꺼풀 수평이완 정도에 따라 수술방법을 달리하여 치료 효과를 알아보았다.
대상과 방법: 퇴행성 눈꺼풀속말림으로 수술 받은 79명 104안을 후향적으로 조사하였다. 눈꺼풀의 수평이완이 있는 62안 중 17안(group Ia)은 가쪽눈꺼풀판띠고정술을, 45안(group Ib)은 가쪽눈꺼풀판띠고정술 및 Quickert 봉합술을 시행하였다. 눈꺼풀의 수평이완이 없는 42안 중 13안(group IIa)은 아래눈꺼풀당김기강화술을, 29안(group IIb)은 아래눈꺼풀당김기강화술 및 피부눈둘레근절제술을 시행하였다.
결과: 술 후 추적관찰 기간은 평균 11.0개월이었고, 재발율은 group Ia, group Ib, group IIa, group IIb 각각 11.7%, 0%, 15.4%, 6.9%이었다. 재발 6안과 과교정 2안은 재수술을 시행하여 좋은 결과를 얻었다.
결론: 퇴행성 눈꺼풀속말림 환자의 교정수술로서 눈꺼풀의 수평이완이 없는 경우는 아래눈꺼풀당김기강화술을, 눈꺼풀의 수평이완이 있는 경우는 가쪽눈꺼풀판띠고정술을 시행하여 효과적인 치료결과를 얻었다. 추가적인 Quickert 봉합술과 피부눈둘레근절제술로 재발을 줄일 수 있었다.

영어초록

Purpose: To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion.
Methods: This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb).
Results: The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively.
Conclusions: The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure.

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