단안 약시 소아에 있어 부분가림 단독 치료의 효과 = Effects of Solitary Part-time Occlusion for the Treatment of Monocular Amblyopia Patients

다국어 초록 (Multilingual Abstract)

Purpose: To assess in monocular amblyopia patients the effectiveness of solitary part-time occlusion in overcoming the disadvantages of full-time occlusion.
Methods: Forty monocular amblyopia patients, aged from 3 to 8 years, who had more than 0.7 in visual acuity of the sound eye and more than 2 lines in binocular difference of visual acuity, were treated only with part-time occlusion for 6 hours per day. Patients were classified into three age groups: 3～4 years, 5～6 years, and 7～8 years. We compared best corrected visual acuity (BCVA) and binocular difference of visual acuity, before and after 6-hour patching. We also compared the difference at the end of patching with that at the last follow-up visit.
Results: BCVA and binocular difference of visual acuity were significantly improved (p<0.001). Average duration of occlusion was 15.4±13.0 months (9～55months). Thirty-two of 40 patients had less than 2 lines of binocular difference of visual acuity after patching. Visual acuity of each age group was also significantly improved but there was no difference in the degree of improvement or the duration of occlusion among the three age groups. It was also maintained well until the last follow-up visit.
Conclusions: For the treatment of amblyopia patients, solitary, 6-hour, part-time occlusion revealed effective improvement of BCVA and good maintenance of the improvement.

국문 초록 (Abstract)

목적 : 종일가림의 여러가지 문제를 해결하기 위해 부분가림만을 사용하여 약시를 효과적으로 치료할 수 있는지를 알아보고자 하였다.
대상과 방법 : 본원에 내원한 3세에서 8세 사이의 단안 약시 환아 중 사시성 또는 부등시성 약시 환아 40명을 대상으로, 건안의 시력이 0.7 이상이면서 양안시력의 차이가 두줄 이상인 환아를 선택해 하루 6시간의 부분가림을 단독 시행하였다. 전체 환아군을 3～4세, 5～6세, 7～8세 군으로 구분하여 가림 전후의 약시안의 시력과 양안 시력의 차이, 가림 후와 마지막 외래 내원시의 시력을 각각 비교하였다.
결과 : 전체 환아를 대상으로 가림 후의 최고 교정 시력은 의미있게 호전되었으며, 양안의 시력차이도 호전되었다(각각 p<0.001). 2줄 이내의 시력의 차이를 보이는 정도로 호전된 환아는 40명 중 32명이었다. 모든 연령군에서 유의한 수준으로 시력이 호전되었고, 연령별 호전 정도와 가림기간의 차이는 없었다. 세 연령군 모두 가림 종료 후에도 시력이 잘 유지되었다.
결론 : 약시 환아의 가림치료에 있어 하루 6시간의 부분가림 단독 치료가 시력을 의미있게 호전시키고 지속적으로도 시력을 잘 유지할 수 있도록 해주는 것으로 생각된다.

참고문헌 (Reference)

1 "약시에서 한눈가림법에 대한 준수조사" 34 : 103-9, 1993

2 "소아 단안 약시의 추적 관찰" 39 : 305-311, 1998

3 "Treatment of eccentric fixation in children under four years of age" 61 : 395-9, 1966

4 "The therapy of amblyopia:an analysis comparing the results of amblyopia therapy utilizing two pooled data sets" 97 : 373-395, 1999

5 "The minimum occlusion trial for the treatment of amblyopia" 109 : 2261-2264, 2002

6 "Results of intensive CAM grating treatment in a strabismic amblyopia" 59 : 511-, 1982

7 "Psychosocial and clinical determinants of compliance with occlusion therapy foramblyopic children" 16 : 150-155, 2002

8 "Preschool vision screening: Results of a Systematic review." University of York 1997

9 "Practical management of amblyopia" 23 : 12-6, 1986

10 "Outcomes of occlusion treatment for amblyopia" 36 : 19-24, 1999

11 "Outcome of occlusion treatment for amblyopia" 36 : 19-24, 1999

12 "Optical penalization can improve vision after occlusion treatment" 3 : 341-343, 1999

13 "Occlusion therapy in amblyopia" 73 : 776-, 1965

14 "Occlusion for amblyopia:a comprehensive surety of outcome" 6 : 300-4, 1992

15 "Long-term follow-up of L-dopa treatment in children with amblyopia" 39 : 326-330, 2002

16 "Levodopa/ carbidopa for childhood amblyopia" 34 : 3090-5, 1993

17 "Full-time occlusion therapy for amblyopia" 30 : 125-30, 1980

18 "Full-time atropine,intermittent atropine,and optical penalization and binocular outcome in treatment of strabismic amblyopia" 104 : 2143-2155, 1997

19 "Factors affecting the outcome of children treated for amblyopia" 8 : 627-31, 1994

20 "Experience with the CAM vision stimulator,preliminary report" 64 : 339-, 1980

21 "Efficacy of occlusion for strabismic amblyopia:can an optimal duration be identified" 84 : 572-578, 2000

22 "Effect of levodopa and carbidopa in human amblyopia" 39 : 81-89, 2002

23 "Diagnosis and Management of Ocualr Motility disorders" 1986

24 "Current trends in amblyopia therapy" 85 : 428-50, 1978

25 "Compliance and result of treatment for amblyopia in children more than 8 years old" 102 : 340-5, 1986

26 "Combined optical and atropine penalization for the treatment of strabismic and anisometropic amblyopia" 6 : 289-293, 2002

27 "Classification of amblyopia" 63 : 238-43, 1967

28 "Binocular vision and ocular motility" Mosby 246 -, 2002

29 "Amblyopia. Preferred Practice Pattern" 1-29, 1997

30 "A practical approach to occlusion therapy for amblyopia" 12 : 161-165, 1997

31 "8세 이상 단안 약시환자의 가림치료 결과" 44 : 1146-1152, 2003

32 "6세 이상의 약시안에서 가림치료에 의한 시력개선의 분석" 35 : 190-5, 1994