최신사시학 5판 > Ophthalmology

1. 시각계 발달

 1) 출생 전 시기 .....................................................2

 2) 출생 후 시기 .....................................................3

2. 정상 시력발달

 1) 시력발달 ..........................................................5

 2) 양안시 발달 ......................................................6

3. 어린이의 눈검사

 1) 문진과 시진 ......................................................7

 2) 시력검사 ..........................................................7

 3) 주시선호검사....................................................8

 4) 시운동눈떨림검사..............................................8

 5) 시유발전위검사.................................................8

 6) 시력.................................................................9

 7) Brückner검사.................................................10

 8) 조절마비굴절검사............................................10

 9) 안저검사 ........................................................11

4. 어린이 시각전기생리검사

 1) 눈전위도검사..................................................15

 2) 망막전위도검사...............................................16

 3) 시유발전위검사...............................................21

CHATER II 외안근 구조

1. 외안근

 1) 수평근 ...........................................................30

 2) 수직근 ...........................................................30

 3) 사근 ..............................................................34

2. 근막구조

 1) 테논주머니 .....................................................37

 2) 근피막 ...........................................................37

 3) 근사이막 ........................................................38

 4) 제한인대 ........................................................39

 5) Lockwood 걸이인대 ......................................39

 6) 윗눈꺼풀의 transverse superior fascial expansion.....40

3. 외안근 신경지배

 1) 동안신경 ........................................................41

 2) 활차신경 ........................................................41

 3) 외향신경 ........................................................42

 4) 외안근의 구획별 신경지배 ................................42

 5) 외안근의 근육내 신경분포 ................................43

4. 외안근의 혈관분포..............................................43

5. 외안근 pulley.....................................................40

6. 외안근 미세구조

 1) 외안근과 일반 골격근의 차이점.........................46

 2) 외안근 분류 ....................................................47

 3) 미세구조에 따른 외안근근섬유 분류...................48

 4) 고유감각기 .....................................................49

CHATER III 외안근 운동생리와 기능

1. 눈위치

 1) 제일눈위치 .....................................................52

 2) 제이눈위치 .....................................................52

 3) 제삼눈위치 .....................................................52

2. 기본눈운동학

 1) 안구회전중심..................................................52

 2) 전위운동과 회전운동........................................53

 3) 외안근 관련 용어정의.......................................53

 4) 눈운동의 기본법칙...........................................55

3. 눈운동과 그 특징

 1) 동향운동 ........................................................58

 2) 이향운동 ........................................................59

4. 일상생활에서의 주시시야

 1) 주시...............................................................60

 2) 주시시야 .......................................................61

 3) 일상생활에서의 주시시야 .................................61

5. 눈운동에 대한 pulley이론 ..................................61

CHATER IV 사시의 영상 진단

1. 뇌신경과 뇌질환

 1) 선천질환 ........................................................68

 2) 후천질환 ........................................................71

2. 안와질환

 1) 외안근을 침범하는 질환 ...................................75

 2) 외상...............................................................76

 3) 혈관(림프관)기형 및 종양.................................77

CHATER V 근거리주시복합운동

1. 조절

 1) 조절의 기전 ....................................................80

 2) 조절의 측정단위..............................................80

2. 눈모음

 1) 눈모음의 측정단위...........................................81

 2) 눈모음의 구성.................................................82

3. 동공수축 ............................................................86

CHATER VI 양안시와 사시환자에서의 감각적응

1. 단안시................................................................90

2. 양안시

 1) 대응망막점 .....................................................91

 2) 호롭터 ...........................................................91

 3) Panum융합구역..............................................93

 4) 주시시차 ........................................................93

 5) 생리적 복시 ....................................................94

3. 입체시

 1) 입체시 원리 ...................................................95

 2) 입체시와 융합.................................................96

 3) 입체시와 사시.................................................96

 4) 3차원(3D)영상1 .............................................97

4. 한눈단서

 1) 움직임 파라락스 .............................................97

 2) 직선원근법 .....................................................97

 3) 형태겹침 .......................................................97

 4) 빛과 그림자분포..............................................97

 5) 물체 크기 .......................................................98

 6) 대기원근법 .....................................................98

5. 망막경합 ............................................................98

6. 융합

 1) 감각융합 ........................................................98

 2) 운동융합 ........................................................99

7. 사시환자에서의 감각적응

 1) 사시환자의 양안시 이상 ...................................99

 2) 사시에서 발생하는 적응기전...........................100

8. 양안시이론

 1) 대응과 시차 ..................................................104

 2) 양안시와 입체시 신경생리이론 .......................104

CHATER VII 감각기능검사

1. 복시와 시각혼란

 1) 한눈복시 ......................................................109

 2) 두눈복시 .....................................................109

2. 억제

 1) 임상양상 .....................................................110

 2) 억제검사 ....................................................110

 3) 억제의 깊이 측정 ..........................................115

3. 이상망막대응

 1) 이상망막대응의 검사 ....................................117

 2) 검사의 평가 .................................................123

 3) 억제와 이상망막대응 .....................................123

 4) 이상망막대응의 발생과 임상양상 ...................123

 5) 이상망막대응에서 양안시의 특성 ....................126

 6) 이상망막대응의 치료 .....................................126

4. 입체시검사

 1) 입체시검사 ...................................................127

 2) 입체시검사의 선택.........................................135

CHATER VIII 눈운동검사

 1. 눈과 머리위치 관찰........................................... 136

 1) 눈꺼풀과 눈꺼풀틈새 관찰 ..............................140

 2) 눈위치 .........................................................140

 3) 머리위치 관찰 ..............................................141

2. 사시검사 .......................................................... 138

 1) 가림검사와 가림안가림검사 ...........................142

 2) 사시각 측정 .................................................143

CHATER IX 약시

1. 약시 유병률...................................................... 160

2. 약시의 분류...................................................... 161

 1) 사시약시 .....................................................161

 2) 굴절부등약시 ...............................................162

 3) 시각차단약시 ...............................................162

 4) 기질약시 ......................................................163

3. 약시의 임상특징

 1) 주시선호 .....................................................163

 2) 약시의 시력 .................................................163

 3) 약시의 주시형태............................................164

 4) 민감기 .........................................................165

4. 약시 병인의 연구

 1) 정신물리학연구 ............................................165

 2) 전기생리연구 ...............................................167

 3) 빛간섭단층촬영 ............................................167

5. 약시와 억제와의 관계 ....................................... 168

6. 약시의 조직학적 이상과 동물실험모델................ 168

7. 약시의 진단

 1) 교정시력감소................................................170

 2) 약시의 위험인자............................................170

8. 약시의 치료

 1) 약시치료의 목적............................................171

 2) 약시치료의 원칙............................................171

 3) 약시치료의 방법............................................172

CHATER X 사시의 용어와 병인

1. 사시의 기본 용어와 분류

 1) 사위와 사시 ..................................................184

 2) 상대안정위치와 절대안정위치.........................184

 3) 눈의 정렬 .....................................................184

 4) 편위방향에 따른 분류.....................................185

 5) 일치와 불일치...............................................185

 6) 편위의 항상성...............................................185

 7) 이향운동체계의 상태......................................186

 8) 주시형태 ......................................................186

 9) 사시의 발생시기............................................186

 10) 마비사시 ....................................................186

 11) 기계적인 원인, 제한사시 ..............................187

 12) 안와사시 ....................................................187

2. 사시의 병인

 1) 안구편위와 관련된 인자 .................................187

 2) 사시의 유전학...............................................191

CHATER XI 내편위

1. 내사위와 간헐내사시

 1) 원인.............................................................197

 2) 임상증상 .....................................................197

 3) 감각이상 .....................................................197

 4) 진단 ............................................................197

 5) 치료 ............................................................198

2. 조절내사시

 1) 굴절조절내사시.............................................199

 2) 비굴절조절내사시 .........................................201

 3) 부분조절내사시 ...........................................203

 4) 조절부족내사시 ...........................................204

3. 비조절내사시

 1) 영아내사시 ...................................................205

 2) 후천내사시 ...................................................214

 3) 한눈주시증후군, 미세사시 .............................216

 4) 주기내사시 ...................................................219

4. 이차내사시

 1) 감각내사시 ...................................................220

 2) 속발내사시 ...................................................220

5. 거짓내사시....................................................... 220

CHATER XII 외편위

1. 간헐외사시

 1) 발생빈도 .....................................................229

 2) 임상양상 ......................................................229

 3) 감각적응 ......................................................230

 4) 자연경과 ......................................................230

 5) 분류.............................................................231

 6) 간헐외사시 검사............................................233

 7) 치료.............................................................236

2. 이차외편위

 1) 감각외사시 ...................................................244

 2) 속발외사시 ...................................................244

3. 기타 외편위

 1) 영아외사시-영아사시증후군 ...........................244

 2) 해리외편위 ...................................................245

 3) 반맹을 동반한 외사시 ....................................246

 4) 한눈주시외사시 ............................................247

CHATER XIII 회선수직편위

1. 일치수직편위

 1) 임상특징 ....................................................254

 2) 치료 ...........................................................254

2. 해리수직편위

 1) 용어 ............................................................254

 2) 정의 ...........................................................254

 3) 임상특징 ....................................................254

 4) 사시각 측정 ..................................................256

 5) 원인.............................................................256

 6) 감별진단 ....................................................259

 7) 치료 ............................................................259

 8) 합병증 ......................................................260

3. 해리수평편위 ................................................... 252

 1) 임상특징 ....................................................261

 2) 치료.............................................................262

4. 내전시 상전

 1) 임상특징 ....................................................262

 2) 원인 ..........................................................262

 3) 치료 ..........................................................264

5. 내전시 하전...................................................... 265

6. 회선편위

 1) 진단.............................................................265

 2) 임상특징 ....................................................265

 3) 치료 .........................................................266

CHATER XIV A-V형사시

1. 분류 ................................................................. 272

2. 발생빈도 .......................................................... 275

3. 원인

 1) 수평근기능이상 ..........................................275

 2) 수직근기능이상 ..........................................275

 3) 사근기능이상 .............................................276

 4) 안와이상 ....................................................276

 5) 외안근부착부이상과 회선 .............................277

4. 임상양상 .......................................................... 278

5. 진단 ................................................................. 278

6. 치료

 1) 직근수술 ......................................................280

 2) 사근수술 ......................................................281

 3) 수평근 수직전위술 .......................................281

 4) 수직근 수평전위술 .....................................282

 5) 근경사부착술 .............................................283

CHATER XV 핵상로와 눈운동이상

1. 핵상계의 개요................................................... 286

2. 안구운동의 종류

 1) 신속운동 ......................................................287

 2) 원활추종운동 ...............................................288

 3) 전정안구반사 ...............................................290

 4) 수평동향운동을 위한 뇌간 연결.......................290

 5) 수직과 회선운동을 위한 뇌간 연결...................291

3. 핵상장애

 1) 수평주시마비................................................292

 2) 신경핵사이눈근육마비 ...................................292

 3) 수평 1½증후군..............................................293

 4) 스큐편위 .....................................................294

 5) 양상전근마비 ...............................................295

 6) 수직 1½증후군 .............................................297

 7) 등쪽중뇌증후군.............................................297

CHATER XVI 마비사시

1. 증상과 진단

 1) 한눈운동과 동향운동 .....................................300

 2) 사시각측정 ..................................................302

 3) 머리기울임검사 ............................................302

 4) 보상머리위치 ...............................................305

 5) 감각이상 ......................................................306

 6) Past-pointing...............................................306

 7) 근전도검사 ..................................................307

 8) 강제견인검사................................................307

 9) 근력검사 ......................................................308

 10) 눈운동속도.................................................309

 11) 마비사시와 비마비사시 ...............................309

 12) 선천 또는 오래된 마비와 최근에 발생한 마비 ........309

 13) 영상검사 ...................................................310

2. 외안근의 신경지배: 핵과 신경

 1) 동안신경 ......................................................311

 2) 활차신경 ......................................................312

 3) 외향신경 ......................................................312

3. 외안근마비

 1) 동안신경마비................................................314

 2) 활차신경마비................................................322

 3) 외향신경마비................................................328

 4) 양상전근마비................................................330

 5) 양하전근마비................................................332

 6) 백내장수술 후 수직근마비 ..............................332

4. 치료 ................................................................. 320

 1) 선천마비 .....................................................333

 2) 후천마비 ......................................................333

 3) 비수술치료 ..................................................334

 4) 수술치료 ....................................................334

CHATER XVII 특수한 형태의 사시

1. Duane 안구후퇴증후군

 1) 원인 ............................................................344

 2) 진단 ............................................................346

 3) 치료 ............................................................347

2. Möbius증후군

 1) 원인 ............................................................349

 2) 치료 ............................................................349

3. Brown증후군

 1) 임상증상 .....................................................350

 2) 원인 ............................................................350

 3) 치료 ............................................................352

4. 유착증후군과 지방유착증후군 .......................... 352

5. 눈과 눈주위 수술 후 생긴 사시

 1) 백내장수술 후 발생되는 사시 .........................354

 2) 공막돌륭술 후 발생되는 사시 ..........................355

 3) 녹내장 방수유출기구 장치 후 발생되는 사시 ....356

 4) 코곁굴수술 후 발생되는 사시 .........................356

6. 고정사시 .......................................................... 357

7. Sagging eye증후군

 1) 병인 및 임상양상...........................................358

 2) 진단.............................................................358

 3) 감별진단 ......................................................358

 4) 치료.............................................................360

8. 중증근무력증 ................................................... 345

 1) 병인 ............................................................360

 2) 분류 ............................................................361

3) 임상양상 .....................................................363

 4) 진단 ............................................................364

 5) 감별진단 .....................................................367

 6) 치료 ............................................................367

 7) 어린이 근무력증/눈근육무력증........................368

9. Miller Fisher증후군

 1) 원인과 병태생리 ...........................................369

 2) 병리 ............................................................372

 3) 임상양상 .....................................................372

 4) 진단 ............................................................372

 5) 감별진단 .....................................................373

 6) 예후 ............................................................375

 7) 치료 ............................................................375

10. 만성진행바깥눈근육마비

 1) 병인 ............................................................376

 2) 사립체 이상 .................................................376

 3) 분류 ............................................................376

 4) 임상양상 .....................................................376

 5) 진단 ............................................................376

 6) 감별진단 .....................................................377

 7) 치료.............................................................377

11. 근긴장이영양증.............................................. 360

 1) 분류 및 병인 .................................................377

 2) 임상양상 ......................................................378

 3) 진단.............................................................379

 4) 감별진단 ......................................................379

 5) 치료 ............................................................379

12. 갑상샘눈병증과 관련된 사시

 1) 역학.............................................................379

 2) 임상양상 .....................................................380

 3) 분류 ............................................................380

 4) 병리 ............................................................381

 5) 진단 ............................................................381

 6) 감별진단 ....................................................382

 7) 치료 ............................................................383

 8) 예후.............................................................385

13. 안와근염

 1) 병인 ............................................................385

 2) 임상양상 .....................................................385

 3) 진단.............................................................386

 4) 감별진단 .....................................................386

 5) 치료 ............................................................386

 6) 예후 ............................................................390

14. 선천섬유증증후군

 1) 분류 ...........................................................390

 2) 발생원인 .....................................................391

 3) 임상양상 .....................................................391

 4) 병리소견 ......................................................392

 5) 감별진단 .....................................................392

 6) 동반될 수 있는 이상 ......................................393

 7) 치료 ............................................................393

15. 안와바깥파열골절

 1) 복시 발생기전 ..............................................394

 2) 골절 부위에 따른 임상양상 ...........................394

 3) 진단 ............................................................396

 4) 치료 ............................................................396

 5) 어린이에서 안와바깥파열골절.........................397

16. 두개안면이상과 사시

 1) 두개골유합증의 분류 및 사시관련요소 .............398

 2) 사시의 원인 및 기전.......................................400

 3) 안과진단 시 유의할 점 ...................................401

 4) 사시수술 시 유의할 점 ...................................402

17. 외안근의 무형성 또는 저형성..........................402

CHATER XVIII 눈모음과 눈벌림의 이상

1. 눈모음이상에 의한 사시

 1) 눈모음부족 ..................................................413

 2) 조절부족과 연관된 눈모음부족........................417

 3) 눈모음마비 ...................................................418

 4) 눈모음연축 ...................................................419

2. 눈벌림이상에 의한 사시

 1) 눈벌림부족과눈벌림마비 ................................... 420

3. 중심융합분열증, 후천운동융합부족증

 1) 임상양상과 병인............................................421

 2) 감별진단 .....................................................421

 3) 치료 ............................................................422

CHATER XIX 근거리주시복합운동

1. 눈떨림이란? .................................................... 426

2. 눈떨림의 분류................................................... 426

3. 영아눈떨림의 원인

 1) 고획득 불안정성 ...........................................427

 2) 신경통합중추누출 .........................................427

 3) 전정긴장 불균형............................................428

 4) 시자극결핍 ...................................................428

 5) 고유수용체결손.............................................428

4. 눈떨림의 기록

 1) 눈떨림 측정방법............................................429

 2) 파형의 분석 ..................................................431

5. 영아눈떨림증후군

 1) 임상양상 ......................................................435

 2) 병인.............................................................437

 3) 치료.............................................................438

6. 잠복눈떨림

 1) 임상양상 ......................................................440

 2) 병인.............................................................440

7. 후천눈떨림

 1) 하향눈떨림 ...................................................440

 2) 회선눈떨림 ...................................................441

 3) 끄덕임연축 ..................................................441

 4) 후천시계추눈떨림 .........................................442

 5) 시소눈떨림 ..................................................442

 6) 주시유발눈떨림.............................................442

 7) 주기교대눈떨림 ............................................443

 8) 감각소실눈떨림.............................................443

 9) 눈모음후퇴눈떨림..........................................443

 10) Bruns눈떨림...............................................444

 11) 반동눈떨림.................................................444

 12) 안구개떨림.................................................444

CHATER XX 비수술적 치료의 종류와 원칙

1. 광학치료

 1) 안경.............................................................448

 2) 이중초점렌즈................................................450

2. 가림치료 .......................................................... 452

3. 프리즘치료....................................................... 452

4. 약물치료

 1) 축동제 .........................................................454

 2) 아트로핀 ......................................................455

 3) 화학적 신경지배제거술 ..................................455

5. 시기능훈련

 1) 눈모음부족 ...................................................456

 2) 융합훈련 ......................................................456

 3) 억제개선훈련................................................457

 4) 이상망막대응................................................457

6. 임상응용 ......................................................... 457

CHATER XXI 보툴리눔 A독소 외안근 화학신경

지배제거술

1. 서론 ................................................................. 462

2. 작용기전 .......................................................... 462

3. 적응증과 금기................................................... 464

4. 시술

 1) 환자선택 ......................................................464

 2) 마취.............................................................464

 3) 시술과정 ......................................................465

5. 치료효과

 1) 일치사시 .....................................................466

 2) 마비사시 .....................................................469

 3) 제한사시 .....................................................470

 4) 전신질환에 의한 사시 ....................................470

 5) 사시수술의 보조요법......................................471

 6) 신경안과 영역...............................................471

6. 합병증.............................................................. 471

CHATER XXII 사시수술 및 합병증

1. 마취

 1) 전신마취 .....................................................478

 2) 국소마취 ......................................................478

2. 기구, 봉합사, 바늘............................................ 478

3. 사시의 수술기법

 1) 수술준비 ......................................................480

 2) 결막절개와 근육노출......................................480

 3) 직근수술 .....................................................483

 4) 조정봉합술 ...................................................487

 5) 하사근수술 ...................................................490

 6) 상사근수술 ...................................................495

 7) 후고정봉합술................................................503

 8) 근전위술 ......................................................505

 9) Heavy eye증후군에서 Yokoyama수술 ............510

 10) 재수술 .......................................................510

4. 합병증

 1) 수술 중 합병증..............................................512

 2) 마취합병증 ..................................................516

 3) 수술 후 합병증..............................................517

CHATER XXIII 사시수술 후 발생한 저교정과 과교정

1. 재수술의 원칙...................................................528

2. 수술 전 검사 .....................................................528

 1) 병력.............................................................528

 2) 임상검사 ......................................................528

3. 문제점..............................................................529

4. 내사시수술 후의 재수술

 1) 부족교정된 내사시(잔류내사시) 치료 ...............529

 2) 속발외사시 치료............................................530

5. 외사시수술 후의 재수술

 1) 부족교정된 외사시(잔류외사시) 치료................531

 2) 속발내사시 치료............................................532

6. 사시수술 후 발생한 수직사시의 수술

 1) 하사근봉입으로 인한 수직사시........................534

 2) 수직사시수술 후 발생한 부족교정과 과교정...........534

Appendix............................................................ 541

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