안구위축 또는 무안구에 동반된 안구함몰 교정을 위한 눈뒤 필러 주입술의 효과
Efficacy of Retrobulbar Filler Injections for Correcting Enophthalmos Associated with Phthisis Bulbi or Anophthalmos
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 안구위축 또는 무안구 환자에서 생긴 안구함몰을 비수술적으로 교정하기 위하여 시행한 눈뒤 필러 주입술의 임상적 결과에대해 알아보고자 한다. 대상과 방법: 안구위축 또는 무안구 환자에서 동반된 편측 안구함몰 교정을 위하여, 히알루론산 필러 또는 콜라겐-polymethylmethacrylate (PMMA) 혼합 필러의 눈뒤 주입술을 시행 받은 뒤 최소 6개월 이상 경과 관찰한 환자들을 후향적으로 분석하였다. 시술 전후 안구돌출계를 측정하고, 눈뒤 주입된 필러의 종류와 용량, 시술 횟수, 시술 사이 기간 및 합병증에 대해 살펴보았다. 결과: 총 5명의 환자가 연구에 포함되었고, 2명은 안구내용제거술 후 무안구 상태였으며, 3명은 안구위축 상태였다. 모든 환자에서안구함몰 개선 효과를 보였고, 시술과 관련된 특별한 합병증은 없었다. 히알루론산 필러의 일회당 주입량은 1.0-1.4 mL였고, 콜라겐-PMMA 필러는 0.75-1.0 mL였다. 필러 1 mL 당 안구함몰 교정 효과는 히알루론산 필러가 평균 1.5 mm였고 콜라겐-PMMA 필러의경우 1.4 mm였다. 시술 사이 기간은 히알루론산 필러가 최대 15개월, 콜라겐-PMMA 필러는 최대 25개월이었다. 결론: 실명한 환자에서 미용 목적으로 안구함몰을 교정할 때, 눈뒤 필러주입술은 눈뒤 주사가 익숙한 안과 의사가 비교적 쉽고 안전하게 시행할 수 있는 비수술적 치료 방법이다. 히알루론산 필러 시술에 좋은 결과를 보이는 환자에서는, 반영구 필러를 사용함으로써더 오랜 기간 교정 효과가 유지되는 것을 기대할 수 있다.
Abstract
Purpose: To describe the clinical outcome of retrobulbar injection of synthetic fillers to correct enophthalmos associated with phthisis bulbi or anophthalmos. Methods: We retrospectively reviewed the medical records of patients who underwent enophthalmos correction using retrobulbar filler injections at Asan Medical Center between January 2015 and October 2019, and who were followed for at least 6 months. We evaluated the number of injections and amount of filler injected, improvement in enophthalmos, interval between injections, and adverse effects of filler injection. Results: The study enrolled five patients (four females and one male). Two patients had anophthalmos after evisceration and three had phthisis bulbi. Two patients received hyaluronic acid (HA) filler only, one had collagen-polymethylmethacrylate (PMMA) filler only, and two had both fillers. The HA and collagen-PMMA filler volumes per injection were 1.0–1.4 and 0.75–1.0 mL, respectively. The average degree of enophthalmos, compared to the contralateral eye, was 1.8 mm; the amount of enophthalmos correction per 1 mL of filler injection was 1.5 mm for HA filler and 1.4 mm for collagen-PMMA filler. The longest duration of enophthalmos correction was 15 months for HA filler and 25 months for collagen-PMMA filler. There were no significant adverse effects, but anterior migration of HA filler was observed in one case that resolved with hyaluronidase injection. Conclusions: Retrobulbar filler injection is a safe, effective, minimally invasive procedure for correcting enophthalmos in patients with anophthalmos or phthisis bulbi. If HA filler injection shows good outcomes without adverse effects, semi-permanent fillers can be used for long-term maintenance of enophthalmos correction. Further studies with more patients and long-term follow-up are needed to compare the effectiveness of various fillers.
참고문헌 (30)
- Hamedani M, "Diagnosis and management of enophthalmos", Surv Ophthalmol, 52, pp.457~473 (2007)
- 박노해, "무안구안구함몰증후군 환자에서 초음파유도하 히알루론산 필러 주입술의 치료 효과", 대한안과학회지, 60(1), pp.1~8 (2019), 대한안과학회
- Honda T, "Correction of late post-traumatic enophthalmos using a tissue expander", Ann Plast Surg, 56, pp.686~688 (2006)
- Steinkogler FJ, "The treatment of the post-enucleation socket syndrome", J Craniomaxillofac Surg, 15, pp.31~33 (1987)
- Paris GL, "Correction of enophthalmos in the anophthalmic orbit", Ophthalmology, 87, pp.1301~1308 (1980)
- Sergott TJ, "Correction of enophthalmos and superior sulcus depression in the anophthalmic orbit : a long-term follow-up", Plast Reconstr Surg, 79, pp.331~338 (1987)
- Tyers AG, "Orbital implants and post enucleation socket syndrome", Trans Ophthalmol Soc U K(1962), 102(Pt 1), pp.90~92 (1982)
- Moon JW, "Correction of lower lid retraction combined with entropion using an ear cartilage graft in the anophthalmic socket", Korean J Ophthalmol, 19, pp.161~167 (2005)
- Lee KE, "The clinical spectrum of periorbital vascular complications after facial injection", J Cosmet Dermatol, 20, pp.1532~1540 (2021)
- Kablik J, "Comparative physical properties of hyaluronic acid dermal fillers", Dermatol Surg, 35(Suppl 1), pp.302~312 (2009)
- O'Connell SR, "The surgical management of hypotony", Ophthalmology, 107, pp.318~323 (2000)
- Choi YJ, "Outcome of smooth surface tunnel porous polyethylene orbital implants(Medpor SST)in children with retinoblastoma", Br J Ophthalmol, 97, pp.1530~1533 (2013)
- Shah CT, "Anophthalmic syndrome : a review of management", Ophthalmic Plast Reconstr Surg, 30, pp.361~365 (2014)
- Wang KJ, "Psychological symptoms in anophthalmic patients wearing ocular prosthesis and related factors", Medicine(Baltimore), 99, pp.e21338~ (2020)
- Wang J, "The psychosocial benefits of secondary hydroxyapatite orbital implant insertion and prosthesis wearing for patients with anophthalmia", Ophthalmic Plast Reconstr Surg, 28, pp.324~327 (2012)
- Paik JS, "Effects of secondary porous orbital implantation in anophthalmic sockets", J Craniofac Surg, 23, pp.1677~1682 (2012)
- Shah S, "Use of Proplast II as a subperiosteal implant for the correction of anophthalmic enophthalmos", Br J Ophthalmol, 79, pp.830~833 (1995)
- Martin C, "Statistical findings in patients with anophthalmia", Eur J Plast Surg, 27, pp.56~60 (2004)
- Sundelin KC, "Complications associated with secondary orbital implantations", Acta Ophthalmol, 93, pp.679~683 (2015)
- Sung Y, "Periorbital injection of hyaluronic acid gel in patients with deep superior sulcus", J Craniofac Surg, 31, pp.271~273 (2020)
- Zamani M, "Adjunctive use of hyaluronic acid gel(Restylane Sub-Q)in anophthalmic volume deficient sockets and phthisical eyes", Ophthalmic Plast Reconstr Surg, 26, pp.250~253 (2010)
- Broder KW, "An overview of permanent and semipermanent fillers", Plast Reconstr Surg, 118(3 Suppl), pp.7S~14S (2006)
- Lemperle G, "PMMA-Microspheres(Artecoll)for long-lasting correction of wrinkles : refinements and statistical results", Aesthetic Plast Surg, 22, pp.356~365 (1998)
- Cohen SR, "Five-year safety and efficacy of a novel polymethylmethacrylate aesthetic soft tissue filler for the correction of nasolabial folds", Dermatol Surg, 33(Suppl 2), pp.S222~S230 (2007)
- Lorenc ZP, "Rheology of polymethylmethacrylate-collagen gel filler : physiochemical properties and clinical applications", Aesthet Surg J, 41, pp.NP88~93 (2021)
- Gold MH, "Optimizing outcomes with polymethylmethacrylate fillers", J Cosmet Dermatol, 17, pp.298~304 (2018)
- Schittkowski M, "Orbital volume in congenital clinical anophthalmos", Klin Monbl Augenheilkd, 221, pp.898~903 (2004)
- Buchanan AG, "Anterior filler displacement following injection of calcium hydroxylapatite gel(Radiesse)for anophthalmic orbital volume augmentation", Ophthalmic Plast Reconstr Surg, 28, pp.335~337 (2012)
- Vagefi MR, "Orbital augmentation with injectable calcium hydroxylapatite for correction of postenucleation", evisceration socket syndrome, 2011, pp.27, 90~94
- 정승일, "안구위축환자에서 히알루론산 필러 구후 주입 후 발생한 하안검 부종의 치료 1예", 대한안과학회지, 56(12), pp.1961~1964 (2015), 대한안과학회