황반원공 망막박리에서 유리체절제술 및 내경계막제거술의 장기 결과
Long-term Outcomes of Vitrectomy with Internal Limiting Membrane Removal to Treat Macular Hole Retinal Detachment
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목적: 황반원공 망막박리 환자를 대상으로 한 유리체절제술 및 내경계막제거술의 장기 임상 경과를 알아보고자 한다. 대상과 방법: 황반원공 망막박리로 진단 후 유리체절제술 및 내경계막제거술을 시행받은 환자를 대상으로 후향적 의무기록 분석을시행하였다. 수술 후 1개월 시점의 망막 재유착 및 황반원공 폐쇄 빈도를 확인하였으며, 망막박리의 재발과 관련된 인자를 분석하였다. 추가적으로 술 전 시력을 최종 추적 관찰 시의 시력과 서로 비교하였다. 결과: 전체 42안을 대상으로 연구를 시행하였으며, 평균 추적 관찰 기간은 38.5 ± 19.1개월이었다. 23안은 가스, 19안은 실리콘기름을주입하였다. 술 후 1개월에 41안(97.6%)에서 망막이 재유착되었는데, 황반원공이 완전히 폐쇄된(1형 폐쇄) 경우는 21안(51.2%), 완전히폐쇄되지 않은(2형 폐쇄) 경우는 20안(48.8%)이었다. 망막박리의 재발은 5안(14.6%)에서 최초 수술 후 3개월 이내에 나타났으며, 2형폐쇄의 경우 재발의 위험 인자로 나타났다(p=0.021). Logarithm of minimum angle of resolution 최대교정시력은 수술 전 1.79 ± 0.79에서 최종 추적 관찰 시 1.30 ± 0.75로 유의하게 호전되었다(p<0.001). 결론: 황반원공 망막박리에 대한 유리체절제술 및 내경계막제거술 결과 거의 대부분 환자에서 망막이 재유착되었으며, 약 절반의 환자에서 원공이 완전히 폐쇄되었다. 첫 수술 후 3개월 이후에는 망막박리의 재발이 나타나지 않았다. 향후 1형 폐쇄의 비율을 높이기위한 시도가 필요할 것이다.
Abstract
Purpose: To evaluate the long-term clinical outcomes of vitrectomy with internal limiting membrane (ILM) removal for patients with macular hole retinal detachment (MHRD). Methods: We retrospectively reviewed the medical records of patients with MHRD who underwent vitrectomy with ILM removal. The incidence of retinal re-attachment and MH closure at 1 month were calculated. Factors associated with RD recurrence were investigated. Visual acuity before surgery was compared to that at the final visit. Results: Forty-two eyes were included; the mean follow-up period was 38.5 ± 19.1 months. Twenty-three eyes received gas injections and 19 silicone oil injections. Retinal re-attachment occurred in 41 (97.6%). Type 1 closure was noted in 21 eyes (51.2%) and type 2 in 20 (48.8%). Recurrent RD was noted in five eyes (14.6%) within 3 months of initial surgery. Type 2 closure was a risk factor for recurrence (p = 0.021). The logarithm of the minimum angle of resolution best-corrected visual acuity improved significantly from 1.79 ± 0.79 before surgery to 1.30 ± 0.75 after surgery (p < 0.001). Conclusions: Retinal re-attachment was noted in most patients and the MH closed in approximately half of all patients after vitrectomy with ILM removal to treat MHRD. RD did not recur later than 3 months after initial surgery. Further efforts to increase the rate of type 1 closure are required.
참고문헌 (18)
- Johnson RN, "Observations, stages of formation, and implications for surgical intervention", Ophthalmology, 95, pp.917~924 (1988)
- Morita H, "Causative factors of retinal detachment in macular holes", Retina, 11, pp.281~284 (1991)
- Gonvers M, "A new approach to treating retinal detachment with macular hole", Am J Ophthalmol, 94, pp.468~472 (1982)
- O'Driscoll AM, "Vitrectomy for retinal detachments with both peripheral retinal breaks and macular holes. An assessment of outcome and the status of the macular hole", Retina, 21, pp.221~225 (2001)
- Kuriyama S, "Surgical techniques and reattachment rates in retinal detachment due to macular hole", Arch Ophthalmol, 108, pp.1559~1561 (1990)
- Ryan EH Jr, "Management of rhegmatogenous retinal detachment with coexistent macular hole in the era of internal limiting membrane peeling", Am J Ophthalmol, 152, pp.815~819 (2011)
- Mancino R, "Anatomical and functional results of macular hole retinal detachment surgery in patients with high myopia and posterior staphyloma treated with perfluoropropane gas or silicone oil", Retina, 33, pp.586~592 (2013)
- Lim LS, "Prognostic factor analysis of vitrectomy for retinal detachment associated with myopic macular holes", Ophthalmology, 121, pp.305~310 (2014)
- Laviers H, "The management of macular hole retinal detachment and macular retinoschisis in pathological myopia; a UK collaborative study", Eye(Lond), 32, pp.1743~1751 (2018)
- 이주은, "황반원공 망막박리의 치료", 대한안과학회지, 42(1), pp.57~63 (2001), 대한안과학회
- 임진섭, "황반원공 망막박리에 있어 유리체절제술", 대한안과학회지, 43(7), pp.10~1178 (2002), 대한안과학회
- 최명근, "후유리체막 및 망막내경계막 제거술을 시행한 황반원공 망막박리의 수술결과", 대한안과학회지, 46(9), pp.1491~1497 (2005), 대한안과학회
- 김화영, "Long-term Outcomes of Macular Hole Retinal Detachment in Highly Myopic Eyes after Surgical Reattachment", Korean Journal of Ophthalmology, 33(6), pp.539~546 (2019), 대한안과학회[DOI]
- Kim DY, "Surgical outcomes of vitrectomy for macular hole-induced retinal detachment according to various surgical methods : a multicenter retrospective study", Semin Ophthalmol, 36, pp.728~733 (2021)
- Kang SW, "Types of macular hole closure and their clinical implications", Br J Ophthalmol, 87, pp.1015~1019 (2003)
- Arias L, "Autofluorescence and axial length as prognostic factors for outcomes of macular hole retinal detachment surgery in high myopia", Retina, 35, pp.423~428 (2015)
- Zhao X, "Macular buckling versus vitrectomy on macular hole associated macular detachment in eyes with high myopia : a randomised trial", Br J Ophthalmol, 106, pp.582~586 (2022)
- Li Y, "Autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment in highly myopic eyes", Acta Ophthalmol, 98, pp.e983~90 (2020)