푹스각막이상증에서 치료적 데스메막박리술 후 초기 임상양상
Clinical Characteristics of the Eye with Fuch’s Corneal Endothelial Dystrophy after Descemet Stripping Only
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목적: 백내장수술이 필요한 푹스각막이상증 환자들에게 치료적 데스메막박리술과 백내장병합수술 시행 후 초기 임상양상에 대하여알아보고자 하였다. 대상과 방법: 2019년 8월부터 2021년 1월까지, 주변부에 비하여 중심부 구타타 소견이 명확하게 확인되는 푹스각막이상증과 수술이필요할 정도의 백내장이 동반된 10명을 대상으로 초음파유화술, 인공수정체 후낭 삽입술 및 치료적 데스메막박리술을 시행하였다. 수술 전, 수술 후 1일, 7일, 30일, 3개월, 6개월에 측정한 시력, 안압, 세극등현미경검사, 경면현미경검사, 전안부 빛간섭단층촬영을통하여 수술 전후 각막내피, 각막부종 및 임상양상의 변화에 대하여 후향적으로 살펴보았다. 결과: 총 7명(10안)의 푹스각막이상증 환자에서 치료적 데스메막박리술이 시행되었으며, 수술 전 시력(logarithm of the minimum angle of resolution, logMAR) 1.01 ± 0.40에서 술 후 6개월 0.33 ± 0.22로 호전되었다(p=0.008). 수술 전 평균 중심각막두께는578.50 ± 36.88 μm에서 술 후 6개월 568.50 ± 48.61 μm로 감소하여 술 전 상태의 두께로 회복하였다(p=0.507). 각막내피세포수는 술 전 663.80 ± 356.40/mm2에서 술 후 6개월 1082.00 ± 274.46/mm2로 증가하였다(p=0.043). 결론: 비각막내피이식 데스메막박리술은 푹스각막이상증 환자를 대상으로 각막이식을 시행할 수 없는 경우, 대체 치료법 중 하나로고려해볼 수 있으나 임상적인 유효성과 안전성을 판단하기에는 추가적인 연구가 필요하다.
Abstract
Purpose: To report the effect of removal of a central descemet membrane on the endothelial function, morphology, and clinical symptoms of eyes with Fuch’s endothelial dystrophy. Methods: From August 2019 to January 2021, patients with Fuch’s endothelial dystrophy, i.e., with confluent, central corneal guttae and cataracts that required surgery, underwent phacoemulsification, intraocular lens implantation, and central descemet membrane stripping. To evaluate the effect of descemet stripping only (DSO), visual acuity and intraocular pressure were measured, and corneal pachymetry, slit-lamp and specular microscopy, and anterior segment optical coherence tomography performed, before surgery and at 1, 7, and 30 days and 3 and 6 months after surgery. Results: Seven patients (10 eyes) were included. Visual acuity improved from 1.01 ± 0.40 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.33 ± 0.22 logMAR 6 months after surgery (p = 0.008). The mean central corneal thickness decreased from 578.50 ± 36.88 μm preoperatively to 568.50 ± 48.61 μm 6 months after surgery; the difference was not significant (p = 0.507). The endothelial cell count increased significantly from 663.80 ± 356.40/mm 2 preoperatively to 1,082.00 ± 274.46/mm 2 6 months after surgery (p = 0.043). Conclusions: DSO can serve as a useful alternative when corneal transplantation is not possible in patients with Fuch’s endothelial dystrophy, but treatment efficacy and safety require further evaluation.
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