가성황반원공, 황반원공의 아형에 따른 혈관밀도의 술 후 변화
Postoperative Changes in Vessel Density according to Macular Hole and Macular Pseudohole Subtypes
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목적: 가성황반원공, 황반원공의 아형에 따라 술 후 혈관밀도의 변화를 확인하고 이를 통해 발생기전의 차이를 알아보고자 하였다. 또한 혈관밀도의 변화가 다국소망막전위도와 최대교정시력의 변화와 상관관계가 있는지 알아보고자 하였다. 대상과 방법: 유리체절제술을 시행 받은 전체층황반원공 15명 15안, 견인성 표층황반원공 9명 9안, 퇴행성 표층황반원공 8명 8안, 가성황반원공 8명 9안이 포함되었다. 술 전과 술 후 1개월, 6개월의 최대교정시력, 중심오목무혈관부위, 중심오목혈관밀도, 중심오목부근혈관밀도, 다국소망막전위도검사상 ring 1, ring 2 P1 진폭을 분석하였다. 결과: 술 후 1개월에 중심오목혈관밀도는 가성황반원공과 견인성 표층황반원공에서 유의하게 증가하였고(p=0.011, p=0.008), 중심오목부근혈관밀도는 가성황반원공, 견인성 표층황반원공 그리고 전체층황반원공에서 유의하게 증가하였다(p=0.007, p=0.038, p=0.031). 하지만 퇴행성 표층황반원공의 중심오목혈관밀도와 중심오목부근혈관밀도의 증가는 유의하지 않았다(p=0.201, p=0.171). 전체층황반원공의 술 후 중심오목부근혈관밀도와 최대교정시력의 변화는 유의한 상관관계가 있었다(r=-0.543, p=0.037). 결론: 유리체절제술 후 혈관밀도의 변화를 통해 황반원공의 종류에 따른 견인력의 영향을 추정해 볼 수 있었다. 전체층황반원공에서중심오목부근혈관밀도와 최대교정시력의 변화는 유의한 상관관계를 보였다. 이를 통해 망막 구조의 회복과 더불어 미세혈관의 회복이 시력 호전에 도움을 줄 수 있음을 추정해 볼 수 있었다.
Abstract
Purpose: To determine the postoperative changes in vessel density according to macular hole and macular pseudohole (MPH) subtypes and to investigate the differences in the mechanisms underlying their development. We also investigated whether changes in vessel density are correlated with changes in the multifocal electroretinogram (mfERG) and best corrected visual acuity (BCVA). Methods: We reviewed the medical records of patients with MPH or a macular hole who underwent pars plana vitrectomy. We included 15 eyes of 15 patients with a full thickness macular hole (FTMH), nine eyes of nine patients with a tractional lamellar macular hole (LMH), eight eyes of eight patients with a degenerative LMH, and nine eyes of eight patients with a MPH. The BCVA, foveal avascular zone (FAZ), foveal and parafoveal vessel density, and mfERG ring 1 and ring 2 P1 amplitudes were analyzed before and 1 and 6 months after surgery. Results: One month postoperatively, the foveal vessel density of patients with a MPH or tractional LMH increased (p = 0.011, p = 0.008). The parafoveal vessel density of patients with a MPH, tractional LMH, and FTMH increased (p = 0.007, p = 0.038, p = 0.031). There was no significant increase in foveal or parafoveal vessel density in patients with a degenerative LMH (p = 0.201, p = 0.171). There was a significant correlation between the change in parafoveal vessel density and that in BCVA 6 months postoperatively in patients with a FTMH (r = -0.543, p = 0.037). Conclusions: By assessing changes in vessel density after vitrectomy, it is possible to estimate the effect of traction according to the type of macular hole. There was a significant correlation between parafoveal vessel density and BCVA in patients with a FTMH. Restoration of the retinal structure and vessel density might improve visual acuity.
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