후방유수정체 안내렌즈삽입술 이후 발생한 황반원공에서 내경계막삽입술
ILM Insertion for the Treatment of Macular Hole Associated with Phakic Intraocular Lens Implantation
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목적: 후방유수정체 안내렌즈삽입술(insertion of implantable contact lens, ICL) 후 발생한 황반원공에 대해 내경계막 피판을 이용한수술을 하여 원공을 폐쇄한 증례를 보고하고자 한다. 증례요약: -12.5 sph의 고도근시의 18세 여성 환자가 양안 ICL 삽입술 이후 좌안 시력저하를 주호소로 내원하였다. 교정시력은 0.02 였다. 안저검사 및 빛간섭단층촬영에서 크기가 가로 688 m, 세로 976 m인 전층황반원공이 관찰되었다. 원공 주변의 내경계막은 원공보다 크게 신경망막층으로부터 뜯어져 있었다. 첫 수술에서 유리체절제술과 내경계막 자유피판덮개술을 시행하였으나 가스가 사라지면서 내경계막이 원공에서 탈락되어 원공이 폐쇄되지 않았다. 2차 수술에서는 남아있는 내경계막절편을 원공 속으로 삽입하고 실리콘기름 주입술 시행하였다. 수술 후 황반원공이 완전히 폐쇄되어 실리콘기름을 제거할 수 있었다. 교정시력은 0.5까지 회복되었다. 결론: 고도근시 환자에서 ICL 삽입술 후 크기가 큰 전층황반원공이 발생할 수 있으며, 내경계막을 이용한 수술을 통해 원공 폐쇄와시력 개선을 도모할 수 있었다.
Abstract
Purpose: To report a case of macular hole closure using an internal limiting membrane (ILM) flap following implantation of a posterior chamber phakic implantable contact lens (ICL). Case summary: An 18-year-old female patient presented with visual loss of the left eye after ICL implantation. She had high myopia of -12.5 diopter (spherical equivalent) and a corrected visual acuity of 2/100. The fundus photograph and optical coherence tomography showed a full-thickness macular hole measuring 688 μm in width and 976 μm in length. The ILM around the hole was detached from the retinal surface, which was greater in size than the macular hole. The initial surgical intervention involved vitrectomy, inverted ILM flap placement, and gas tamponade. The decrease in gas volume was associated with a loss of the ILM flap. For hole closure, the remaining ILM flap in the peripheral macula was harvested and inserted in the hole during the second surgery. The silicone oil was used for tamponade. One month after ILM insertion, complete closure of the hole was observed. The visual acuity improved to 20/40 after silicone oil removal. Conclusions: A large full-thickness macular hole developed after ICL implantation in a patient with high myopia. Macular hole surgery using ILM insertion and prolonged tamponade closed the hole and effectively improved the visual acuity.
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