보스톤 인공각막이식술의 국내 장기 임상 결과
Clinical Outcomes of Boston Type-I Keratoprosthesis Implantation: A 4-year Retrospective Study in South Korea
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목적: 보스톤 인공각막이식술을 시행받은 환자들을 대상으로 수술 후 장기 임상 결과를 국내 최초로 분석하여 보고하고자 한다. 대상과 방법: 각막이식편 실패의 과거력이 있으며, 이후 보스톤 인공각막이식술을 시행하고 33개월 이상 추적 관찰된 6명 환자의 의무기록을 후향적으로 분석하였다. 술 전과 술 후 최대 48개월까지 최대교정시력, 현성굴절검사, 인공각막 유지 여부 등을 추적 관찰하고녹내장 진행 여부를 포함한 합병증을 평가하였다. 결과: 6명의 6안의 경과 관찰 기간은 평균 44.3 ± 7.0개월이었다. 인공각막이식술 이전 평균 시력은 2.33 ± 0.51 logarithm of the minimum angle of resolution (logMAR)이었고, 수술 후 마지막 내원 시 평균 시력은 0.67 ± 0.59 logMAR로 통계적으로 유의하게호전되었다(p=0.028). 수술 후 3안에서 인공각막 후막이 관찰되었으나 3안에서 술 후 시력이 일정하게 유지되었다. 모든 환자에서술 후 1주 이내에 빠른 시력 호전을 보였고, 최소 36개월에서 52개월의 추적 기간 동안 술 후 인공각막은 해부학적으로 유지되었다. 결론: 반복된 각막이식 실패 과거력이 있는 환자에서 보스톤 인공각막이식술은 전체층각막이식술보다 빠른 회복과 호전된 시력을보여 우수성을 입증하였다. 모든 환자에서 면역억제제 사용 없이 인공각막이 유지되었다. 본 연구는 보스톤 인공각막이식술의 장기임상 결과를 국내 최초로 다루었다는 의의가 있다.
Abstract
Purpose: To evaluate the long-term results of Boston type-I keratoprosthesis implantation in Korea. Methods: Medical records of six patients (six eyes) who underwent Boston type-I keratoprosthesis implantation between August 2018 and November 2019 were retrospectively reviewed for more than 36 months. Results: The mean follow-up period was 44.3 ± 7.0 months. Best corrected visual acuity (BCVA) improved significantly for all six eyes, from 2.33 ± 0.51 logarithm of the minimum angle of resolution (logMAR) to 0.67 ± 0.59 logMAR. The vision recovered immediately after the surgery in all patients. Retroprosthetic membrane developed in three of the patients, but the visual acuity remained unchanged. Anatomical success was achieved in all six eyes after Boston type-I keratoprosthesis implantation. Conclusions: The long-term analysis of Boston type-I keratoprosthesis implantation showed a faster recovery and improved visual acuity compared with conventional penetrating keratoplasty. Without the use of systemic immunosuppressants, all six eyes showed long-term survival of the Boston keratoprosthesis. Boston type-I keratoprosthesis implantation may be used in patients with recurrent graft failure after keratoplasty. This was the first study investigating the long-term results of Boston keratoprosthesis implantation in Korean patients.
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