망막과 망막색소상피의 복합과오종에 동반된 망막전막과 특발성 망막전막의 비교
Epiretinal Membrane of Combined Hamartoma of Retina and Retinal Pigment Epithelium Versus Idiopathic Epiretinal Membrane
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목적: 망막과 망막색소상피 복합과오종에 동반된 망막전막에서 술 후의 황반부 모세혈관밀도 및 다국소망막전위도 변화를 확인하고이를 특발성 망막전막과 비교하고자 하였다. 대상과 방법: 망막과 망막색소상피 복합과오종에 동반된 망막전막으로 망막전막제거술을 시행한 환자 15명, 15안, 특발성 망막전막으로 망막전막제거술을 시행한 환자 21명, 21안을 대상으로 술 전과 술 후 6개월의 최대교정시력, 중심망막두께, 빛간섭단층혈관조영술을 통한 황반 각 영역의 표층모세혈관밀도, 망막중심오목무혈관부위, 다국소망막전위도 상의 ring 1, ring 2 P1 진폭 및 함의점 시간결과를 비교 분석하였다. 결과: 특발성 망막전막과 비교하였을 때 망막과 망막색소상피 복합과오종에서 황반부 평균 표층모세혈관밀도는 감소되어 있었으나(p=0.047) 중심와 표층모세혈관밀도는 유의하게 증가되어 있었다(p=0.003). 복합과오종에서 수술 전 망막중심오목무혈관부위가 유의하게 감소되어 있었고 수술 6개월 후에는 유의하게 증가하였다. 술 후 다국소망막전위도에 대하여 P1 진폭이 유의하게 증가하였으나 특발성 망막전막과 비교하였을 때 유의한 차이는 보이지 않았다. 결론: 망막과 망막색소상피 복합과오종에 동반된 망막전막에서 황반부 평균 표층모세혈관밀도는 감소되어 있고 황반부 중심 표층모세혈관밀도 및 중심오목무혈관부위는 증가되어 있었다. 수술 후 중심오목무혈관부위 크기가 증가한 것을 볼 때 망막전막의 물리적제거가 망막의 구조적 회복에 영향을 주지만 황반부 표층미세혈관의 개선에는 유의한 결과를 보여주지 못하였다.
Abstract
Purpose: To evaluate the postoperative changes in macular vessel density and the multifocal electroretinogram (mfERG) in the epiretinal membrane (ERM) of a combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). And we compared these results with those of idiopathic ERM. Method: We retrospectively reviewed the records of 15 patients (15 eyes) with an epiretinal membrane of a CHRRPE, and 21 patients (21 eyes) with idiopathic ERM who were treated with pars plana vitrectomy and removal of the ERM. The best corrected visual acuity, central macula thickness, foveal and perifoveal vessel density, foveal avascular zone (FAZ), and mfERG rings 1 and 2 P1 amplitudes were analyzed before and 6 months after ERM removal. Results: The average macular vessel density in the CHRRPE with ERM was reduced (p = 0.047) compared to an idiopathic epiretinal membrane, but the central foveal vessel density was significantly increased (p = 0.003). In CHRRPE, the preoperative FAZ was significantly reduced, and while it increased significantly 6 months postoperatively. After removing the ERM, the P1 amplitude increased significantly on mfERG, but there was no significant difference compared to the idiopathic ERM. Conclusions: The macular mean superficial capillary plexus (SCP) vascular density was reduced in CHRRPE and the foveal SCP vascular density and FAZ were increased. Considering the increased size of the FAZ area after surgery, physical removal of the ERM affected the structural recovery of the fovea, but resulted in no significant improvement of the macular superficial microvascular system.
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