열공망막박리에서 공막두르기술 단독수술과 유리체절제술 병합수술의 장기간 맥락막두께 비교 분석
Long-term Comparison of Choroidal Thickness between Scleral Encircling and Combined with Trans-pars Plana Vitrectomy in Retinal Detachment
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목적: 열공성 망막박리 환자에서 공막두르기 단독수술과 공막두르기 및 유리체절제술 병합수술 후 중심오목하 맥락막두께의 변화를비교 분석하고자 하였다. 대상과 방법: 단안의 일차 열공망막박리로 본원에서 2019년 1월부터 2021년 6월까지 공막두르기술을 받은 환자를 후향적으로 분석하였다. 중심오목하 맥락막두께는 수술 전, 수술 후 1개월, 2개월, 3개월, 6개월로 총 5회 측정되었다. 결과: 총 33명의 환자가 본 연구에 포함되었다. 공막두르기술만을 시행한 환자는 18명(54%), 동시 시행군은 15명(46%)이었다. 전체환자에서 맥락막두께는 수술 후 시간이 경과함에 따라 점차 감소되었다(p<0.05). 공막두르기술만을 시행한 환자군의 수술 6개월 후맥락막두께(260.51 ± 78.30 μm)는 동시 시행군의 맥락막두께(225.55 ± 75.24 μm)보다 통계적으로 유의하게 두껍게 측정되었다(p<0.05). 또한 수술 전 맥락막두께는 황반부 박리가 있으면(276.46 ± 20 μm) 그렇지 않은 경우(223.93 ± 20 μm)와 비교하여 유의하게 두꺼웠다(p<0.05). 또한 수술 전 중심오목하 맥락막두께와 시력은 유의한 음의 상관관계를 보였다(p<0.05). 결론: 일차 열공망막박리 환자에서 공막두르기술을 시행할 경우 중심오목하 맥락막두께는 시간 경과에 따라 감소하였다. 또한 유리체절제술을 동시 시행한 경우 감소 정도가 컸다. 추후 맥락막의 변화 기전과 망막박리에 미치는 영향에 대한 추가적 연구가 필요할것으로 사료된다.
Abstract
Purpose: To compare the subfoveal choroidal thickness (SFCT) before and after scleral encircling (SE), with or without trans-pars plana vitrectomy (TPPV), in patients with monocular primary rhegmatogenous retinal detachment (RRD). Methods: We retrospectively analyzed patients who underwent SE for monocular primary RRD between January 2019 and June 2021 and underwent optical coherence tomography during follow-up. SFCT was measured independently at three regions before the surgery and 1, 2, 3, and 6 months after the surgery. The values were manually analyzed by two independent ophthalmologists. Results: Of the 33 eyes included in the study, 18 (54%) underwent SE alone, while 15 (46%) underwent SE with TPPV. SFCT gradually decreased after surgery in all patients (p < 0.05). The SFCT was significantly greater 6 months postoperatively in the SE alone group (260.51 ± 78.30 μm) compared to the SE with TPPV group (225.55 ± 75.24 μm) (p < 0.05). Macular detachment patients had significantly greater preoperative SFCTs (276.46 ± 20 μm) compared to others (223.93 ± 20 μm) (p < 0.05). Preoperative SFCT was significantly related to visual acuity (p < 0.05), while the remaining SFCT values did not have any significant effects. Conclusions: In primary RRD eyes, SFCT decreased over time after SE, more so when TPPV was also performed. Further studies are required to investigate the mechanism of SFCT change and its impact on RRD.
참고문헌 (32)
- Sayman Muslubas I, "Choroidal thickness in chronic rhegmatogenous retinal detachment before and after surgery, and comparison with acute cases", Int Ophthalmol, 38, pp.1035~1042 (2018)
- Sezer T, "The choroid and optical coherence tomography", Turk J Ophthalmol, 46, pp.30~37 (2016)
- Tan CS, "Diurnal variation of choroidal thickness in normal, healthy subjects measured by spectral domain optical coherence tomography", Invest Ophthalmol Vis Sci, 53, pp.261~266 (2012)
- Odrobina D, "Choroidal thickness changes after vitrectomy with silicone oil tamponade for proliferative vitreoretinopathy retinal detachment", Retina, 37, pp.2124~2129 (2017)
- Kimura M, "Subfoveal choroidal thickness change following segmental scleral buckling for rhegmatogenous retinal detachment", Am J Ophthalmol, 154, pp.893~900 (2012)
- Sayman Muslubas I, "Subfoveal choroidal thickness change after pars plana vitrectomy in recent onset rhegmatogenous retinal detachment", Retina, 36, pp.2371~2376 (2016)
- Giacuzzo C, "Evolution and patterns of choroidal thickness changes in rhegmatogenous retinal detachment", Retina, 40, pp.47~55 (2020)
- Akkoyun I, "Choroidal thickness after scleral buckling surgery in macula-off rhegmatogenous retinal detachment", Ophthalmologe, 111, pp.954~960 (2014)
- Akkoyun I, "Choroidal thickness after scleral buckling surgery versus pars plana vitrectomy in macula-off rhegmatogenous retinal detachment", Klin Monbl Augenheilkd, 231, pp.1029~1033 (2014)
- Williams GA, "Prostacyclin and thromboxane A2 derivatives in rhegmatogenous subretinal fluid", Arch Ophthalmol, 101, pp.463~464 (1983)
- Ricker LJ, "Chemokine levels in subretinal fluid obtained during scleral buckling surgery after rhegmatogenous retinal detachment", Invest Ophthalmol Vis Sci, 51, pp.4143~4150 (2010)
- Quintyn JC, "Subretinal fluid in primary rhegmatogenous retinal detachment : physiopathology and composition", Surv Ophthalmol, 49, pp.96~108 (2004)
- Alm A, "Uveoscleral outflow-a review", Exp Eye Res, 88, pp.760~768 (2009)
- Pederson JE, "Experimental retinal detachment. V. Fluid movement through the retinal hole", Arch Ophthalmol, 102, pp.136~139 (1984)
- Azad R, "Corneal thickness and I.O.P. changes in rhegmatogenous retinal detachment", Indian J Ophthalmol, 38, pp.4~6 (1990)
- Sugawara R, "Choroidal blood flow in the foveal region in eyes with rhegmatogenous retinal detachment and scleral buckling procedures", Br J Ophthalmol, 90, pp.1363~1365 (2006)
- Kimura I, "Relaxation of encircling buckle improved choroidal blood flow in a patient with visual field defect following encircling procedure", Jpn J Ophthalmol, 50, pp.554~556 (2006)
- Michalewska Z, "Choroidal thickness measured with swept source optical coherence tomography before and after vitrectomy with internal limiting membrane peeling for idiopathic epiretinal membranes", Retina, 35, pp.487~491 (2015)
- Kang EC, "Changes in choroidal thickness after vitrectomy for epiretinal membrane combined with vitreomacular traction", Acta Ophthalmol, 95, pp.e393~8 (2017)
- Ahn SJ, "Choroidal thickness change following vitrectomy in idiopathic epiretinal membrane and macular hole", Graefes Arch Clin Exp Ophthalmol, 254, pp.1059~1067 (2016)
- Friberg TR, "A comparison of the elastic properties of human choroid and sclera", Exp Eye Res, 47, pp.429~436 (1988)
- Holekamp NM, "Vitrectomy surgery increases oxygen exposure to the lens : a possible mechanism for nuclear cataract formation", Am J Ophthalmol, 139, pp.302~310 (2005)
- Lim LS, "Retinal vessel oxygen saturation increases after vitrectomy", Invest Ophthalmol Vis Sci, 55, pp.3851~3856 (2014)
- Käsdorf BT, "Diffusion regulation in the vitreous humor", Biophys J, 109, pp.2171~2181 (2015)
- Odrobina D, "Influence of scleral buckling surgery with encircling band on subfoveal choroidal thickness in long-term observations", Biomed Res Int, 2013, pp.586894~ (2013)
- Miura M, "Choroidal thickness after scleral buckling", Ophthalmology, 119, pp.1497~1498 (2012)
- Stitt AW, "Retinal and choroidal responses to panretinal photocoagulation : an ultrastructural perspective", Graefes Arch Clin Exp Ophthalmol, 233, pp.699~705 (1995)
- Zhang Z, "Changes in choroidal thickness after panretinal photocoagulation for diabetic retinopathy : a 12-week longitudinal study", Invest Ophthalmol Vis Sci, 56, pp.2631~2638 (2015)
- Veckeneer M, "Randomized clinical trial of cryotherapy versus laser photocoagulation for retinopexy in conventional retinal detachment surgery", Am J Ophthalmol, 132, pp.343~347 (2001)
- Lira RP, "Cryotherapy vs laser photocoagulation in scleral buckle surgery : a randomized clinical trial", Arch Ophthalmol, 128, pp.1519~1522 (2010)
- Yilmaz T, "Long-term changes in subfoveal choroidal thickness after cataract surgery", Med Sci Monit, 22, pp.1566~1570 (2016)
- Shahzad R, "Choroidal thickness changes following cataract surgery using swept source optical coherence tomography", Can J Ophthalmol, 53, pp.60~64 (2018)