열공망막박리에서 4개의 공막창을 이용한 유리체절제술
Four-port Vitrectomy in Rhegmatogenous Retinal Detachment
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 열공망막박리에서 4개의 공막창과 샹들리에 조명 장치를 이용하여 술자가 직접 공막누르기(scleral depression)를 시행하는수술법의 치료 성적을 알아보고자 하였다. 대상과 방법: 2012년 3월부터 2022년 2월까지 본원에서 열공망막박리로 진단받고 4개의 공막창을 이용한 일차 유리체절제술을 받은179안의 해부학적, 기능적 성공률과 합병증을 분석하였다. 결과: 168안(93.9%)은 재수술 없이 해부학적 성공을 거두었고 11안(6.1%)은 재발하였으나 최종 성공률은 100%였다. 최대교정시력은수술 전 logarithm of the minimum angle of resolution (logMAR) 1.03 ± 0.92에서 수술 후 logMAR 0.24 ± 0.39로 유의한 호전을보였다(p<0.001). 합병증은 일시적인 안압상승(3안, 1.7%), 공막절개창을 통한 방수 누출(2안, 1.1%), 전방 및 유리체강 내 출혈(10안, 5.6%), 의인성 망막열공(1안, 0.6%)이 있었으나 치료 후 모두 호전되었다. 결론: 열공망막박리에서 4개의 공막창을 이용한 유리체절제술은 샹들리에 조명 장치를 이용하여 술자가 직접 공막누르기를 시행하는수술법으로, 조수의 숙련도와 상관 없이 주변부 망막을 효과적으로 확인할 수 있어 더 꼼꼼한 수술이 가능하며, 기존의 수술법과 비교하였을 때 해부학적, 기능적 측면에서 열등하지 않은 결과를 보였으므로 유용한 수술법이라 할 수 있다.
Abstract
Purpose: The study investigated the results of direct surgical scleral depression using four ports and the chandelier lighting system in rhegmatogenous retinal detachment. Methods: Anatomical and functional success rates and complications were analyzed in 179 eyes diagnosed with rhegmatogenous retinal detachment that underwent primary vitrectomy using four ports at our hospital between March 2012 and February 2022. Results: A total of 168 (93.9%) eyes had anatomical success without reoperation while 11 (6.1%) developed recurrence. However, the final success rate was 100%. The best-corrected visual acuity improved significantly from logarithm of the minimum angle of resolution (logMAR) 1.03 ± 0.92 to logMAR 0.24 ± 0.39 after surgery (p < 0.001). Complications included a temporary increase in the intraocular pressure (n = 3, 1.7%), leakage through the scleral incision (n = 2, 1.1%), hyphema and vitreous hemorrhage (n = 10, 5.6%), and iatrogenic retinal break (n = 1, 0.6%), but these improved after treatment. Conclusions: Four-port vitrectomy for rhegmatogenous retinal detachment in which scleral depression is directly performed using the chandelier lighting system is a useful surgical method. It allows effective visualization of the peripheral retina regardless of the assistant’s proficiency which results in a more meticulous surgery. The anatomical and functional results of this technique were similar to the conventional technique.
참고문헌 (21)
- Park SJ, "Five year nationwide incidence of rhegmatogenous retinal detachment requiring surgery in Korea", PLoS One, 8, pp.e80174~ (2013)
- Minihan M, "Primary rhegmatogenous retinal detachment : 20 years of change", Br J Ophthalmol, 85, pp.546~548 (2001)
- García-Arumí J, "Guías de tratamiento del desprendimiento de retina rhegmatógeno", Arch Soc Esp Oftalmol, 88, pp.11~35 (2013)
- Heimann H, "Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment : a prospective randomized multicenter clinical study", Ophthalmology, 114, pp.2142~2154 (2007)
- Hillier RJ, "The pneumatic retinopexy versus vitrectomy for the management of primary rhegmatogenous retinal detachment outcomes randomized trial(PIVOT)", Ophthalmology, 126, pp.531~539 (2019)
- Sultan ZN, "Rhegmatogenous retinal detachment : a review of current practice in diagnosis and management", BMJ Open Ophthalmol, 5, pp.e000474~ (2020)
- Richardson EC, "Primary vitrectomy for rhegmatogenous retinal detachment : an analysis of failure", Eur J Ophthalmol, 10, pp.160~166 (2000)
- Martínez-Castillo V, "Pars plana vitrectomy alone with diffuse illumination and vitreous dissection to manage primary retinal detachment with unseen breaks", Arch Ophthalmol, 127, pp.1297~1304 (2009)
- Kuhn F, "Rhegmatogenous retinal detachment : a reappraisal of its pathophysiology and treatment", Ophthalmic Res, 51, pp.15~31 (2014)
- Chaturvedi V, "Scleral depressed vitreous shaving, 360 laser, and perfluoropropane(C3 F8)for retinal detachment", Indian J Ophthalmol, 62, pp.804~808 (2014)
- Liu S, "Combined treatment of minimally invasive 23-G vitrectomy and chandelier for superior bullous rhegmatogenous retinal detachment", Eur Rev Med Pharmacol Sci, 19, pp.2744~2749 (2015)
- Tsang CW, "Primary 23-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment", Retina, 28, pp.1075~1081 (2008)
- Yanyali A, "Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment", Int J Ophthalmol, 5, pp.226~230 (2012)
- Nam SK, "Factors affecting the visual outcome after successful retinal reattachment surgery in rhegmatogenous retinal detachment involving the macula", J Korean Ophthalmol Soc, 38, pp.1788~1796 (1997)
- Yorston D, "Factors affecting visual recovery after successful repair of macula-off retinal detachments : findings from a large prospective UK cohort study", Eye(Lond), 35, pp.1431~1439 (2021)
- 신민규, "열공망막박리에서 일차수술로서 20게이지와 23게이지 유리체절제술의 비교", 대한안과학회지, 50(3), pp.405~411 (2009), 대한안과학회
- 이연호, "열공망막박리 환자에서 25게이지 플러스 시스템을 이용한 경결막유리체절제술의 결과", 대한안과학회지, 56(3), pp.351~356 (2015), 대한안과학회
- 구병영, "원발성열공망막박리 환자에서 단독유리체절제술과 수정체유화술 및 유리체절제술병합술의 결과 비교", 대한안과학회지, 52(5), pp.537~543 (2011), 대한안과학회
- Tan HS, "Air versus gas tamponade in retinal detachment surgery", Br J Ophthalmol, 97, pp.80~82 (2013)
- Zhou C, "Air versus gas tamponade in rhegmatogenous retinal detachment with inferior breaks after 23-gauge pars plana vitrectomy : a prospective, randomized comparative interventional study", Retina, 35, pp.886~891 (2015)
- Wang ZY, "Four-port bimanual 23-gauge vitrectomy for diabetic tractional retinal detachment", Acta Ophthalmol, 94, pp.365~372 (2016)