영구 양막이식술 이후 양막의 장기간 임상 경과
Long-term Clinical Course of Amniotic Membrane after Permanent Amniotic Membrane Transplantation
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목적: 각막에 영구 양막이식술을 시행받은 환자에서 이식된 양막의 장기적인 임상 경과를 알아보고자 하였다. 대상과 방법: 2014년 4월부터 2021년 3월까지 영구 양막이식술을 시행받은 환자 68명 72안의 의무기록과 외안부 디지털 사진을 후향적으로 분석하였다. 수술 후 각막의 완전한 재상피화까지의 기간 및 치료콘택트렌즈 착용 기간을 조사하였고, 수술 후 최대 6년까지의경과 관찰 기간 동안 매년 융해된 부분을 제외한 보존된 양막의 크기를 Image J 프로그램을 이용하여 분석하였으며, 이를 단층 이식군과 복층 이식군으로 나누어 비교하였다. 또한 양막의 융해가 발생한 경우, 융해가 일어난 원인, 시점 및 관련 요인을 분석하였다. 결과: 수술 후 완전한 재상피화까지 걸리는 기간은 평균 12.2 ± 11.0일이었고, 치료콘택트렌즈를 수술 후 평균 8.7 ± 8.5개월까지착용하였다. 전체 환자군에서 수술 후 6년째까지 매년 보존된 양막의 비율은 각각 94.9%, 94.3%, 97.8%, 96.4%, 95.8%, 91.6%였고, 각 경과 관찰 시점에서 단층 이식군과 복층 이식군의 유의한 차이는 없었다. 전체 환자군의 38.9% (28안)의 환자에서 양막의 융해가나타났으며, 수술 후 평균 16.4 ± 17.2개월째 융해가 처음 관찰되었다. 융해의 원인으로는 수포의 형성 및 파열이 71.4% (20안)로가장 많았으며, 통계학적으로 유의하게 수포 형성에 관여하는 인자는 없었다. 결론: 각막의 다양한 질환에서 시행되는 영구 양막이식술의 경우 이식된 양막은 일부 융해되지만 수술 후 6년까지는 대부분 보존되어안정적인 안구표면을 형성하는 것으로 사료된다.
Abstract
Purpose: To investigate the long-term clinical outcomes of transplanted amniotic membrane in patients who underwent permanent amniotic membrane transplantation (P-AMT) on cornea. Methods: From April 2014 to March 2021, medical records and digital photographs of 68 patients (72 eyes) who underwent P-AMT were analyzed retrospectively. The duration of complete re-epithelization of cornea and wearing therapeutic contact lense (T-lens) after surgery were investigated, the size of preserved amniotic membrane (AM) excluding the melted portion was analyzed using the Image J program every year up to 6 years after surgery, and it was compared by dividing into a single-layer group and a double-layer group. In addition, when the AM melts, the cause, time, and related factors of melting were analyzed. Results: The average duration to complete re-epithelialization after surgery was 12.2 ± 11.0 days, and T-lens were worn on average up to 8.7 ± 8.5 months after surgery. In total group, the average ratio of preserved AM annually up to 6 years after surgery was 94.9%, 94.3%, 97.8%, 96.4%, 95.8%, 91.6% respectively, and there was no significant difference between the single-layer group and the double-layer group. AM melting appeared in 38.9% (28 eyes) of the total group, and melting was first observed on average 16.4 ± 17.2 months after surgery. The formation and rupture of bullae was the most common cause of melting at 71.4% (20 eyes), and there were no statistically significant related factors involved in the formation of bullae. Conclusions: In the case of P-AMT performed in various diseases of the cornea, the transplanted AM is partially melt but considered to be well preserved up to 6 years after surgery to form a stable ocular surface.
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