백내장수술 이후 망막전막의 발생률 및 위험인자
Incidence and Risk Factors of Epiretinal Membrane after Cataract Surgery
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목적: 백내장수술 후 망막전막의 발생률과 위험인자를 알아보고자 하였다. 대상과 방법: 2016년 1월부터 2018년 12월까지 본원에서 단일 술자에 의해 백내장수술을 받은 환자들을 대상으로 의무기록을 조사하였다. 술 후 1-2개월에 시행한 빛간섭단층촬영검사에서 망막전막이 있는 눈은 연구에서 제외하였다. 이후에 안저촬영사진을 이용하여 망막전막을 진단하였으며, 술 후 2-6개월, 6-12개월, 12-24개월 사이로 기간을 나누어 발생률을 조사하였다. 또한 Kaplan-Meier 분석을 통해 망막전막의 누적발생률을 구하였다. 망막전막 발생과 각 변수들과의 관련성을 로지스틱 회귀분석을 이용하여 분석하였다. 결과: 161명 218안이 연구에 포함되었으며 수술 당시 평균 연령은 66.6 ± 9.7세였다. 술 후 2-6개월 사이에는 218안 중 3안(1.4%), 6-12개월 사이에는 176안 중 15안(8.3%), 12‒24개월 사이에는 150안 중 14안(10.3%)에서 망막전막이 진단되었다. 망막전막의 누적발생률은 술 후 24개월까지 11.7%였다. 다변량 로지스틱 회귀분석에서 고령(65세 이상, 교차비 8.6, 95% 신뢰구간 1.43-51.49), 반대안 망막전막의 존재(교차비 3.63, 95% 신뢰구간 1.04-12.73), 긴 안축장(26 mm 이상, 교차비 8.02, 95% 신뢰구간 1.08-59.66), 완전 후유리체박리 발생(교차비 7.48, 95% 신뢰구간 1.64-34.14)이 망막전막 발생과 유의하게 관련 있었다. 결론: 백내장수술 후 망막전막의 발생은 드물지 않았다. 백내장수술 후 장기적인 망막검진이 필요할 것이다.
Abstract
Purpose: To investigate the incidence and risk factors of epiretinal membrane (ERM) after cataract surgery. Methods: We reviewed the medical records of patients who underwent cataract surgery between January 2016 and December 2018. Eyes with ERM, as observed by optical coherence tomography performed 1-2 months after surgery, were excluded from the study. ERM was diagnosed by fundus photography. The incidence rate was determined 2-6, 6-12, and 12-24 months after surgery. The cumulative incidence rate of ERM was calculated by Kaplan-Meier analysis. Data were analyzed using logistic regression to determine the associations between ERM development and various factors. Results: The study included 218 eyes of 161 patients with a mean age of 66.6 ± 9.7 years at the time of surgery. ERM was observed in 3 of 218 eyes (1.4%) between 2 and 6 months, 15 of 176 eyes (8.3%) between 6 and 12 months, and 14 of 150 eyes (10.3%) between 12 and 24 months after surgery. The cumulative incidence rate of ERM was 11.7% over the 24-month period after surgery. In multivariate logistic regression analysis, older age (≥65 years; odds ratio [OR], 8.59, 95% confidence interval [CI], 1.43-51.49), fellow eye with ERM (OR, 3.63; 95% CI, 1.04-12.73), longer axial length (≥26 mm; OR, 8.02; 95% CI, 1.08-59.66), and complete posterior vitreous detachment development (OR, 7.48; 95% CI, 1.64-34.14) were significantly associated with ERM development. Conclusions: ERM is not rare after cataract surgery. Long-term retinal examination should be required after cataract surgery.
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