황반원공과 망막앞막에서 25게이지 유리체수술과 관련된 의인성 망막열공
Iatrogenic Retinal Breaks in Macular Hole and Epiretinal Membrane Using 25-gauge Vitrectomy
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목적: 황반원공과 특발성 망막앞막으로 25게이지 유리체수술을 시행한 환자에서 수술과 관련된 의인성 망막열공의 발생과 특징을수술 기록과 수술 전 광각안저촬영 및 안저검사와 비교하여 알아보고자 한다. 대상과 방법: 2016년 1월부터 2019년 12월까지 본원에서 유리체절제술을 시행받은 황반원공 82안과 망막앞막 285안에 대해 후향적으로 의무기록을 분석하였다. 의무기록을 통해 수술 전 안저검사 및 광각안저촬영에서 관찰된 망막열공과 수술 중 관찰된 망막열공의수와 위치를 비교하고, 망막원공, 망막격자변성 여부를 조사하였다. 후유리체박리 여부를 확인하여 각 인자와의 연관성을 알아보았다. 결과: 유리체절제술을 시행받은 367안 중 6안(1.6%)에서 의인성 망막열공이 발생하였다. 그 외 34안(9.3%)에서는 수술 전 망막열공이확인되었다. 망막원공은 15안(4.1%), 망막격자변성은 32안(8.7%), 후유리체박리는 261안(71.1%)에서 있었으며, 의인성 망막열공과의연관성은 확인할 수 없었다. 수술 전 망막열공 중 안저검사에서 발견된 것 외에 광각안저촬영에서 14개를 더 확인할 수 있었다. 결론: 25게이지 유리체절제술과 관련된 의인성 망막열공은 기존의 보고된 20게이지 유리체절제술보다 낮은 빈도로 발생하였고, 광각안저촬영으로 기존 연구 방식보다 더 정확하게 망막열공을 확인할 수 있었다.
Abstract
Purpose: To determine the incidence and characteristics of iatrogenic retinal breaks in patients who underwent 25-gauge vitreous surgery for macular hole and idiopathic epiretinal membrane, with a comparison and analyses of surgical records and preoperative data, including wide-angle fundus imaging and indirect ophthalmoscopic examination findings. Methods: The medical records were analyzed retrospectively for 82 macular hole eyes and 285 epiretinal membranes that underwent vitrectomy at our hospital from January 2016 to December 2019. The number and location of retinal breaks observed in preoperative fundus examination and wide-angle fundus imaging were compared with those indicated in the surgical records. The presence of retinal breaks and retinal lattice degeneration was investigated, and the relationship of each factor with respect to posterior vitreous detachment (PVD) was examined. Results: Of the 367 eyes that underwent vitrectomy, six eyes (1.6%) developed iatrogenic retinal breaks. Thirty-four eyes (9.3%) had retinal breaks before surgery. Retinal break was found in 15 (4.1%) eyes, retinal lattice degeneration was indicated in 32 eyes (8.7%), and PVD occurred in 261 eyes (71.1%). The association of iatrogenic retinal break and PVD was not confirmed. An additional 14 preoperative breaks, not seen in indirect ophthalmoscopic examination, were identified in wide-angle fundus images. Conclusions: It was found that 25-gauge vitrectomy-related iatrogenic retinal breaks occurred at a lower frequency than previously reported for 20-gauge vitrectomy procedures. Wide-angle fundus imaging was able to identify retinal breaks more accurately than conventional research methods.
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