보존제가 없는 분말 형태의 트리암시놀론 아세토나이드를 이용한 내경계막의 시각화
Preservative-free Triamcinolone Acetonide-assisted Visualization of the Internal Limiting Membrane
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 보존제가 없는 분말 형태 트리암시놀론 아세토나이드(triamcinolone acetonide, TA)와 현탁액 형태 TA의 내경계막의 시각화 정도를 비교하고자 하였다. 대상과 방법: 유리체절제술 및 내경계막 제거를 시행 받은 61명에 대한 후향적 분석을 실시하였다. 사용한 TA의 종류로 환자군을 두 군으로 나누고, 유리체 및 내경계막 가시화 정도를 각각 4단계로 나누어 평가하였다. 염료의 유리체강내 주입 횟수, indocyanine green (ICG)의 추가 사용 여부, 내경계막제거술에 걸린 시간 및 수술 전후의 안압을 분석하였다. 결과: 분말 형태 TA를 이용한 경우, 유리체 및 내경계막의 가시화 정도가 현탁액 형태 TA를 이용한 경우에 비하여 우수하였다(p<0.01). 염료의 유리체강내 주입 횟수는 분말 형태 TA군에서 평균 2.65회 ± 0.07회, 현탁액 형태 TA군에서 2.37 ± 1.08회로 차이는 없었으나(p=0.06), ICG를 이용한 염색법이 필요한 경우는 각각 6안과 22안으로 차이를 보였고(p<0.01), 내경계막제거술에 걸리는 평균 시간도 각각 185.68 ± 130.02초, 411.15 ± 267.38초로 차이를 보였다(p<0.01). 수술 1개월 후 안압은 각각 12.88 ± 3.10 및 14.41 ± 2.91 mmHg로 차이를 보였다(p=0.03). 결론: 가시화를 위하여 분말 형태 TA를 이용하는 경우 유리체와 내경계막의 시각화가 보다 용이하였고, ICG 사용의 필요성을 줄이고, 내경계막 제거에 걸리는 시간을 줄이는 데 도움이 되었으며, 수술 1개월 후 안압상승도 비교적 적었기 때문에 보다 안전하고 효과적인 방법인 것으로 생각된다.
Abstract
Purpose: To evaluate and compare the degree of visualization of the vitreous and internal limiting membrane (ILM) during pars plana vitrectomy (PPV) using preservative-free triamcinolone acetonide (PF-TA) or triamcinolone acetonide suspension (TAS). Methods: We retrospectively analyzed the medical records of 61 eyes of 61 patients who underwent 25-gauge PPV and ILM peeling for various macular diseases. We assigned the patients to PF-TA and TAS groups, i.e., according to the type of triamcinolone acetonide used. The degree of visualization of the vitreous and ILM was classified into four different categories. The number of dye injections during PPV, need for indocyanine green (ICG), time elapsed before ILM peeling, and intraocular pressure (IOP) before surgery, 1 day and 1 month after surgery were determined. Results: The degree of visualization of the vitreous and ILM was significantly better in the PF-TA group compared with the TAS group. Although the number of dye injections during PPV was not different between the PF-TA and TAS groups (2.56 ± 0.07 and 2.37 ± 1.08, respectively, p = 0.06), the need for ICG was significantly different (6 and 22 eyes, respectively, p < 0.01). The time elapsed before ILM peeling was 185.68 ± 130.02 s in the PF-TA group and 411.15 ± 267.38 s in the TAS group (p < 0.01). The IOP was not different before or 1 day after surgery between the PF-TA and TAS groups, but was significantly different 1 month after surgery (12.88 ± 3.10 and 14.41 ± 2.91 mmHg, respectively, p = 0.03). Conclusions: Visualization of the vitreous and ILM was better when using PF-TA compared to TAS. PF-TA-assisted PPV could reduce the usage of ICG and was associated with a reduced latency to ILM peeling. Because this was in turn associated with a lower IOP at postoperative 1 month, PF-TA was safer and more effective than TAS.
참고문헌 (28)
- Shah GK, "Triamcinolone-assisted internal limiting membrane peeling", Retina, 25, pp.972~975 (2005)
- Tognetto D, "Staining of the internal limiting membrane with intravitreal triamcinolone acetonide", Retina, 25, pp.462~467 (2005)
- Eckardt C, "Removal of the internal limiting membrane in macular holes. Clinical and morphological findings", Ophthalmologe, 94, pp.545~551 (1997)
- Gandorfer A, "Indocyanine green selectively stains the internal limiting membrane", Am J Ophthalmol, 131, pp.387~388 (2001)
- Kwok AK, "Internal limiting membrane staining with various concentrations of indocyanine green dye under air in macular surgeries", Am J Ophthalmol, 136, pp.223~230 (2003)
- Kadonosono K, "Staining of internal limiting membrane in macular hole surgery", Arch Ophthalmol, 118, pp.1116~1118 (2000)
- Gandorfer A, "Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage", Am J Ophthalmol, 132, pp.431~433 (2001)
- Engelbrecht NE, "Retinal pigment epithelial changes after macular hole surgery with indocyanine green-assisted internal limiting membrane peeling", Am J Ophthalmol, 133, pp.89~94 (2002)
- Horiguchi M, "Kinetics of indocyanine green dye after intraocular surgeries using indocyanine green staining", Arch Ophthalmol, 121, pp.327~331 (2003)
- Machida S, "Observation of the ocular fundus by an infrared-sensitive video camera after vitreoretinal surgery assisted by indocyanine green", Retina, 23, pp.183~191 (2003)
- Tadayoni R, "Persistence of fundus fluorescence after use of indocyanine green for macular surgery", Ophthalmology, 110, pp.604~608 (2003)
- Peyman GA, "Triamcinolone acetonide as an aid to visualization of the vitreous and the posterior hyaloid during pars plana vitrectomy", Retina, 20, pp.554~555 (2000)
- Horio N, "Triamcinolone-assisted internal limiting membrane peeling during idiopathic macular hole surgery", Arch Ophthalmol, 123, pp.96~99 (2005)
- Sakamoto T, "Triamcinolone-assisted pars plana vitrectomy improves the surgical procedures and decreases the postoperative blood-ocular barrier breakdown", Graefes Arch Clin Exp Ophthalmol, 240, pp.423~429 (2002)
- 임한웅, "여러 가지 트리암시놀론제재의 유리체강내 투명기름방울모양 잔존물 발생 양상의 비교", 대한안과학회지, 49(7), pp.1087~1093 (2008), 대한안과학회
- Shimamura S, "A comparison of characteristic properties and qualitative difference between three kinds of triamcinolone acetonide", Tokai J Exp Clin Med, 42, pp.67~70 (2017)
- Smiddy WE, "Internal limiting membrane peeling in macular hole surgery", Ophthalmology, 108, pp.1471~1476 (2001)
- Chang WC, "Vitrectomy with or without internal limiting membrane peeling for idiopathic epiretinal membrane : a meta-analysis", PLoS One, 12, pp.e0179105~ (2017)
- Chatziralli I, "Long-term changes of macular thickness after pars plana vitrectomy in optic disc pit maculopathy : a spectral-domain optical coherence tomography study", Semin Ophthalmol, 32, pp.302~308 (2017)
- Burk SE, "Visualizing vitreous using Kenalog suspension", J Cataract Refract Surg, 29, pp.645~651 (2003)
- Furino C, "Triamcinolone-assisted pars plana vitrectomy for proliferative vitreoretinopathy", Retina, 23, pp.771~776 (2003)
- Fraser EA, "Triamcinolone acetonide–assisted peeling of retinal internal limiting membrane for macular surgery", Retina, 23, pp.883~884 (2003)
- Kampougeris G, "Safety of Triamcinolone acetonide(TA)-assisted pars plana vitrectomy in macular hole surgery", Eye(Lond), 21, pp.591~594 (2007)
- Yeung CK, "The toxic and stress responses of cultured human retinal pigment epithelium(ARPE19)and human glial cells(SVG)in the presence of triamcinolone", Invest Ophthalmol Vis Sci, 44, pp.5293~5300 (2003)
- Spitzer MS, "Preservative-free triamcinolone acetonide injectable suspension versus"traditional"triamcinolone preparations : impact of aggregate size on retinal biocompatibility", Retina, 31, pp.2050~2057 (2011)
- Walter P, "Antibiotics and light responses in superfused bovine retina", Cell Mol Neurobiol, 19, pp.87~92 (1999)
- Zhu MD, "Development of experimental chronic intraocular hypertension in the rabbit", Aust N Z J Ophthalmol, 20, pp.225~234 (1992)
- Morrison VL, "Intravitreal toxicity of the kenalog vehicle(benzyl alcohol)in rabbits", Retina, 26, pp.339~344 (2006)