특발망막앞막에서 막제거술에 따른 시력 및 망막두께 변화 비교
Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane
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목적: 특발망막앞막환자의 유리체절제술 및 막제거술에서 술기 차이가 수술 전후 시력 및 망막두께변화에 미치는 영향을 비교하고자 한다. 대상과 방법: 특발망막앞막을 진단 후 유리체절제술 및 막제거술을 받고 6개월 이상 경과 관찰한 환자 77명(77안)의 의무기록을 후향적으로 분석하였다. 막제거술 술기에 따라 망막앞막과 내경계막제거에서 diamond-dusted membrane scraper (DDMS)와 눈속집게(intraocular forceps, IOF)의 사용 여부에 따라 두 군으로 나누어 수술 전후 최대교정시력 및 망막두께를 비교하였다. 결과: 최대교정시력은 IOF군에서 술 전에 비해 수술 1주 후 유의하게 감소하였고, DDMS군은 수술 4주 뒤, IOF군은 12주 후부터 향상되었다. 수술 후 6개월 뒤 망막두께는 중심부에서 DDMS군과 IOF군 모두 수술 전에 비해 유의하게 감소하였으며(모두, p<0.001), 두 군 간에 유의한 차이는 없었다(p=0.400). 수술 후 망막두께는 내하측 구역에서는 12주 뒤부터, 외하측 구역에서 4주 뒤부터 DDMS군이 IOF군에 비해 유의하게 낮았다(p=0.046, p=0.039). DDMS군 중 5안, IOF군 중 15안에서 수술 후 낭포황반부종이 발생하였고 이 중 14안은 자연 호전되었다. 결론: 특발망막앞막환자에서 DDMS 및 눈속집게를 이용한 두 군 모두에서 수술 후 최종시력이 향상되었고, 평균 망막두께가 감소하였다.
Abstract
Purpose: To compare the visual acuity and retinal thickness in patients with an idiopathic epiretinal membrane (ERM) after vitrectomy and membranectomy using two different methods. Methods: This retrospective observational study included 77 eyes (32 eyes in the diamond-dusted membrane scraper [DDMS] group, and 45 eyes in the intraocular forceps [IOF] group) of 77 patients with idiopathic ERM who underwent pars plana vitrectomy and membranectomy. The main outcome measures were best-corrected visual acuity (BCVA, logMAR) and mean retinal thickness. Results: In the IOF group, the BCVA at postoperative 1 week was significantly lower than at baseline and had improved at 12 weeks after surgery. In the DDMS group, the BCVA at postoperative 1 week showed no significant difference at baseline and had improved at 4 weeks after surgery. The central macular thickness at postoperative 6 months was significantly lower than at baseline (all, p < 0.001); there was no significant difference between the two groups (p = 0.400). The postoperative macular thickness of the DDMS group was significantly lower than that of the IOF group in the inner inferior and outer inferior areas at postoperative 12 weeks and 4 weeks (p = 0.046 and p = 0.039, respectively). Five eyes of the DDMS group and 15 eyes of the IOF group developed cystoid macular edema, 14 eyes of that improved without treatment. Conclusions: In patients with ERM, the use of DDMS or IOF for vitrectomy and membranectomy both resulted in improved visual acuity and decreased mean retinal thicknesses.
참고문헌 (29)
- Koutsandrea CN, "Indocyanine green-assisted epiretinal membrane peeling evaluated by optical coherence tomography and multifocal electroretinography", Clin Ophthalmol, 1, pp.535~544 (2007)
- Klein R, "The epidemiology of epiretinal membranes", Trans Am Ophthalmol Soc, 92, pp.403~425 (1994)
- Mitchell P, "Prevalence and associations of epiretinal membranes. The Blue Mountains Eye Study, Australia", Ophthalmology, 104, pp.1033~1040 (1997)
- Machemer R, "The surgical removal of epiretinal macular membranes(macular puckers)(author's transl)", Klin Monbl Augenheilkd, 173, pp.36~42 (1978)
- Margherio RR, "Removal of epimacular membranes", Ophthalmology, 92, pp.1075~1083 (1985)
- McDonald HR, "Surgical management of idiopathic epiretinal membranes", Ophthalmology, 93, pp.978~983 (1986)
- Yooh HS, "Ultrastructural features of tissue removed during idiopathic macular hole surgery", Am J Ophthalmol, 122, pp.67~75 (1996)
- 김태완, "황반전막 수술에서 내경계막의 제거", 대한안과학회지, 46(6), pp.989~994 (2005), 대한안과학회
- Park DW, "Macular pucker removal with and without internal limiting membrane peeling : pilot study", Ophthalmology, 110, pp.62~64 (2003)
- Kim SH, "Phacoemulsification and foldable intraocular lens implantation combined with vitrectomy and silicone oil tamponade for severe proliferative diabetic retinopathy", J Cataract Refract Surg, 30, pp.1721~1726 (2004)
- Kuhn F, "The Tano Diamond Dusted Membrane Scraper : indications and contraindications", Acta Ophthalmol Scand, 76, pp.754~755 (1998)
- Hattenbach LO, "Intravitreal sustained-release steroid implants for the treatment of macular edema following surgical removal of epiretinal membranes", Ophthalmologica, 237, pp.232~237 (2017)
- Chylack LT Jr, "The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group", Arch Ophthalmol, 111, pp.831~836 (1993)
- Kawasaki R, "Racial difference in the prevalence of epiretinal membrane between Caucasians and Asians", Br J Ophthalmol, 92, pp.1320~1324 (2008)
- Kwok AK, "Indocyanine green-assisted internal limiting membrane removal in epiretinal membrane surgery : a clinical and histologic study", Am J Ophthalmol, 138, pp.194~199 (2004)
- Sivalingam A, "Visual prognosis correlated with the presence of internal-limiting membrane in histopathologic specimens obtained from epiretinal membrane surgery", Ophthalmology, 97, pp.1549~1552 (1990)
- 장선영, "망막앞막 수술 후 남아있는 황반부종", 대한안과학회지, 50(11), pp.1657~1660 (2009), 대한안과학회
- Lewis JM, "Diamond-dusted silicone cannula for epiretinal membrane separation during vitreous surgery", Am J Ophthalmol, 124, pp.552~554 (1997)
- Ray S, "Pseudophakic cystoid macular edema", Semin Ophthalmol, 17, pp.167~180 (2002)
- Kim SJ, "Incidence of postvitrectomy macular edema using optical coherence tomography", Ophthalmology, 116, pp.1531~1537 (2009)
- Johnson MW, "Tractional cystoid macular edema : a subtle variant of the vitreomacular traction syndrome", Am J Ophthalmol, 140, pp.184~192 (2005)
- Johnson MW, "Etiology and treatment of macular edema", Am J Ophthalmol, 147, pp.11~21.e1 (2009)
- Hattenbach LO, "Intravitreal dexamethasone implant for treatment of persistent postoperative macular edema after vitrectomy", Ophthalmologe, 113, pp.581~588 (2016)
- Klamann A, "Intravitreal dexamethasone implant for the treatment of postoperative macular edema", Ophthalmologica, 236, pp.181~185 (2016)
- Miyake K, "Prostaglandins and cystoid macular edema", Surv ophthalmology, 47(Suppl 1), pp.S203~S218 (2002)
- Xu H, "Cataract surgery induces retinal pro-inflammatory gene expression and protein secretion", Invest Ophthalmol Vis Sci, 52, pp.249~255 (2011)
- Tranos PG, "Macular edema", Surv ophthalmology, 49, pp.470~490 (2004)
- Arevalo JF, "Intravitreal bevacizumab for refractory pseudophakic cystoid macular edema : the Pan-American Collaborative Retina Study Group results", Ophthalmology, 116, pp.1481~1487 (2009)
- Daruich A, "Mechanisms of macular edema : beyond the surface", Prog Retin Eye Res, 63, pp.20~68 (2018)