망막전막이 있는 녹내장환자에서 내경계막제거술 후 시야 변화
Visual Field Changes after Internal Limiting Membrane Peeling in Glaucoma Patients with Epiretinal Membrane
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목적: 망막전막이 있는 녹내장환자에서 내경계막제거술 후 녹내장 시야 손상 정도에 따라 시야 변화의 차이가 있는지 알아 보고자한다. 대상과 방법: 아주대학교병원 안과에서 특발망막전막으로 진단받고 내경계막제거술을 시행받은 녹내장환자들을 대상으로 수술 전과후에 시야검사와 빛간섭단층촬영검사를 후향적으로 조사하였다. 수술 전 시행한 시야검사에서 Advanced Glaucoma Intervention Study (AGIS) scoring system을 통해 녹내장 정도를 판단하였으며, AGIS score가 1점 이하인 경우 초기 녹내장으로, AGIS score가 2점 이상인 경우 진행된 녹내장으로 분류하여 시야검사 지표를 비교 분석하였다. 결과: 총 37안(37명) 중 초기 녹내장은 15안, 진행된 녹내장은 22안이었다. 초기 녹내장과 진행된 녹내장 모두에서 내경계막제거술후 시야검사 지표가 악화되었다. 진행된 녹내장에서 초기 녹내장에 비해 visual field index 감소가 의미 있게 더 크고, 시야 손상 범위가 더 넓게 나타났다. 두 군 모두 수술 후 비측 시야 손상이 더 두드러지게 나타났으며, 황반부 신경절세포-내망상층과 망막신경섬유층 두께는 감소하였다. 특히 진행된 녹내장의 이측에서 의미 있는 황반부 신경절세포-내망상층 두께 감소를 보였다. 시력은 수술 전후 의미 있는 변화를 보이지 않았다. 결론: 망막전막이 있는 녹내장환자에서 내경계막제거술 후 초기 녹내장에 비해 진행된 녹내장에서 시야 손상의 진행이 더 깊고 넓게 나타났다.
Abstract
Purpose: To report visual field changes after internal limiting membrane (ILM) peeling for macular epiretinal membrane (ERM) according to the severity of glaucoma. Methods: A retrospective review of 37 eyes from 37 patients who underwent ILM peeling to treat ERM. Standard automated perimetry (Humphrey visual field 24-2 program) was performed preoperatively and postoperatively. Based on the Advanced Glaucoma Intervention Study (AGIS) scoring system of preoperative visual field, patients were classified into the early glaucoma (AGIS ≤ 1) group or the advanced glaucoma (AGIS ≥ 2) group. Postoperative visual field sensitivity at each point was compared with the preoperative value. Results: Out of 37 eyes, 15 eyes had early glaucoma and 22 had advanced glaucoma. Eyes from both groups had poor postoperative visual field parameters. For eyes with advanced glaucoma, the visual field index was significantly reduced and the visual field damage was larger and wider compared to those with early glaucoma. In both groups, visual field impairment was greater on the nasal side than on the temporal side, and visual acuity was not significantly different. Postoperatively, the macular ganglion cell-inner plexiform layer thickness was decreased, especially on the temporal side of advanced glaucoma. Conclusions: Visual field impairment was greater and wider in eyes with advanced glaucoma than in those with early glaucoma after ILM peeling in patients with ERM.
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