다층 속말림 내경계막 절편술을 이용한 크기가 큰 황반원공의 치료
The Treatment of Large Macular Holes Using a Multi-layered Inverted Internal Limiting Membrane Flap Technique
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목적: 다층 속말림 내경계막 절편술의 수술 방법을 소개하고 기저직경의 크기가 800 μm 이상인 황반원공 환자에서 그 수술 결과를 알아보고자 하였다. 대상과 방법: 다층 속말림 내경계막 절편술을 시행받은 황반원공 환자의 의무기록을 후향적으로 조사하여, 수술 전 원공 기저직경의 크기가 800 μm 이상인 환자를 연구대상으로 하였다. 대상 환자에서 수술 전후 교정시력, 빛간섭단층영상에서 측정한 수술 전 원공의 최소직경과 기저직경, 최대높이, 술 후 원공 폐쇄 여부 등을 확인하였다. 수술은 유리체절제술을 실시한 뒤 인도시아닌그린으로 내경계막을 염색한 후 내경계막을 원공 경계면까지만 박리하였다. 벗겨진 내경계막을 뒤집어서 2-3겹으로 원공에 이식한 뒤 안구 내에 가스를 충전하였다. 결과: 12안의 평균 나이는 65.2 ± 12.3세였다. 수술 전 평균 교정시력(logMAR)은 1.27 ± 0.61이었고 원공 크기는 563.6 ± 221.9 μm, 기저부는 1,182.8 ± 298.5 μm, 높이는 418.8 ± 80.9 μm였다. 수술 후 평균 경과관찰 기간은 174.4 ± 143.3일이었다. 9안은 수술 후 원공이 폐쇄되었고 3안에서는 폐쇄가 이루어지지 않았다. 수술 후 평균 교정시력(logMAR)은 0.21 ± 0.51이었고 8안에서는 시력 호전이 되었으나 4안은 시력 호전이 없었다. 결론: 다층 속말림 내경계막 절편술을 통해 안정적으로 수술 후 원공의 폐쇄와 시력의 호전을 기대할 수 있었다. 크기가 큰 황반 원공에서 시행해 볼 만한 가치가 있는 유용한 수술 술기라고 생각된다.
Abstract
Purpose: To describe a multi-layered inverted internal limiting membrane (ILM) flap technique and to evaluate the surgical outcomes of this surgery in patients with macular holes > 800 μm in base diameter. Methods: The medical records of patients who received a multi-layered ILM flap technique were retrospectively studied and patients with macular holes > 800 μm were included in the analyses. Best-corrected visual acuity (BCVA) before and after surgery, preoperative hole size, hole base size, vertical size, and hole closure after surgery were checked using spectral domain optical coherence tomography. Pars plana vitrectomy was performed and the ILM was stained using indocyanine green and peeled with the base attached at the hole margin. The ILM flap was inverted over the macular hole with 2~3 layers, and gas injection was performed. Results: The mean age of 12 patients was 65.2 ± 12.3 years. The mean BCVA (logMAR) was 1.27 ± 0.61. The mean hole size was 563.6 ± 221.9 μm, the mean vertical size was 418.8 ± 80.9 μm, and the mean hole base size was 1,182.8 ± 298.5 μm. The mean follow-up period was 174.4 ± 143.3 days. Nine macular holes were closed after surgery but three macular holes were not closed. The postoperative mean BCVA (logMAR) was 0.21 ± 0.51. Eight eyes showed visual improvement while three eyes did not show visual improvement after macular hole surgery. Conclusions: The macular hole was closed successfully and the visual acuity improved after the multi-layered, inverted ILM flap technique. The multi-layered, inverted ILM flap technique is therefore considered the treatment of choice for large macular holes.
참고문헌 (25)
- La Cour M, "Macular holes: classification, epidemiology, natural history and treatment", Acta Ophthalmol Scand, 80, pp.579~587 (2002)[DOI]
- Johnson RN, "Idiopathic macular holes. Observations, stages of formation, and implications for surgical intervention", Ophthalmology, 95, pp.917~924 (1988)[DOI]
- Yooh HS, "Ultrastructural features of tissue removed during idiopathic macular hole surgery", Am J Ophthalmol, 122, pp.67~75 (1996)[DOI]
- Tatham A, "Face-down posturing after macular hole surgery: a meta-analysis", Br J Ophthalmol, 94, pp.626~631 (2010)[DOI]
- Konstantinidis A, "Efficacy of autologous platelets in macular hole surgery", Clin Ophthalmol, 7, pp.745~750 (2013)
- Michalewska Z, "Inverted internal limiting membrane flap technique for large macular holes", Ophthalmology, 117, pp.2018~2025 (2010)[DOI]
- Kuriyama S, "Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia", Am J Ophthalmol, 156, pp.125~131 (2013)[DOI]
- Michalewska Z, "Inverted internal limiting membrane flap technique for surgical repair of myopic macular holes", Retina, 34, pp.664~669 (2014)[DOI]
- Shin MK, "Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery", Retina, 34, pp.1905~1910 (2014)[DOI]
- Khodani M, "Inverted internal limiting membrane flap technique for very large macular hole", Int J Ophthalmol, 9, pp.1230~1232 (2016)
- Kang SW, "Types of macular hole closure and their clinical implications", Br J Ophthalmol, 87, pp.1015~1019 (2003)[DOI]
- Shukla SY, "Outcomes of chronic macular hole surgical repair", Indian J Ophthalmol, 62, pp.795~798 (2014)[DOI]
- Tognetto D, "Internal limiting membrane removal during macular hole surgery: results of a multicenter retrospective study", Ophthalmology, 113, pp.1401~1410 (2006)[DOI]
- Haritoglou C, "Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane: update of a prospective study", Retina, 26, pp.618~622 (2006)
- Freeman WR, "Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Results of a multicentered randomized clinical trial. The Vitrectomy for Treatment of Macular Hole Study Group", Arch Ophthalmol, 115, pp.11~21 (1997)[DOI]
- Morizane Y, "Autologous transplantation of the internal limiting membrane for refractory macular holes", AmJ Ophthalmol, 157, pp.861~869 (2014)[DOI]
- Aurora A, "Cabbage leaf inverted flap ILM peeling for macular hole: a novel technique", Ophthalmic Surg Lasers Imaging Retina, 48, pp.830~832 (2017)[DOI]
- Ip MS, "Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography", Arch Ophthalmol, 120, pp.29~35 (2002)[DOI]
- Wakely L, "A comparison of several methods of macular hole measurement using optical coherence tomography, and their value in predicting anatomical and visual outcomes", Br J Ophthalmol, 96, pp.1003~1007 (2012)[DOI]
- Michalewska Z, "Correlation between foveal structure and visual outcome following macular hole surgery: a spectral optical coherence tomography study", Graefes Arch Clin Exp Ophthalmol, 246, pp.823~830 (2008)[DOI]
- Leonard RE 2nd, "Long-term visual outcomes in patients with successful macular hole surgery", Ophthalmology, 104, pp.1648~1652 (1997)[DOI]
- Kumagai K, "Variables that influence visual acuity after macular hole surgery", Jpn J Ophthalmol, 45, pp.112~ (2001)
- Ullrich S, "Macular hole size as a prognostic factor in macular hole surgery", Br J Ophthalmol, 86, pp.390~393 (2002)[DOI]
- Mahalingam P, "Surgical outcomes of inverted internal limiting membrane flap technique for large macular hole", Indian J Ophthalmol, 61, pp.601~603 (2013)[DOI]
- 이재정, "Vascular Displacement in Idiopathic Macular Hole after Singlelayered Inverted Internal Limiting Membrane Flap Surgery", Korean Journal of Ophthalmology, 31(4), pp.336~342 (2017), 대한안과학회