열공망막박리 유리체절제술 시 백내장수술 동시 시행 여부에 따른 재발 차이와 위험요인 분석
Comparison of the Recurrence of RRD in PPV Combined Cataract Surgery with PPV Alone, and Risk Factors in PPV Combined Cataract Surgery
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목적: 열공망막박리에서 유리체절제술 시 백내장수술 병행 여부에 따른 망막박리의 재발 빈도의 차이와 기존에 알려진 망막박리 재발의 위험요인을 분석해 보고자 한다. 대상과 방법: 1997년 1월부터 2016년 9월까지 20년에 걸쳐 내원 당시 처음으로 열공망막박리를 진단 받고 유리체절제술을 시행 받은 환자 중 진단 당시 유수정체안 158안을 대상으로, 유리체절제술과 동시에 본원에서 백내장수술을 받은 환자군과 그렇지 않은 환자군으로 나누어 이들의 의무기록을 후향적으로 분석하였다. 결과: 유리체절제술과 동시에 백내장수술을 받은 군과 받지 않은 군 간 비교에서는 백내장수술을 병행한 군이 평균 나이가 더 많았고(p=0.002) 두 군 간 망막박리 재발률은 유의한 차이를 보이지 않았다. 백내장수술을 받은 군에서 망막박리 재발의 위험 요인으로는, 단변량 분석에서 백내장수술 중 후낭파열이 있었던 경우(p=0.020), 아래쪽의 망막 열공(p=0.037), 증식성 유리체망막병증 grade B 이상(p=0.037)이었으나 다변량 분석에서는 백내장수술 중 후낭파열이 있는 경우에만 망막박리의 재발 위험이 높은 것으로 나타났다(odds ratio 1.880, p=0.021). 결론: 본 연구에서는 열공망막박리로 인한 유리제절제술 시 백내장수술 동시 시행 여부가 망막박리의 재발을 높인다는 근거를 발견하지 못했다. 백내장수술 동시 시행 여부는 여러 상황을 고려하여 탄력적으로 결정할 수 있으며, 백내장수술을 동시에 시행 시 후낭파열이 있었던 경우에 망막박리의 재발이 있는지를 추후 잘 살펴야 한다.
Abstract
Purpose: To compare the recurrence percentage and risk factors of recurrence in rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) by in two groups of patients according to combined cataract surgery. Methods: The recurrence percentage of RRD and risk factors after PPV over 20 years, performed by a single surgeon from January 1997 to September 2016, were retrospectively evaluated by classification into two groups according to combined cataract surgery. The risk factors were the patients' factors (age and sex), duration of disease, preoperative visual analyses, posterior capsular tears (PCR) during cataract surgery, the tamponade used, retinal detachment ranges, macular status, number and position of retinal tears, proliferative vitreoretinopathy (PVR) grade, and vitreous opacity. A total of 158 cases were included in the study. Results: The recurrence percentage of RRD was not associated with combined cataract surgery. In the combined cataract surgery group, PCR (p = 0.020), inferior retinal tears (p = 0.037), and PVR above grade B (p = 0.037) were associated with the recurrence of RRD using univariate logistic regression analyses, but PCR (odds ratio 1.880, p = 0.021) was the only significant risk factor for RRD using multivariate logistic regression analyses. Conclusions: Cataract surgery can be performed at any time, but there should be consideration of the recurrence of RRD if there was PCR during combined cataract surgery.
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