열공망막박리 미세절개 유리체절제술의 해부학적 성공의 예측인자
Prognostic Factors of Anatomical Success in Microincisional Vitrectomy for Rhegmatogenous Retinal Detachment
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목적: 열공망막박리에서 미세절개 유리체절제술 후 일차 해부학적 성공의 예후인자를 알아보고자 한다. 대상과 방법: 2009년부터 2014년까지 열공망막박리로 미세절개 유리체절제술을 시행 받은 206명(206안)의 의무기록을 후향적으로 분석하였다. 시력, 열공위치, 열공 개수, 열공 크기, 망막박리 범위, 고도근시, 렌즈상태 등 술 전 인자 및 백내장수술 병용 여부, 유리체 절제기구, 안내충전물, 공막절개창 크기 등 술 중 인자와 일차 해부학적 성공과의 연관성을 분석하였다. 결과: 198안(96.1%)이 일차 유리체절제술 후 재유착되었다. 아래쪽 열공이 있었던 48안 중 46안(95.8%, p=1.000), 위수정체였던 44안 중 42안(95.5%, p=1.000), 여러 개의 열공이 관찰된 89안 중 84안(95.4%, p=0.296), 충전물로 공기를 사용한 39안 모두(100%, p=0.224)에서 재유착되었고 일차 해부학적 성공과 의미 있는 연관성이 없었다. 반면, 고도근시안 49안 중 44안(89.8%, p=0.028)에서 일차 수술 후 재유착되어, 비고도근시안의 경우(98.1%, p=0.028)보다 낮은 재유착률을 보였다. 다중회귀분석에서도 고도근시는 수술 후 일차 재유착 실패의 독립적인 예측인자로 나타났다(odds ratio = 5.795, 95% confidence interval = 1.332–25.208, p=0.019). 결론: 열공망막박리에서 시행된 미세절개 유리체절제술은 열공의 위치, 개수, 렌즈상태, 충전물의 종류와 상관 없이 높은 재유착 성공률을 보였다. 다만 고도근시에서 상대적으로 일차 재유착 실패가 흔하므로 세심한 주의가 필요하다.
Abstract
Purpose: To determine the prognostic factors of primary anatomical success after microincisional vitrectomy for rhegmatogenous retinal detachment (RRD). Methods: The medical records of 206 eyes treated with microincisional vitrectomy for RRD from 2009 to 2014 were retrospectively reviewed. The preoperative factors (best corrected visual acuity, break sites, number of breaks, break size, extent of retinal detachment, high myopia, lens status) and intraoperative factors (combined cataract surgery, vitrectomy machine, tamponade, sclerotomy size) were investigated to determine correlations with primary anatomical success. Results: Of the 206 eyes, 198 eyes (96.1%) were reattached after primary vitrectomy; 46 eyes of 48 eyes with inferior breaks (95.8%, p = 1.000), 42 eyes of 44 pseudophakic eyes (95.5%, p = 1.000), 84 eyes of 89 eyes with multiple breaks (95.4%, p = 0.296). All 39 eyes using air tamponade (100%, p = 0.224) were reattached and there was no significant correlation with primary anatomical success. Conversely, 44 eyes of 49 eyes with high myopia (89.8%) were reattached after primary surgery, which was lower than non-high myopic eyes (98.1%, p = 0.028). Multivariate logistic regression showed that high myopia was an independent factor for primary reattachment failure (odds ratio = 5.795, 95% confidence interval = 1.332–25.208, p = 0.019). Conclusions: Microincisional vitrectomy for RRD showed a high reattachment rate regardless of break site and number, lens status, or tamponade type. However, primary reattachment failure was relatively common in high myopia patients, thus, meticulous care is required.
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