유리체절제술 중 공막 렌즈 사용이 술 후 각막 상태에 미치는 영향
Scleral Lens Application for Preventing Corneal Edema During Vitrectomy
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목적: 유리체절제술로 인해 생길 수 있는 각막 합병증을 예방하기 위해 수술 중 공막 렌즈를 사용하여 그 효과를 알아보고자 하였다. 대상과 방법: 2014년 11월부터 2015년 6월까지 본원에서 유리체절제술을 시행 받은 환자 42명(42안)을 대상으로 후향적으로 연구를 진행하였다. 유리체절제술 중 직경 15.8 mm의 공막 렌즈를 사용한 환자군과 사용하지 않은 환자군을 나누어 유리체절제술 전, 수술1일, 7일, 28일 후에 각막의 상태를 세극등 현미경검사 및 전안부 OCT (RTVue 100, Optovue, Fremont, CA, USA)를 이용해 평가하였다. 공막 렌즈 사용 여부에 따른 술 후 각막 상태의 변화를 분석하였다. 결과: 42안 중 18안에서 유리체절제술 중 공막 렌즈를 사용하였다. 환자의 평균 나이는 56.8 ± 11.4세, 남자 22명, 여자 20명이었다. 유리체절제술 후 모든 환자에서 각막의 두께는 증가하였다. 수술 1일 후 공막 렌즈를 사용한 환자군의 평균 각막 두께 증가량은 23.9 ± 9.7 μm, 공막 렌즈를 사용하지 않은 환자군의 평균 각막 두께 증가량은 43.0 ± 19.5 μm로 공막 렌즈를 사용한 군에서 각막 부종이적게 나타났다(p<0.001). 수술 7일 후 평균 각막 두께 증가량은 각각 8.1 ± 7.2 μm, 32.3 ± 19.2 μm로, 마찬가지로 공막 렌즈를사용한 군에서 각막 부종이 적게 나타났다(p<0.001). 수술 1일 및 7일 후 각막 두께의 증가량은 두 군 간에 유의한 차이를 보였다. 모든 기간에 걸쳐 점상각막염의 정도는 두 군 간에 유의한 차이를 보이지 않았다. 결론: 유리체절제술 중 공막 렌즈의 사용은 수술 중 시야를 가리지 않고 수술로 인해 생기는 각막 부종을 감소시키는 방법이 될 수 있다.
Abstract
Purpose: To analyze the effect of scleral lens application for preventing corneal edema during vitrectomy on postoperative corneal status using anterior segment OCT (RTVue 100, Optovue, Fremont, CA, USA). Methods: The medical records of 42 eyes (42 patients) who underwent total vitrectomy with no appreciable corneal disease between November 2014 and June 2015 were retrospectively reviewed. Evaluations were performed at 1 day, 1 week, and 1 month after total vitrectomy. Corneal status was noted at every follow-up visit using anterior segment OCT. An analysis was performed to define the changes in corneal status in association with scleral lens application during the surgery. Results: 18 of 42 eyes were treated with a scleral lens during total vitrectomy. The corneal thickness increased after vitrectomy in all cases. The mean corneal thickness increment was 23.9 ± 9.7 μm in the scleral lens group and 43.0 ± 19.5 μm in the non-scleral lens group at 1 day after vitrectomy (p < 0.001). At 1 week after vitrectomy, the mean corneal thickness increment was 8.1 ± 7.2 μm in the scleral lens group and 32.3 ± 19.2 μm in the non-scleral lens group (p < 0.001). The difference in superficial punctate keratitis grade between the two groups was not statistically significant. Conclusion: Scleral lens application during vitrectomy seems to prevent postoperative corneal edema. More cases and a longer period of study is needed to draw definitive conclusions.
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