큰 황반원공에서 시행한 내경계막 자가이식술
Autologous Transplantation of Internal Limiting Membrane for the Treatment of Large Macular Hole
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목적: 크기가 큰 황반원공의 수술적 치료로서 내경계막 자가이식술을 시행한 환자 5명의 수술방법과 결과를 알아보고자 한다. 대상과 방법: 크기가 400 μm 이상인 큰 황반원공 환자를 대상으로 유리체절제술을 시행하고 0.025% Briliant blue G로 내경계막을 염색하였다. 원공 주변의 내경계막을 약 2.5 유두직경의 크기로 벗겨낸 뒤, 원공 속에 내경계막 절편을 이식하고, 추가적으로 약 1.5유두직경 정도의 내경계막을 더 제거하였다. 액체공기교환을 하고 가스를 충전하였다. 수술 후 빛간섭단층영상으로 원공 폐쇄를 조사하였다. 결과: 5안의 평균 나이는 65.0 ± 11.8 (52-77)세였다. 평균 수술 전 교정시력(logMAR)은 0.80 ± 0.27이었고, 평균 구면대응 굴절값은 -2.0 ± 2.2디옵터였다. 원공 크기는 평균 수평직경 701.4 ± 129.4 μm, 수직 직경 630.2 ± 202.8 μm였다. 기저부는 1,043.4 ± 225.0 μm, 높이는 464.4 ± 218.9 μm였다. 4안은 수술 후 1일째, 1안은 수술 후 4-7일 사이에 원공이 완전히 폐쇄되었다. 경과관찰 기간 동안 중심와의 해부학적 모양은 더욱 개선되었다. 2안에서는 시력호전이 되었으나, 3안은 술 전과 차이가 없었다. 결론: 내경계막 자가이식술을 통해 수술 후 빠른 기간에 성공적인 원공의 폐쇄를 얻을 수 있었다. 크기가 큰 황반원공에서 시행해 볼 만한 유용한 수술 술기라고 생각한다.
Abstract
Purpose: To evaluate the surgical outcome of autologous transplantation of internal limiting membrane (ILM) for the treatment of large macular hole. Methods: Twenty-five gauge pars plana vitrectomy was performed for the treatment of patients with full thickness macular hole larger than 400 μm. ILM was stained using 0.025% brilliant blue G. ILM around the hole was circumferentially peeled as large as 2.5 disc diameter (DD) in size and then transplanted inside the hole. ILM was peeled out additionally approximately 1.5 DD in size. Fluid-air exchange and gas injection were performed. After surgery, the hole was scanned using spectral domain optical coherence tomography. Results: A total of 5 eyes were included in the present study. The mean age was 65.0 ± 11.8 years (52-77) and mean best corrected visual acuity (log MAR) was 0.80 ± 0.27. The mean refractive error was -2.0 ± 2.2 diopter, mean horizontal size of hole was 701.4 ± 129.4 μm, mean vertical size was 630.2 ± 202.8 μm, mean hole base size was 1,043.4 ± 225.0 μm and hole height was 464.4 ± 218.9 μm. At the first day after surgery, transplanted ILM was detected inside the hole in all 5 eyes and complete closure of the hole occurred in 4 eyes. One hole was closed between postoperative days 4 and 7. Foveal contour improved gradually but photoreceptor integrity did not during the follow-up period. Two eyes showed visual improvement but 3 did not after surgery. Conclusions: Macular hole was closed successfully and quickly using the autologous ILM transplantation technique. Based on our results, the autologous ILM should be considered the treatment of choice for large macular holes.
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