자가결막편 이식술을 이용한 원발성 군날개 수술의 임상성적
Surgical Outcome of Primary Pterygium Excision with Conjunctival Autograft
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
목적: 자가결막편 이식술을 이용한 원발성 군날개 수술의 임상성적을 알아보고자 하였다. 대상과 방법: 군날개 절제술 및 자가결막편 이식술을 시행받은 원발성 군날개 환자 112명, 129안의 의무기록을 후향적으로 조사하여군날개 절제술 및 양막이식술, 결막피판술, 단순결막봉합술을 시행받은 환자 28명, 32안의 수술 성적과 비교하였다. 또한 자가결막편이식술을 이용한 군날개 수술 중 마이토마이신 C 점적을 동반한 경우와 동반하지 않은 경우의 수술 성적을 비교하였다. 결과: 군날개 절제술 및 자가결막편 이식술을 시행받은 원발성 군날개 129안 중 3안(2.3%)에서 재발하였다. 반면 군날개 절제술 및양막이식술을 시행받은 10안 중 2안(20.0%), 군날개 절제술 및 결막피판술을 시행받은 10안 중 1안(10.0%), 군날개 절제술 및 단순결막봉합술을 시행받은 12안 중 1안(8.3%)에서 재발이 관찰되어 자가결막편 이식을 이용한 수술에서 자가결막편 이식을 이용하지 않은경우보다 유의하게 군날개 재발률이 적었다(p=0.024, Breslow‐Wilcoxon 법). 또한 군날개 절제술 및 자가결막편 이식술 도중 마이토마이신 C 점적을 사용한 10안 중 1안(10.0%)에서 군날개가 재발하였고, 마이토마이신 C를 사용하지 않은 군날개 절제술 및 자가결막편 이식술을 받은 119안 중 2안(1.7%)에서 군날개가 재발하였다. 결론: 원발성 군날개의 치료로 자가결막편 이식술을 이용한 군날개 절제술은 낮은 재발률과 적은 합병증을 보이는 유용한 치료법으로생각된다.
Abstract
Purpose: To investigate the clinical outcomes of primary pterygium excision combined with free conjunctival autograft. Methods: The medical records of 112 patients (129 eyes) who underwent pterygium excision and free conjunctival autograft for primary pterygium were retrospectively reviewed for recurrence and postoperative complications and the outcomes compared with pterygium excision combined with amniotic membrane transplantation, conjunctival flap, or simple conjunctival closure. Additionally, the surgical outcomes were evaluated in relation to the intraoperative use of mitomycin C. Results: Postoperative recurrences were observed in 3 of 129 eyes (2.3%) that received pterygium excision and free conjunctival autograft, 2 of 10 eyes (20.0%) that received pterygium excision with amniotic membrane transplantation, 1 of 10 eyes (10.0%) that received pterygium excision with conjunctival flap and 1 of 12 eyes (8.3%) that received pterygium excision and simple conjunctival closure. Therefore, the recurrence rate was significantly lower in patients with conjunctival autograft than in those without (p = 0.024, Breslow-Wilcoxon test). Additionally, recurrence was observed in 1 of 10 eyes (10.0%) in patients that underwent pterygium surgery when mitomycin C was used intraoperatively and in 2 of 119 eyes (1.7%) without the use of mitomycin C. Conclusions: Pterygium excision combined with free conjunctival autograft is an effective and safe surgical procedure to treat primary pterygium.
참고문헌 (26)
- Taylor HR., "The long-term effects of visible light on the eye", Arch Ophthalmol, 110, pp.99~104 (1992)
- Di Girolamo N., "Pathogenesis of pterygia : role of cytokines, growth factors, and matrix metalloproteinases", Prog Retin Eye Res, 23, pp.195~228 (2004)
- Reisman D., "Loss of heterozygosity and p53 expression in pterygium", Cancer Lett, 206, pp.77~83 (2004)
- Tan DT., "Apoptosis and apoptosis related gene expression in normal conjunctiva and pterygium", Br J Ophthalmol, 84, pp.212~216 (2000)
- Solomon A., "Regulation of collagenase, stromelysin, and urokinase-type plasminogen activator in primary pterygium body fibroblasts by inflammatory cytokines", Invest Ophthalmol Vis Sci, 41, pp.2154~2163 (2000)
- 윤경철, "Prevalence of Eye Diseases in South Korea: Data from the Korea National Health and Nutrition Examination Survey 2008-2009", Korean Journal of Ophthalmology, 25(6), pp.421~433 (2011), 대한안과학회
- Hirst LW., "The treatment of pterygium", Surv Ophthalmol, 48, pp.145~180 (2003)
- Kaufman SC., "Options and adjuvants in surgery for pterygium : a report by the American Academy of Ophthalmology", Ophthalmology, 120, pp.201~208 (2013)
- Ang LP., "Current concepts and techniques in pterygium treatment", Curr Opin Ophthalmol, 18, pp.308~313 (2007)
- Young AL., "Ten-year results of a randomized controlled trial comparing 0. 02% mitomycin C and limbal conjunctival autograft in pterygium surgery", Ophthalmology, 120, pp.2390~2395 (2013)
- 김창현, "원발성 군날개 환자에서 양막이식술, 자가결막이식술, 자가윤부결막이식술의 재발률 비교", 대한안과학회지, 50(12), pp.1780~1788 (2009), 대한안과학회
- Tan DT., "Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision", Arch Ophthalmol, 115, pp.1235~1240 (1997)
- Gazzard G., "Pterygium in Indonesia : prevalence, severity and risk factors", Br J Ophthalmol, 86, pp.1341~1346 (2002)
- Durkin SR., "The prevalence, severity and risk factors for pterygium in central Myanmar : the Meiktila Eye Study", Br J Ophthalmol, 92, pp.25~29 (2008)
- Zheng K., "Comparison of pterygium recurrence rates after limbal conjunctival autograft transplantation and other techniques : meta-analysis", Cornea, 31, pp.1422~1427 (2012)
- Jaworski CJ., "Expression analysis of human pterygium shows a predominance of conjunctival and limbal markers and genes associated with cell migration", Mol Vis, 15, pp.2421~2434 (2009)
- Reid TW., "What a study of pterygia teaches us about the cornea? Molecular mechanisms of formation", Eye Contact Lens, 36, pp.290~295 (2010)
- Chui J., "Ophthalmic pterygium : a stem cell disorder with premalignant features", Am J Pathol, 178, pp.817~827 (2011)
- Danjo S., "Conjunctival epithelium in healing of corneal epithelial wounds", Invest Ophthalmol Vis Sci, 28, pp.1445~1449 (1987)
- Dua HS., "The conjunctiva in corneal epithelial wound healing", Br J Ophthalmol, 82, pp.1407~1411 (1998)
- Kareem AA., "The use of antimetabolites as adjunctive therapy in the surgical treatment of pterygium", Clin Ophthalmol, 6, pp.1849~1854 (2012)
- Shehadeh-Mashor R., "Management of recurrent pterygium with intraoperative mitomycin C and conjunctival autograft with fibrin glue", Am J Ophthalmol, 152, pp.730~732 (2011)
- 배성근, "양막이식술을 이용한 군날개 제거술에서 마이토마이신 C의 효과", 대한안과학회지, 53(2), pp.200~207 (2012), 대한안과학회
- Kheirkhah A., "Effects of mitomycin C on corneal endothelial cell counts in pterygium surgery : role of application location", Am J Ophthalmol, 151, pp.488~493 (2011)
- Menghini M., "Corneal melting two weeks after pterygium excision with topical mitomycin C : successfully treated with lamellar keratoplasty and amnion membrane transplantation", Case Rep Ophthalmol, 3, pp.24~29 (2012)
- Owoeye JF., "Surgically induced necrotising scleritis after pterygium excision", West Afr J Med, 31, pp.142~144 (2012)