반복각막진무름에서 Nd:YAG Laser 치료와 보존적 치료의 비교
Comparison of Nd:YAG Laser versus Conservative Management in the Treatment of Recurrent Corneal Erosion
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목적: 반복각막진무름에서 Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser 치료와 보존적 치료의 효과를 비교하고자 한다. 대상과 방법: 반복각막진무름을 진단 받은 환자에서 Nd:YAG laser를 시행한 23안과 고삼투압제제를 포함한 보존적 치료를 시행한24안을 대상으로 재발 유무, 양상, 빈도, 재발하기까지의 시간, 치료 후 최대교정시력, 합병증 유무에 대해 후향적 연구를 시행하였다. 결과: 재발률은 Nd:YAG laser를 받은 군에서 56.5%, 보존적 치료를 시행한 군에서 50.0%로 통계학적으로 유의미한 차이를 보이지않았으나(p=0.654) 보존적 치료를 한 환자 중 재발한 12안 중 10안은 각막상피 결손을 동반한 형태로 재발하여 Nd:YAG laser군에서의 13안 중 5안보다 재발의 정도가 심함을 보여 주었다(p=0.041). 두 군 모두 시술 후 1년까지는 치료 성공률이 각각 64.1%, 60.5%였으나 시간이 지나면서 재발률이 상승하였고(p=0.649), 치료 후 최종 시력은 Nd:YAG laser를 받은 환자에서 0.05 ± 0.06 logMAR, 보존적 치료를 받은 환자에서 0.09 ± 0.08 logMAR로 유의한 차이를 보이지 않았으며(p=0.110) 두 군 모두에서 각막반흔 등의 합병증은 없었다. 결론: 반복각막진무름에서 Nd:YAG laser 치료와 보존적 치료의 재발률은 유의한 차이를 보이지 않았으나 재발 후 중증도는 Nd:YAG laser 치료가 보존적 치료보다 경미하였다.
Abstract
Purpose: To compare the treatment effects of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser and conservative management in treatment of recurrent corneal erosion. Methods: Twenty-three eyes that received Nd:YAG laser treatment and 24 eyes that underwent conservative management including hyperosmotic agent were retrospectively reviewed for the rate and frequency of recurrence, presentation, time to recurrence, final visual acuity and complications. Results: The rate of recurrence in eyes treated with Nd:YAG laser was 56.5% and that in eyes with conservative management was 50.0%. The difference was not statistically significant (p = 0.654). However, 10 of 12 eyes that recurred after conservative treatment presented with macroform erosion at the time of recurrence, whereas 5 of 13 eyes that recurred after Nd:YAG laser had an accompanying epithelial defect (p = 0.041). After the Nd:YAG laser treatment or conservative treatment, 64.1% and 60.5% of the eyes, respectively, remained free from recurrence 1 year after treatment, however the success rate decreased over time (p = 0.649). The final visual acuity in the group that received Nd;YAG laser treatment was 0.05 ± 0.06 log MAR and 0.09 ± 0.08 log MAR (p = 0.649) in the group that received conservative management. None of the patients in either group experienced complications of corneal scarring. Conclusions: The difference in the recurrence rates between Nd:YAG laser treatment and conservative treatment were not statistically different, however, the severity of recurred episodes were milder in the eyes that received Nd:YAG laser treatment.
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