특발성 황반전막에서 빛간섭단층촬영상의 형태학적 분류에 따른 수술 전후 망막층별 두께변화분석
Evaluation of Each Retinal Layer Thickness According to Preoperative OCT Patterns after Idiopathic ERM Removal
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목적: 특발성 황반전막환자에서 술 전 빚간섭단층촬영상의 형태학적 분류에 따라 수술 전후 망막층별 두께변화에 차이가 있는지 분석하고, 시력호전과의 상관관계를 알아보고자 하였다. 대상과 방법: 특발성 황반전막으로 수술을 받고 6개월 이상 경과관찰이 가능했던 환자 63명 63안을 대상으로 후향적으로 분석하였다. 술 전 빛간섭단층촬영을 통해 황반전막의 형태를 편평형, 볼록형, 오목형으로 분류하고 수술 전후 망막층별 두께변화에 차이가 있는지 분석하고, 시력호전과의 상관관계를 비교해 보았다. 결과: 술 후 시력은 오목형, 편평형, 볼록형 순이었고, 볼록형에서만 유의한 시력호전을 보였다. 정상안과 비교 시 술 전 신경절세포층+내망상층, 내과립층, 외망상층에서 볼록형, 오목형, 편평형 순으로 유의한 두께증가를 보였고, 술 후 신경절세포층+내망상층과 내과립층에서 볼록형, 편평형, 오목형 순으로 망막두께의 유의한 감소를 보였다. 술 후 시력과 상관성을 보이는 술 전 망막층은 없었고,시력호전은 볼록형에서 술 전 신경절세포층+내망상층과 내과립층이, 편평형에서는 외망상층이 두꺼울수록 높은 것으로 나타났다. 결론: 특발성 황반전막환자에서 빛간섭단층촬영상의 형태학적 분류에 따라 술 전 망막층별 두께의 차이를 보였다. 또한 형태학적 분류에 따라 술 후 감소한 망막층별 두께 및 시력호전과 상관성을 보이는 망막층에도 차이가 있었음을 확인할 수 있었다.
Abstract
Purpose: To evaluate the changes in each retinal layer thickness according to preoperative optical coherence tomography(OCT) patterns after idiopathic epiretinal membrane (ERM) removal and to investigate the correlation between retinal layer thicknessand visual improvement. Methods: The medical records of 63 patients (63 eyes) who underwent vitrectomy with internal limiting membrane (ILM) peelingfor idiopathic ERM and followed for more than 6 months were retrospectively reviewed. The OCT images of preoperative idiopathicERM were classified into 3 patterns being flat, convex, and concave. Then, the changes of each retinal layer thicknesswere compared among OCT patterns and the correlations between retinal layer thickness and visual improvement wereanalyzed. Results: Improvement in visual acuity was measured in the following order: concave, flat, and convex patterns. The patients withthe convex pattern only showed significant improvement of visual acuity. Ganglion cell layer plus inner plexiform layer (GCL +IPL), inner nuclear layer (INL), and outer plexiform layer (OPL) thicknesses were significantly larger in preoperative ERM patientsthan in normal controls in the following order: convex, concave, and flat patterns. Retinal layer thickness decreased significantlyin GCL + IPL and INL after surgery in convex, flat, and concave patterns, in that order. Generally, preoperative retinallayer thickness and postoperative visual acuity were not correlated. However, improvement of visual acuity was significantly relatedto GCL + IPL and INL thicknesses in the convex pattern and IPL thickness in the flat pattern. Conclusions: In patients with idiopathic ERM, preoperative difference in each retinal layer thickness according to preoperativeOCT patterns was observed. After ERM removal, reduction of each retinal layer thickness and specific retinal layerrelated to visual improvement was different according to preoperative OCT patterns.
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