원인을 알 수 없었던 심한 유리체출혈 환자에서 시행된 유리체절제술의 결과
Outcomes of Vitrectomy for Severe Vitreous Hemorrhage of Unknown Etiology
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목적: 원인을 알 수 없는 심한 유리체출혈로 유리체절제술을 시행 받은 환자들에서 수술 과정에서 밝혀진 출혈의 원인 및 임상 양상과예후에 대하여 알아보았다. 대상과 방법: 안과적 기왕력이나 외상력이 없는 환자 중 초진 안저검사상 Grade IV의 유리체출혈을 보여, 원인을 알 수 없는 상태에서유리체절제술을 시행 받은 환자들의 의무 기록을 후향적으로 분석하였다. 수술 과정에서 밝혀진 출혈의 원인과 수술 후 시력 회복의정도 및 경과에 대하여 알아보고, 수술 후 최대교정시력이 20/200 미만의 시력을 보였던 환자들에 대해 추가로 분석하였다. 결과: 전체 50안 중 망막분지정맥폐쇄가 24안(48%), 망막중심정맥폐쇄가 8안(16%), 연령관련황반변성이 6안(12%), 망막열공이 4안(8%),당뇨망막병증이 2안(4%), 열공망막박리가 2안(4%), 터슨증후군 1안(2%), 일스병 1안(2%), 원인을 밝힐 수 없는 경우가 2안(4%)이었다. 술 전 평균 최대교정시력은 logMAR 2.17 ± 0.53였고, 수술 6개월 후 logMAR 0.64 ± 0.58로 회복되었다(p＜0.001). 망막분지정맥폐쇄에서 좋은 시력 예후를 보였으며, 술 후 최대교정시력 20/200 미만의 환자군에서 황반허혈, 황반변성, 황반부종, 황반하출혈, 황반부를 포함한 견인망막박리, 시신경위축 등이 확인되었다. 결론: 원인을 알 수 없는 심한 유리체출혈에서 황반부 병적 소견이나 비가역적인 시신경의 위축이 있는 환자의 경우 수술 후 나쁜시력 예후를 보였다. 망막분지정맥폐쇄에 의한 출혈이 가장 많았고 비교적 좋은 예후를 보였다.
Abstract
Purpose: To analyze the clinical course and outcomes of vitrectomy for severe vitreous hemorrhage of unknown etiology and todetermine the primary cause of hemorrhage during the surgical process. Methods: The medical records of patients who showed vitreous hemorrhage of Grade IV at their initial visit with no remarkableophthalmologic or trauma history were reviewed retrospectively. All included patients underwent vitrectomy for severe vitreoushemorrhage for which a primary cause was not revealed before the surgery. The authors investigated the postoperative visualoutcome, complications, and etiology of vitreous hemorrhage that was determined during the surgical process. We also analyzedthe detailed intraoperative and postoperative funduscopic findings of patients with poor postoperative visual outcomes(BCVA < 20/200). Results: Among the 50 eyes of 50 patients, the causes of vitreous hemorrhage included: branch retinal vein occlusion (48%),central retinal vein occlusion (16%), age-related macular degeneration (12%), retinal tear (8%), diabetic retinopathy (4%), rhegmatogenousretinal detachment (4%), Terson’s syndrome (2%), Eales’ disease (2%) and unknown causes (4%). The meanbest-corrected visual acuity (BCVA) before surgery was 2.17 ± 0.53 (log MAR) and it was recovered to 0.64 ± 0.58 (log MAR) 6months after the surgery (p < 0.001). The branch retinal vein occlusion showed better visual outcome than other disease entities. On funduscopic examination of the patients with poor visual outcome whose postoperative BCVA was poorer than 20/200, macularischemia, macular degeneration, macular edema, submacular hemorrhage, tractional retinal detachment (including macular),or optic nerve atrophy were verified. Conclusions: After the vitrectomy for severe vitreous hemorrhage of unknown origin, pathologic findings of macular or irreversibleoptic nerve atrophy showed poor postoperative BCVA. Of all the causes of vitreous hemorrhage that were revealed afterthe surgery, branch retinal vein occlusion was the most common etiology of this condition and showed the most favorable visualoutcome, comparatively.
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