내경계막 제거술 후 발생한 활꼴모양의 망막신경섬유층의 부종
Arcuate Retinal Nerve Fiber Swelling after Internal Limiting Membrane Peeling
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목적: 특발성 망막전막 및 황반원공 환자에서 내경계막 제거술 후 적외선 안저촬영상 관찰된 활꼴모양의 어두운 선과 이에 해당하는부위의 망막신경섬유층의 부종에 대해 보고하고자 한다. 대상과 방법: 특발성 망막전막 혹은 황반원공으로 진단받은 환자 40명의 41안을 대상으로 적외선 안저촬영과 빛간섭단층촬영은 술전 및 술 후 1주일, 1개월, 3개월, 6개월째에 시행하였다. 술 후 적외선 안저촬영상 활꼴모양의 어두운 선이 관찰된 경우, 해당 부위의빛간섭단층촬영을 추가로 시행하여 망막 내층의 변화를 관찰하였다. 결과: 내경계막 제거술 후 9.7% (41안 중 4안)에서 적외선 안저촬영상 활꼴모양의 어두운 선이 관찰되었으며, 해당 부위의 빛간섭단층촬영상 망막신경섬유층의 부종이 관찰되었다. 술 후 6개월째에 망막신경섬유층의 부종은 모든 증례에서 호전되었으나, 4 증례 중3 증례에서 이측 망막내층의 얇아짐 및 망막신경섬유층의 패임이 관찰되었다. 술 전후의 최대교정시력은 망막신경섬유층의 부종이발생한 환자군과 부종이 발생하지 않은 환자 군간에 통계학적으로 유의한 차이가 없었다. 결론: 망막전막 혹은 황반원공에서 유리체 절제술 및 내경계막 제거술 후에 일시적인 활꼴모양의 망막신경섬유층의 부종이 발생할수 있다.
Abstract
Purpose: To evaluate the cause of dark arcuate striae observed in infrared photographs in idiopathic epiretinal membrane (ERM)and macular hole patients after internal limiting membrane (ILM) peeling. Methods: Forty patients (41 eyes) of idiopathic ERM and macular hole who underwent trans pars plana vitrectomy with ILM peelingand gas tamponade were included in the present study. The best corrected visual acuity (BCVA) was recorded at preoperativeand postoperative 6 months. Infrared (IR) photography with spectral domain optical coherence tomography (SD-OCT)were obtained at preoperative and postoperative 1 week, 1 month, 3 months, and 6 months. When abnormal findings were visibleon IR photographs, additional SD-OCT was performed at the corresponding sites. Results: Of 40 patients, 4 patients demonstrated dark striae extending from the optic nerve to near macular area in IR photographsat 1 week postoperatively. SD-OCT images of the dark striae region revealed the swelling of retinal nerve fiber layer(RNFL). At postoperative 6 months, however, RNFL swelling previously observed subsided in all 4 cases, while temporal retinalthinning and dimples were observed in 3 cases. The preoperative and postoperative BCVA did not show any statistical differencebetween the patients with the RNFL swelling and the patients without the swelling. Conclusions: Swelling of RNFL may occur in idiopathic ERM and macular hole patients after pars plana vitrectomy and ILM peeling,which may present as dark striae in IR photographs.
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