군날개 삼중수술의 단기결과
Short-Term Result of Triple Procedure in Pterygium Surgery
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목적: 새로운 군날개 수술 방법인 군날개 절제, 결막 밑 양막 삽입, 자가결막 이식을 이용한 삼중 수술의 단기 성적을 보고하고자 한다. 대상과 방법: 2011년 8월부터 2012년 10월까지 본원에서 원발성 또는 재발성 군날개를 진단 받은 환자를 대상으로 하였다. 삼중수술의경우 군날개 제거하고 노출된 공막 주변의 결막 밑으로 동결건조양막을 삽입한 후 자가윤부결막을 이식하였다. 수술 후 6개월 이상추적관찰 한 45안을 대상으로 수술 중, 수술 후 합병증, 그리고 재발률을 조사하였다. 재발의 정도는 G0 (혈관조직이 발견되지 않는경우)에서 G3 (섬유조직이 윤부를 침범한 경우)까지로 분류하였다. 결과: 원발성 군날개 43안, 재발성 군날개 2안에서 수술을 시행하였다. 대상군의 평균연령은 59.87 ± 14.30세였으며, 추적관찰기간은12.9 ± 4.6개월이었다. 술 후 1예에서 부분적인 창상 개열이 관찰되었으며 다른 1예에서 자가이식 결막에 단순 결막낭종이 발생하였으나, 수술 중 합병증은 발견되지 않았다. 39안은 G0 이었으며 6안은 G1 이었다. G2 및 G3의 임상적으로 의미 있는 재발은 관찰되지않았다. 결론: 군날개 삼중 수술은 군날개 재발에 생물학적 장벽으로 작용하는 자가윤부결막이식술의 장점을 그대로 유지하면서 최소한의 양막을 이용한 간단한 삽입시술로 혈관신생억제 등 양막이식술의 장점도 함께 취할 수 있는 유용한 수술법으로 생각된다.
Abstract
Purpose: To evaluate the success and complication rates of triple procedure, including pterygium excision, marginal amnioticmembrane insertion beneath the conjunctiva, and limbal-conjunctival autograft in pterygium surgery. Methods: We conducted a retrospective study on 45 eyes of 45 patients who underwent pterygium surgery betweenAugust 2011 and October 2012. After pterygium excision, amniotic membrane was placed beneath the conjunctiva alongthe margin of the exposed sclera followed by a limbal conjunctival autograft. Success rates, intraoperative and postoperativecomplications were evaluated. Results: Forty-three eyes with primary pterygium and 2 eyes with recurrent pterygium were enrolled in the present study. The mean age of the patients was 59.87 ± 14.30 years with a mean follow-up of 12.9 ± 4.6 months. There were no complicationsduring surgery. Early postoperative complications included partial wound dehiscence in 1 eye and a simple conjunctivalcyst on the autografted conjunctiva in the another eye. No clinically significant recurrence (G2, G3) was noted duringthe observational periods. Thirty-nine (86.7%) and 6 (13.3%) eyes were graded as G0 and G1, respectively. Conclusions: Our surgical technique not only has the benefits of the limbal conjunctival autograft acting as a barrier againstfibrovascular invasion of the cornea and supplying stem cells to the corneal epithelium but also has antiangiogenic effectsof amniotic membrane with minimal use. In addition, this technique is a safe surgical method in primary and recurrentpterygium.
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