황반원공 수술 후 중심와 주변 미세구조변화의 장기 결과
Long-Term Changes in Foveal Microstructure after Macular Hole Surgery
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목적: 황반원공 수술 후 나타나는 중심와 조직 신장의 장기 결과를 알아보고자 한다. 대상과 방법: 황반원공으로 유리체 절제술을 시행 받은 후 1년 이상 추적 관찰한 20안을 대상으로 후향적 의무기록 분석을 시행하였다. 빛간섭단층촬영 결과를 바탕으로 중심와 부근에서 외망상층이 끝나는 위치 사이의 거리를 외망상층사이 거리로 정의하였다. 특정 방향으로 더 많이 늘어나는 정도를 비대칭적 신장 정도로 정의하였다. 술 후 5-8개월과 최종추적관찰 시에 각각 측정을 시행하였으며,두 시점에서 측정된 값을 서로 비교하였다. 결과: 황반원공의 평균 직경은 321.5 ± 99.5 μm였다. 술 후 평균 6.3 ± 1.1개월과 22.7 ± 7.8개월에 측정을 시행하였는데, 수평 이미지에서 외망상층사이 거리는 각각 552.3 ± 130.5 μm, 502.8 ± 139.3 μm였으며, 수직 이미지에서 외망상층사이 거리는 각각 478.9± 107.2 μm, 447.5 ± 107.1 μm였다. 수평 및 수직 외망상층사이 거리는 모두 최종추적관찰 시에 측정한 값이 유의하게 작은 결과를보였다(p＜0.001, p=0.002). 평균 6.3개월 및 22.7개월의 평균 비대칭적 신장 정도는 각각 10.8 ± 6.5%, 11.8 ± 7.9%였다(p=0.426). 결론: 황반원공 수술 6개월 이후로는 중심와 조직의 신장이 멈추고 오히려 축소되는 결과를 보였으며, 평균 비대칭적 신장 정도는더 증가하지 않았다. 이러한 변화는 술 후 장기간의 시기능 회복과 연관이 있을 것으로 생각한다.
Abstract
Purpose: To evaluate long-term outcome of foveal tissue elongation after macular hole (MH) surgery. Methods: This retrospective, observational case series was performed on patients who underwent MH surgery and were followed-up more than 12 months. Distance between the parafoveal edge of the outer plexiform layer (OPL) was defined as the inter-OPL distance and measured using optical coherence tomography images at 5 to 8 months postoperatively and at the last follow-up. The horizontal and vertical inter-OPL distances were compared between the 2 defined time points. In addition, further elongation of the foveal tissue in certain directions was defined as asymmetric elongation and was compared between the defined time points. Results: The early and late postoperative examination was performed at 6.3 ± 1.1 (mean ± standard deviation) months and 22.7 ± 7.8 months, respectively. The horizontal inter-OPL distance was 552.3 ± 130.5 μm and 502.8 ± 139.3 μm at the defined time points, respectively and the vertical inter-OPL distance was 478.9 ± 107.2 μm and 447.5 ± 107.1 μm,respectively. Both horizontal and vertical inter-OPL distances were significantly shortened at the last postoperative examination (p < 0.001, p = 0.002, respectively). The degree of asymmetric elongation was 10.8 ± 6.5% and 11.8 ± 7.9% at the defined time points, respectively, and was not different between the defined time points (p = 0.426). Conclusions: The long-term shortening of foveal tissue after MH surgery without progression of asymmetry may partially contribute to the long-term recovery of visual function after MH surgery.
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