수포각막병증에서 치료레이저각막절제술의 단독시행 또는 양막이식술과 동시시행의 치료효과 비교
Phototherapeutic Keratectomy with or without Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy
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목적: 증상을 동반하고 시력예후가 불량한 수포각막병증 환자에서 치료레이저각막절제술의 단독시행과, 치료레이저각막절제술과 양막이식술의 동시시행의 치료효과에 대해서 비교해보고자 하였다. 대상과 방법: 수포각막병증 환자 중 치료레이저각막절제술을 단독으로 시행 받은 10명 10안(A군)의 환자와, 치료레이저각막절제술과양막이식술을 동시에 시행 받은 15명 15안(B군)의 환자로 나누어 시력 및 증상의 변화, 상피화 기간, 수포의 재발 유무, 중심각막두께변화, 그리고 수술 후 합병증 등을 조사하였다. 결과: 수술 후 시력은 A군 2안(20%), B군 2안(13%)에서 호전을 보였다. A군에 속한 10안 중 9안(90%), B군에 속한 15안 중 13안(86.7%)에서증상이 호전되었으며 상피화기간은 A군에서 12.40 ± 4.33일, B군에서 8.13 ± 1.19일로 증상의 호전 및 상피화기간 모두 두 군간 유의한차이는 없었다. 수술 후 두 군 모두에서 중심각막두께는 감소하였으나 두 군간 유의한 차이는 보이지 않았다. 최종 추적관찰 시까지 A군에서 7안(70.0%), B군에서 12안(80.0%)에서는 수포의 재발이 발생하지 않았으며, 수술 후 합병증은 두 군 모두에서 관찰되지 않았다. 결론: 수포각막병증 환자에서 치료레이저각막절제술의 단독시행만으로도 치료레이저각막절제술과 양막이식술의 동시시행과 비교하여증상 호전과 수포 재발 방지에 동등한 결과를 보였다.
Abstract
Purpose: We evaluated the therapeutic effects of phototherapeutic keratectomy (PTK) with or without amniotic membrane transplantation (AMT) in patients who had symptomatic bullous keratopathy with poor visual potential. Methods: Twenty-five eyes of 25 patients with bullous keratopathy were reviewed retrospectively. Ten eyes (group A) were treated with PTK, and the other 15 eyes (group B) were treated with combined PTK and AMT. Changes of vision and symptoms, re-epithelization time, recurrence of bulla, central corneal thickness measured by anterior segment optical coherence tomography, and postoperative complications were analyzed. Results: At post-operative 3 months, visual acuity improved in 2 patients in both A and B groups. Nine patients in group A (90%) and 13 patients in group B (86.7%) showed symptom improvement. Mean re-epithelization time was 12.40 ± 4.33days in group A and 8.13 ± 1.19 days in group B (p ＞ 0.05). In both groups, central corneal thickness decreased postoperatively without statistically significant difference between groups. At the final follow-up visit, epithelial bulla had not recurred in 7eyes (70.0%) in group A and 12 eyes (80.0%) in group B. No postoperative complication was detected. Conclusions: PTK alone appears comparable to the combined treatment of PTK and AMT in terms of symptom improvement,re-epithelization time and recurrence rate.
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