수정체안 열공망막박리의 유리체절제술에서 수정체 보존과 백내장 동시수술의 비교
Lens-Save Versus Phacoemulsification with Intraocular Lens Implantation in Primary Vitrectomy for Phakic Rhegmatogenous Retinal Detachment
2
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
목적: 수정체안 열공망막박리에서 유리체절제술을 하였을 때 수정체를 보존한 경우와 백내장수술을 함께 시행한 경우의 수술성적을비교해 보고자 한다. 대상과 방법: 수정체를 보존한 단독수술군과 백내장수술을 함께 시행한 동시수술군으로 분류하여 LOCSⅢ의 기준에 따라 백내장을 평가하고 최대교정시력, 수술성공률, 합병증 등을 비교하였다. 결과: 단독수술군은 20안, 46.9세, 동시수술군은 34안, 60.5세로 동시수술군의 평균나이가 많았다(p＜0.001). 최대교정시력(logMAR)은각각 술전 1.27, 1.30에서 12개월 0.45, 0.28로 호전되었으나(p＜0.05), 두군 사이에 차이는 없었다. 백내장 등급은 동시수술군에서술전 3.2이었다. 단독수술군은 술전 1.8에서 12개월 2.5로 증가하였으며(p=0.001), 2안에서 백내장 수술이 추가로 시행되었다. 일차수술성공률은 단독수술군 90.0%, 동시수술군 94.1%으로 차이를 보이지 않았다. 결론: 수정체의 보존여부는 해부학적 성공률과 술후시력에 영향을 주지 않았다. 술후 백내장의 진행이 있었으나 젊은 환자에서는 시력에 유의한 영향을 주는 경우가 많지 않으므로 가능한 수정체를 보존하는 것이 좋겠다.
Abstract
Purpose: To compare lens-save and simultaneous phacoemulsification with intraocular lens implantation in primary vitrectomy for phakic rhegmatogenous retinal detachment (RRD). Methods: A retrospective comparative analysis of 54 consecutive eyes from 54 phakic RRD patients who underwent vitrectomy with a minimum of 12 months of follow-up was performed. The patients were divided into the vitrectomy group and the combined group (patients who underwent vitrectomy with concurrent cataract surgery). The main outcome measures were the best corrected visual acuity (BCVA), anatomical success rate, complications and cataract status according to LOCSⅢ grading. Results: Baseline characteristics were similar in both groups, except for age and cataract status. The mean age was 46.9year in the vitrectomy group (n = 20) and 60.5 years in the combined group (n = 34) (p < 0.001). The postoperative BCVA (log MAR) improved from 1.27 and 1.30 at baseline to 0.45 and 0.28 at 12 months (p < 0.05), respectively, which was not a significant difference between the 2 groups. In the vitrectomy group, cataract status was changed from 1.8 at baseline to 2.5 at 12 months (p = 0.001). Two patients (11.1%) had an additional cataract surgery performed. The primary anatomical success rate was 90.0% in the vitrectomy group and 94.1% in the combined group. Conclusions: The vitrectomy group and combined group had similar results in the repair of phakic RRD. Although postoperative cataract progression was noted, lens should be saved in vitrectomy for young patients, as significant cataract is uncommon.
참고문헌 (21)
- Kang SW, "Preferences for treatment modalities of simple rhegmatogenous tetinal detachment in Korea", J Korean Ophthalmol Soc, 43, pp.1179~1185 (2002)
- Heimann H, "Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study", Ophthalmology, 114, pp.2142~2154 (2007)
- 한남수, "유리체절제술에 의한 망막박리수술, 백내장수술, 및 인공수정체삽입술 - 삼중수술의 성적", 대한안과학회지, 45(12), pp.13~13 (2004), 대한안과학회
- 구병영, "원발성열공망막박리 환자에서 단독유리체절제술과 수정체유화술 및 유리체절제술병합술의 결과 비교", 대한안과학회지, 52(5), pp.537~543 (2011), 대한안과학회
- Smith M, "Phacovitrectomy for primary retinal detachment repair in presbyopes", Retina, 27, pp.462~467 (2007)
- Chylack LT Jr, "The Lens Opacities Classification System Ⅲ. The Longitudinal Study of Cataract Study Group", Arch Ophthalmol, 111, pp.831~836 (1993)
- Jabs DA, "Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop", Am J Ophthalmol, 140, pp.509~516 (2005)
- Heimann H, "Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment", Graefes Arch Clin Exp Ophthalmol, 234, pp.561~568 (1996)
- Azad RV, "Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment", Acta Ophthalmol Scand, 85, pp.540~545 (2007)
- Weichel ED, "Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment", Ophthalmology, 113, pp.2033~2040 (2006)
- Kang SW, "Vitrectomy without Dcleral buckling for the treatment of primary rhegmatohenous retinal detachment", J Korean Ophthalmol Soc, 38, pp.227~235 (1997)
- Heimann H, "Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases", Graefes Arch Clin Exp Ophthalmol, 244, pp.69~78 (2006)
- Von Fricken MA, "25-Gauge sutureless vitrectomy versus 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachment", Retina, 29, pp.444~450 (2009)
- Tsang CW, "Primary 23-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment", Retina, 28, pp.1075~1081 (2008)
- Colyer MH, "Retrospective comparison of 25-gauge transconjunctival sutureless vitrectomy to 20- gauge vitrectomy for the repair of pseudophakic primary inferior rhegmatogenous retinal detachment", Retina, 30, pp.1678~1684 (2010)
- 신민규, "열공망막박리에서 일차수술로서 20게이지와 23게이지 유리체절제술의 비교", 대한안과학회지, 50(3), pp.405~411 (2009), 대한안과학회
- Sharma YR, "Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment", Acta Ophthalmol Scand, 83, pp.293~297 (2005)
- Wickham L, "Vitrectomy and gas for inferior break retinal detachment: are the results comparable to vitrectomy, gas, and scleral buckle?", Br J Ophthalmol, 88, pp.1376~1379 (2004)
- Demetriades AM, "Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology", Am J Ophthalmol, 135, pp.291~296 (2003)
- Oshima Y, "Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula- off rhegmatogenous retinal detachment", Jpn J Ophthalmol, 44, pp.538~549 (2000)
- Tewari HK, "Comparison of scleral buckling with combined scleral buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks", Clin Experiment Ophthalmol, 31, pp.403~407 (2003)