전층각막이식술을 받은 반점각막이상증 환자의 장기 임상성적
Long Term Clinical Results of Penetrating Keratoplasty for Macular Corneal Dystrophy
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목적: 반점각막이상증 환자에서 시행한 전층각막이식술의 장기 임상성적에 대해 보고하고자 하였다. 대상과 방법: 1986년 11월부터 2011년 12월까지 반점각막이상증 환자 31명 46안을 대상으로 전층각막이식술을 시행하고 수술 전, 후의최대교정시력, 각막내피세포의 변화율, 수술 후 합병증, 재발여부에 대해 분석하였다. 결과: 평균 경과 관찰 기간은 91.59 ± 3.2개월이었으며, 최대교정시력은 술 전 0.99 ± 0.24 logMAR에서 술 후 12개월째 0.38 ±0.12 logMAR로 통계적으로 유의하게 향상되었다. 각막내피세포의 감소율은 수술 후 12개월째 33.43 ± 21.65%, 36개월째 56.79 ±19.42%로 나타났다. 이식 생존율은 수술 후 1년째 45안(98.2%), 2년째 44안(97.3%), 4년째 43안(94.6%), 8년째 40안(89.7%)이였다. 수술 후 합병증으로는 8안에서 녹내장이 발생하였으며, 반점각막이상증의 재발은 1안에서 관찰되었다. 결론: 반점각막이상증 환자에게 전층각막이식술은 장기간 관찰하여 시력 개선 효과와 높은 이식성공률을 기대할 수 있는 방법이다.
Abstract
Purpose: To report the long term clinical results of penetrating keratoplasty as a treatment for corneal macular dystrophy. Methods: Retrospective review of the medical record of 46 eyes (31 indivisuals) who underwent primary PK for corneal macular dystrophy at the Seoul St. Mary’s Hospital between November, 1986 and December, 2011. Data extracted preoperative and postoperative best-corrected visual acuity (BCVA), postoperative complications (including graft rejection episodes,and recurrent dystrophy), change of endothelial cell density at 1, 6, 12, 24, 36 months and yearly thereafter. Results: After a mean follow-up period of 91.59 ± 3.2 months, the mean BCVA was significantly improved after penetrating keratoplasty. Endothelial cell loss rate was marked during the 1st year after penetrating keratoplasty. Graft survival was 40graft (89.7%) at 8yrs. There was a statistically significant increased likelihood of graft failure if the patient was older than 40years at the time of surgery (p = 0.03). Glaucoma as postoperative complication was 17.4%. Clinically significant recurrence was 2%. Conclusions: Penetrating keratoplasty is associated with a good visual outcome and prognosis for graft survival of long-term efficacy with a low complication rate in eyes with macular corneal dystrophy.
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