원발 군날개절제술 후 영구양막이식술과 일시양막이식술의 비교
Comparison of Permanent Amniotic Membrane Transplantation and Temporary Amniotic Membrane Patch after Primary Pterygium Excision
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목적: 원발군날개에서 군날개절제술 후 영구양막이식술(1군)과 일시양막이식술(2군)을 시행한 경우의 임상성적과 재발률, 재발영향인자를 비교해보고자 하였다. 대상과 방법: 양막이식수술을 시행한 원발군날개 139안 중 1군 66안(T1/T2/T3: 0/32/34안)과 2군 73안(T1/T2/T3: 2/42/29안)을 대상으로재발 정도를 평가하였다. G0/G1은 수술성공으로, 재발은 G2(결막재발)와 G3(각막재발)로 나누었다. 성별, 나이, 수술 전 분류, 군날개의 수평 ․ 수직길이와 각막침범크기, 상피재생완료일 등에 따라 재발률에 차이가 있는지 분석하였다. 결과: 임상적 재발인 G2/G3가 1군에서 3(4.5%)/1(1.5%)안, 2군에서 4(5.5%)/2(2.7%)안이었다. 임상적 재발(G2/G3)의 경우 1군(6.1%)이2군(8.2%)에 비해 낮았으나 통계적 유의성은 없었다(p=0.62). Cox 비례위험 생존 회귀분석에서 G2이상의 재발에는 1군, 2군 모두 위험인자가 없었다. 결론: 본 연구에서 T3안이 1군에 상대적으로 많이 포함된 점을 고려할 때 영구양막이식술이 일시양막이식술에 비해 군날개의 재발률을다소 낮추는 경향을 보였으나, 두 군 간의 임상적 재발의 유의한 차이는 확인되지 않았다.
Abstract
Purpose: To compare the clinical results, recurrence rates, and recurrence-related risk factors of permanent amniotic membrane transplantation (PAMT, group 1) and temporary amniotic membrane patch (TAMP, group 2) after excision of primary pterygium. Methods: Recurrence grades were evaluated for 66 eyes (T1, T2, and T3; 0, 32, and 34 eyes, respectively) in group 1 and 73 eyes (T1, T2, and T3; 2, 42, and 29 eyes, respectively) in group 2. Surgical results were classified into surgical success (G0 or G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender,age, Tan’s preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, and epithelial healing time. Results: In the postoperative grading, 3 eyes (4.5%) and 1 eye (1.5%) in group 1, and 4 eyes (5.5%) and 2 eyes (2.7%) in group 2 were graded as clinically recurrence-occurred G2 and G3, respectively. There was no statistically significant difference in recurrence-occurred G2 and G3 cases between the two groups (p = 0.62). No risk factors of clinically significant G2 and G3 recurrence were identified in either group by Cox proportional hazards survival regression analysis. Conclusions: The results of the present study suggest that PAMT tends to lower the recurrence rate compared to TAMP because the PAMT group had more T3 eyes than the TAMP group, although the two groups showed no statistically significant difference in clinically significant recurrence after pterygium excision.
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