외상으로 인한 안구 내 금속이물 처치에 대한 수술 결과 및 예후인자 분석
The Surgical Outcome of Metallic Intraocular Foreign Body due to Trauma
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목적: 외상으로 인한 안구 내 금속이물에 대한 수술 결과 및 시력 예후 인자에 대하여 연구하고자 한다. 대상과 방법: 2000년부터 2010년까지 안구 열상으로 인한 안구 내 금속이물로 수술 받은 47명 47안을 대상으로 후향적 의무기록을 조사하였다. 안구 열상의 위치 및 크기, 금속이물의 크기, 초진 시 임상양상, 수술방법, 최종시력을 조사하였으며 최종시력에 영향을 미치는 시력 예후인자를 분석하였다. 결과: 평균 나이는 45세였고 예초기로 인한 경우가 가장 많았다. 열상부위는 각공막 열상이 77%로 가장 많았고 초진 시 세극등검사상 전방출혈(72%)이 가장 많이 발견되었으며 안구 내 이물은 망막(38%)에 위치한 경우가 가장 많았다. 술 전 평균시력은 0.17 ± 0.49이었고 술 후 최종시력은 0.23 ± 0.39로 호전되었다. 초진시력이 좋은 경우(p=0.018), 금속이물이 전안부에 위치한 경우 양호한 시력예후를 보였고(p=0.001), 초진시력이 나쁘거나(p=0.010), 후안부 금속이물이 있는 경우(p=0.015), 안내염을 포함한 유리체 혼탁이 있는 경우(p=0.004) 시력예후가 불량하였다. 결론: 안구 내 금속이물이 발견되면 빠른 수술이 필요하며, 초진시력과 안구 내 이물의 위치가 시력예후의 중요한 인자가 될 수 있다.
Abstract
Purpose: To investigate the outcome of surgery for a metallic intraocular foreign body and prognostic factors for visual acuity. Methods: A retrospective chart review was performed on 47 eyes of 47 patients who underwent surgical removal of a metallic intraocular foreign body (IOFB) after eyeball laceration between 2000 and 2010. We investigated the location and size of eyeball lacerations, the location of IOFB, the clinical findings at initial examination, surgical methods and best corrected visual acuity. We analyzed the prognostic factors for final visual acuity. Results: The mean age was 45 years, and the most common cause of IOFB was lawnmower use. Cornea (77%) was the most frequently involved structure, and hyphema (72%) was the most common finding at initial slit lamp examination. Retina was the most common site of IOFB. The average visual acuity was 0.17 ± 0.49 before surgery, and the final visual acuity was 0.23 ± 0.39. Good visual prognosis was observed when the initial visual acuity was good or when the IOFB was located in the anterior segment, but the prognosis was poor when there was a vitreous opacity compromised with endophthalmitis at initial examination. Conclusions: An IOFB should be removed as soon as possible. Good initial visual acuity and anterior segment IOFB are good prognostic factors of visual outcome.
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