자가윤부결막이식술을 이용한 군날개 제거술에서 결막하 섬유혈관 조직의 광범위절제술의 효과
Effectiveness of Wide Excision of Subconjucntival Fibrovascular Tissue with Conjunctivo-Limbal Autograft in Pterygium Surgery
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목적: 군날개제거술 및 자가윤부결막이식술을 시행한 환자에서 결막하 섬유혈관 조직의 광범위절제술을 시행한 경우와 시행하지 않은경우의 결과를 비교하였다. 대상과 방법: 자가윤부결막이식술을 이용한 군날개제거술을 받고 술 후 1년 이상 추적관찰이 가능했던 환자 59명 65안 중, 광범위절제술을 시행한 33명 36안과 시행하지 않은 26명 29안을 대상으로 재발여부, 합병증 및 수술시간 등을 조사하였다. 결과: 술 후 1년째, 두 군에서 모두 군날개의 재발은 관찰되지 않았다. 광범위절제술을 시행한 군에서 공여부위의 결막하 섬유화가 6안(17%), 공여부위의 결막하 신생혈관형성, 이식부위의 창상열개가 1안(3%)씩 관찰되었고, 시행하지 않은 군에서 공여부위의 결막하 섬유화 2안(7%), 공여부위의 육아종, 이식부위의 저류낭포가 1안(3%)씩 관찰되었다. 평균수술시간은 시행하지 않은 군에서 45.2 ± 6.9분으로 시행군의 62.4 ± 6.2분에 비해 유의하게 단축되었다. 결론: 군날개수술에서 자가윤부결막이식술을 시행할 경우, 결막하 섬유혈관조직의 광범위절제술은 시행하지 않은 군에 비해 수술시간은 더 길어지는 반면 재발률에는 차이가 없으므로 불필요하다고 생각된다.
Abstract
Purpose: To evaluate the efficacy of wide excision of subconjucntival fibrovascular tissue after conjunctivo-limbal autograft of primary and recurrent pterygium. Methods: Sixty-five eyes of 59 patients underwent pterygium excision with conjunctivo-limbal autograft. Thirty-six eyes of 33 patients had wide excision of pterygium, 29 eyes of 26 patients did not have wide excision of pterygium. All patients underwent follow-up for more than one year. Complications, recurrence rate, and operation time were evaluated. Results: With a minimum of one year of follow-up, there was no recurrence in either group. Six cases (17%) of subconjunctival fibrosis at the donor site, one case (3%) of subconjunctival neovascularization at the donor site, and one case (3%) of wound gapping at the recipient site were noted in the wide excision group. In the non-wide excision group, there were two cases (7%) of subconjunctival fibrosis at the donor site, one case (3%) of granuloma at the donor site, and one case (3%) of retention cyst at the recipient site. Mean operating time in the non-wide excision group (45.2 ± 6.9 minutes)was significantly shorter than that in the wide excision group (62.4 ± 6.2 minutes). Conclusions: Non-wide excision with conjunctivo-limbal autograft in pterygium surgery can be considered an effective treatment with shorter operating time than the wide excision method. Both of these methods show low recurrence rates and few complications for both primary and recurrent pterygia.
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