백내장수술 중 낙하된 유리체내 수정체로 의뢰된 잔류수정체 제거술의 결과
Surgical Outcomes for Lens Fragments Dropped into the Vitreous Cavity during Cataract Surgery
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목적: 백내장수술 중 발생된 유리체내 수정체조각에 대해 임상양상과 수정체제거술의 결과를 알아보고자 하였다. 대상과 방법: 일차의원에서 백내장수술 중 발생된 유리체내 수정체조각으로 수술을 시행 받은 환자 22명 22안을 대상으로 낙하수정체의 관련인자, 임상양상, 술 후 시력결과 및 합병증을 후향적으로 분석하였다. 술 후 최종 스넬렌 시력 0.5 미만 군과 0.5 이상 군에서통계학적으로 유의한 차이를 보이는 인자를 조사하였다. 결과: 백내장수술 후 유리체절제술까지 평균 2.6 ± 3.7일이었으며 모두 1주 이내에 시행되었다. 술 후 최종 평균 시력은 0.57 ± 0.20이었고, 16안(72.7%)이 0.5 이상이었다. 기저안과질환이 있었던 환자(7안)를 제외하면 15안 중 14안(93.0%)에서 0.5 이상의 최종시력을보였다. 다변량분석 결과 술 후 0.5 이상의 시력을 나타내는 유의한 예후인자는 기저안과질환이 없는 경우(p=0.007)였다. 술 후 합병증으로 2안(9.0%)은 낭포황반부종이, 1안(4.5%)은 망막박리가 발생하였다. 결론: 수정체 낙하 후 1주 이내에 유리체절제술에 의한 잔류 수정체의 제거가 시행된다면 기저 안과질환이 없는 경우 좋은 수술결과를기대할 수 있다.
Abstract
Purpose: To assess the clinical features and outcomes of patients referred for management of dropped lens fragments during cataract surgery. Methods: The medical records of 22 eyes from 22 patients who were referred to our hospital to undergo pars plana vitrectomy (PPV) for management of dropped lens fragments after phacoemulsification surgery at private clinics were reviewed. Data including patient demographics, preoperative and postoperative visual acuity, factors associated with dropped lens fragment, and postoperative complications were recorded. The factors were compared between 2 patient groups: postoperative Snellen acuity of 0.5 or better and acuity less than 0.5. The statistical significances of differences in factors between the 2 groups were calculated. Results: The mean interval between cataract surgery and PPV was 2.6 ± 3.7 days. At the final examination, the mean postoperative acuity was 0.57 ± 0.20, and 16 eyes (72.7%) had a visual outcome of 0.5 or better. After excluding 7 eyes with other pre-existing ocular co-morbidities, 14 eyes (93.0%) achieved a final visual acuity of 0.5 or better. Multivariate analysis showed that the predictor for visual outcomes of 0.5 or better was absence of preoperative eye disease (p = 0.007). Complications after PPV included 2 (9.0%) cases of cystoid macular edema and 1 (4.5%) case of retinal detachment. Conclusions: Prompt referral and surgical management within 1 week for dropped lens fragments during cataract surgery may achieve a better visual outcome in cases with no pre-existing eye disease.
참고문헌 (29)
- 윤상철, "Cataract and Refractive Surgery in; a Survey of KSCRS Members From 1995~2006", Korean Journal of Ophthalmology, 23(3), pp.142~147 (2009), 대한안과학회
- Pande M, "Incidence of lens matter dislocation during phacoemulsification", J Cataract Refract Surg, 22, pp.737~742 (1996)
- Mahmood S, "Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: incidence and risk factors", Br J Ophthalmol, 92, pp.488~492 (2008)
- Murat Uyar O, "Vitreoretinal surgery for retained lens fragments after phacoemulsification", Eur J Ophthalmol, 13, pp.69~73 (2003)
- Soliman Mahdy M, "Intravitreal phacoemulsification with pars plana vitrectomy for management of posteriorly dislocated nucleus or lens fragments", Eur J Ophthalmol, 20, pp.115~119 (2010)
- Lai TY, "Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery", Eye (Lond), 19, pp.1157~1162 (2005)
- Olsson RB, "A retrospective study of patients with retained nuclear fragments after cataract extraction", Acta Ophthalmol Scand, 78, pp.677~679 (2000)
- Al-Khaier A, "Determinants of visual outcome after pars plana vitrectomy for posteriorly dislocated lens fragments in phacoemulsification", J Cataract Refract Surg, 27, pp.1199~1206 (2001)
- Kageyama T, "Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments", Br J Ophthalmol, 85, pp.1038~1040 (2001)
- Schwartz SG, "Retained lens fragments in resident-performed cataract extractions", CLAO J, 28, pp.44~47 (2002)
- Hansson LJ, "Vitrectomy for retained lens fragments in the vitreous after phacoemulsification", J Cataract Refract Surg, 28, pp.1007~1011 (2002)
- Kwok AK, "Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery", Clin Experiment Ophthalmol, 30, pp.399~403 (2002)
- Smiddy WE, "Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification", Am J Ophthalmol, 135, pp.183~187 (2003)
- Scott IU, "Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments", Ophthalmology, 110, pp.1567~1572 (2003)
- Stefaniotou M, "Timing of dislocated nuclear fragment management after cataract surgery", J Cataract Refract Surg, 29, pp.1985~1988 (2003)
- Greven CM, "Delayed visual loss after pars plana vitrectomy for retained lens fragments", Retina, 24, pp.363~367 (2004)
- Salam GA, "Retinal tears and retinal detachment as factors affecting visual outcome after cataract extraction complicated by posteriorly dislocated lens material", Retina, 25, pp.570~575 (2005)
- Merani R, "Pars plana vitrectomy for the management of retained lens material after cataract surgery", Am J Ophthalmol, 144, pp.364~370 (2007)
- Ho SF, "Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification", J Cataract Refract Surg, 33, pp.2106~2110 (2007)
- Chen CL, "Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification", Ophthalmologica, 222, pp.277~283 (2008)
- Ho LY, "Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction", Am J Ophthalmol, 147, pp.587~594 (2009)
- Chang Hyun Park, "Suture Fixation Technique for a Single-piece Foldable Closed-loop Intraocular Lens", Korean Journal of Ophthalmology, 22(4), pp.205~209 (2008), 대한안과학회
- 이성진, "LONG-TERM STABILITY AND VISUAL OUTCOMES OF A SINGLE-PIECE, FOLDABLE, ACRYLIC INTRAOCULAR LENS FOR SCLERAL FIXATION", RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES, 29, pp.91~97, Lippincott Williams & Wilkins
- 이성진, "후방인공수정체 탈구에 대한 반대방향 외부(ab externo) 공막고정술", 대한안과학회지, 48(10), pp.1341~1345 (2007), 대한안과학회
- Schulze-Bonsel K, "Visual acuities "hand motion" and "counting fingers" can be quantified with the freiburg visual acuity test", Invest Ophthalmol Vis Sci, 47, pp.1236~1240 (2006)
- Little J, "Lens antigens in the Intraocular tissues of the human eye", Arch Ophthalmol, 72, pp.820~825 (1964)
- Rahi AH, "Immunopathology of the lens. I. Humoral and cellular immune responses to heterologous lens antigens and their roles in ocular inflammation", Br J Ophthalmol, 61, pp.164~176 (1977)
- Wilkinson CP, "Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery", Ophthalmology, 108, pp.1633~1637 (2001)
- 정진권, "보조마취 없이 테논낭밑마취를 이용한 유리체 절제술", 대한안과학회지, 47(1), pp.48~54 (2006), 대한안과학회