결막 뮬러근 절제술의 임상 결과와 수술 성공에 미치는 요인
Clinical Outcomes of Conjunctiva-Müller Muscle Resection and Factors Which Affect Success
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목적: 결막 뮬러근 절제술의 임상 결과를 알아보고 성공에 영향을 미치는 요인들에 대한 분석을 시행하였다. 대상과 방법: 2004년 2월부터 2010년 10월까지 본원에서 결막 뮬러근 절제술을 시행 받은 눈꺼풀처짐 환자 22명, 총 30안을 대상으로후향적 의무기록 분석을 시행하였다. 수술 전후 MRD1과 IPF, 동공에서 눈썹까지의 길이의 변화량과 수술 결과와 술 전 페닐에프린검사 결과와의 상관관계를 분석하였고, 조직 검사를 통해 근육의 존재와 결막 염증 유무를 조사하였다. 수술 성공은 단안의 경우 2mm 이상 올라갈 때 양안의 경우에는 양안 MRD1 차이가 1 mm 이하일 때로 정의하였다. 결과: 전체 수술 성공률은 93% (30안 중 28안)였으며, MRD1은 0.87 ± 1.16 mm에서 수술 후 2.35 ± 0.67 mm로 평균 1.47 mm 증가하였으며 이는 통계학적으로 유의한 차이를 나타냈다(p=0.00). 동공 눈썹간 거리는 유의한 변화가 없었다(p=0.872). 조직검사 결과 모든예에서 뮬러근이 관찰되었으며 14안에서 만성 상피하 염증이 관찰되었다. 결론: 결막 뮬러근 절제술은 경도 또는 중등도 눈꺼풀 처짐에서 안전하며 효과적인 수술법이다.
Abstract
Purpose: To investigate clinical outcomes and to analyze the factors of successful treatment of conjunctiva-Müller muscle resection (CMMR) in patients with mild to moderate ptosis. Methods: The medical records of 22 patients (30 eyes) with upper lid ptosis were retrospectively reviewed. All patients underwent conjunctiva-Müller muscle resections, and four patients (seven eyes) underwent concurrent upper lid blepharoplasty. The mean follow-up period was 81.62 ± 21 days. Pre- and post-operative MRD1, IPF and pupil to brow distance were measured using the Image J program. A preoperative phenylephrine test and a pathologic examination were performed to analyze the presence of Müller’s muscle and the tear secreting glands from the CMMR specimens. Results: The overall success rate of the procedure was 93%. Postoperatively, the MRD1 increased on average by 1.47 mm (p = 0.00) and increased by an average of 1.72 mm when the phenylephrine test response was greater than 2 mm and by 0.99 mm when the response less than 2 mm. The Müller muscle was observed in every specimen. Conclusions: Conjunctiva-Müller muscle resection is an effective and safe method for treating mild to moderate ptosis, for which the preoperative phenylephrine test result is the most important factor for surgical success.
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