유리체절제술 시행 후 각막내피세포밀도의 변화
The Change in Corneal Endothelial Cell Density after Pars Plana Vitrectomy
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목적: 유리체절제술 및 눈 속 가스 주입술이 각막내피세포밀도의 감소에 미치는 영향을 알아보고자 하였다. 대상과 방법: 유리체절제술을 시행한 145안을 대상으로 수술 전과 수술 3개월 후의 각막내피세포밀도를 측정하였다. 유리체절제술을 시행한 군(1군, 32안), 유리체절제술과 눈 속 가스주입술을 시행한 군(2군, 26안), 유리체절제술 및 초음파유화술을 시행한 군(3군, 34 안), 유리체 절제술, 초음파유화술 및 눈 속 가스주입술을 시행한 군(4군, 53안)으로 나누어 각 군 간 각막내피세포밀도 변화를 비교하 였다. 결과: 1군에 비해 2군의 각막내피세포밀도는 유의하게 감소하였으나(p=0.012), 3, 4군간 차이는 없었다(p=0.063). 2군에서 각막 중심 부에 고인 혈액성분 때문에 밀도가 감소하였을 것이라 생각하였으며, 이러한 6안을 제외한 후 1군과 비교 시 차이는 없었다. 2, 4군에 서 각막내피세포에 혈액성분이 묻어 있던 경우를 그렇지 않은 경우와 비교하면 각막내피세포밀도의 감소가 현저하였다(p＜0.001). 결론: 유리체절제술 후 눈 속 가스주입술을 시행할 때는 출혈 부위를 최대한 지혈하고, 유리체세척을 충분히 하여 혈액성분을 최소화 하는 것이 필요하다.
Abstract
Purpose: To assess the effect of pars plana vitrectomy and gas tamponade on corneal endothelial cell density. Methods: The corneal endothelial cell density in 145 eyes that underwent pars plana vitrectomy was examined with a noncontact specular microscope 3 months pre- and post-operation. The subjects were divided as follows: Group 1 (32 eyes) underwent pars plana vitrectomy, group 2 (26 eyes) underwent pars plana vitrectomy combined with gas tamponade, group 3 (34 eyes) underwent pars plana vitrectomy combined with phacoemulsification and group 4 (48 eyes) underwent pars plana vitrectomy combined with phacoemulsification and gas tamponade. The changes in corneal endothelial cell density between groups was compared. Results: The mean endothelial cell loss was more significant in group 2 than in group 1 (p = 0.012), and there was no difference between groups 3 and 4 (p = 0.063). However, after excluding 6 eyes that had blood in the center of the corneal endothelium as a result of being in the prone position following gas tamponade, the mean endothelial cell loss in group 2 was not less than in group 1. In eyes with blood in the corneal endothelium, endothelial cell loss significantly increased (p < 0.001). Conclusions: The results of this study suggest that ophthalmic surgeons should attempt to carefully control bleeding and sufficiently irrigate the vitreous during pars plana vitrectomy combined with gas tamponade.
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