유리체출혈의 원인으로서의 망막열공과 열공망막박리의 비교 분석
Comparison between Retinal Tear and Rhegmatogenous Retinal Detachment as the Cause of Dense Vitreous Hemorrhage
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목적: 유리체출혈의 원인으로 망막열공의 임상양상을 분석하고 이를 단순 망막열공과 열공 망막박리로 나누어 그 차이점을 알아보고자 하였다. 대상과 방법: 2005년 1월부터 2009년 6월까지 본원에 내원하여 심한 비당뇨유리체출혈로 진단받고 유리체절제술을 받은 환자 중 망막 열공이 원인이었던 환자를 후향적으로 분석하여 이를 단순 망막열공군과 열공망막박리군으로 나누어 비교하였다. 결과: 총 134안 중 망막열공이 출혈과 관계된 경우는 27안(20.1%)이었으며, 단순 망막열공이 원인이었던 눈은 18안, 열공망막박리까지 진행된 경우는 9안이었다. 두 군간 나이, 성별, 좌 우 안의 비율, 술 전 시력은 유의한 차이가 없었으나, 증상에서 진단까지의 기간은 열공망막박리군이 유의하게 오래 걸렸다(p=0.035). 술 후 각군의 logMAR 시력은 0.30 ± 0.34과 1.27 ± 1.03로 단순 망막열공군에서 유의한 시력 향상을 보였다(p=0.002). 결론: 비당뇨유리체출혈에서 망막열공은 중요한 원인 중 하나이며 진단이 늦어질 경우 망막박리로 진행할 수 있으며 치료 후에도 시력 예후가 나쁘므로 조기에 좀 더 적극적인 검사와 수술적 치료가 필요하리라 생각된다.
Abstract
Purpose: To analyze retinal tears and to compare the clinical outcomes between retinal tear and rhegmatogenous retinal detachment (RRD) as the cause of dense non-diabetic vitreous hemorrhage in patients who underwent vitreoretinal surgery. Methods: In a retrospective case series, the medical records of patients who presented dense non-diabetic vitreous hemorrhage and who underwent vitreoretinal surgery between January 2005 and June 2009 were reviewed. Among the 134 patients, 27 patients had dense vitreous hemorrhage caused by retinal tears. The first group had retinal tears only and the second group had accompanying RRD. A comparison of clinical features and postoperative prognoses between the two groups was performed. Results: Among the 27 eyes with non-traumatic retinal tear and RRD, 18 were categorized into the retinal tear group and 9 to the RRD group. The demographic findings between the two studied groups exhibited no significant differences except for time between onset of symptoms and diagnosis. However, the time to diagnosis was significantly delayed in the group with RRD (22.67 ± 37.47 days) compared to the retinal tear group (5.00 ± 3.41 days) (p = 0.035). The amount of visual improvement was also greater in the retinal tear group than the RRD group (p = 0.002). Conclusions: Retinal tears are a major cause of non-diabetic vitreous hemorrhage. Vitreous hemorrhage caused by retinal detachment may result in delayed diagnosis and poor visual recovery. Therefore, early examinations in suspicion of RRD and appropriate treatments are needed in non-diabetic vitreous hemorrhage.
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