망막동맥대혈관류 파열로 인한 황반부출혈에 대한 유리체절제술 후 임상결과
Clinical Results of Vitrectomy in Macular Hemorrhage From a Ruptured Retinal Artery Macroaneurysm
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목적: 망막동맥대혈관류 파열로 인한 황반부출혈로 유리체절제술을 받은 환자에서 빛간섭단층촬영 검사소견과 시력의 관계를 알아보고자 하였다. 대상과 방법: 망막동맥대혈관류에서 발생한 황반부출혈로 유리체절제술을 받은 환자를 대상으로 후향적 연구를 시행하였다. 술 후빛간섭단층촬영 소견과 시력의 관계를 분석하였다. 결과: 대상환자는 총 12명이었다. 수술 전 logMAR 시력은 1.7±0.8이었고 수술 후 0.6±0.5로 유의하게 향상되었다(p=0.004). 빛간섭단층촬영에서 술 전 중심와두께는 437.5±161.5 μm에서 술 후 3 개월째 252.8±84.9 μm로 유의하게 감소하였다(p=0.017). 술 후 유기화된 출혈이 많이 제거되어 중심와두께가 얇을수록 좋은 최종 시력을 나타냈다(p=0.048). 술 후 시력은 빛간섭단층촬영에서 중심와광수용체의 파괴가 관찰된 경우에 보존된 경우보다 불량하였다(logMAR: 1.4±0.4 vs 0.3±0.2, p=0.009). 결론: 망막동맥대혈관류 파열에 합병된 황반부출혈이 있었던 환자에서 유리체절제술 후 빛간섭단층촬영에서의 광수용체 보존 소견은좋은 시력 결과와 연관이 있었다.
Abstract
Purpose: To evaluate the relationship between postoperative optical coherence tomography (OCT) findings and visual acuity in patients who underwent vitrectomy for macular hemorrhage related to the rupture of a retinal artery macroaneurysm. Methods: A retrospective case review was conducted for patients who underwent vitrectomy for macular hemorrhage caused by a retinal arterial macroaneurysm. The relationship between postoperative OCT findings and visual acuity was analyzed. Results: This study included 12 patients whose preoperative mean best corrected visual acuity (BCVA) (logMAR) was 1.7±0.8and whose mean final BCVA was 0.6±0.5. These values were statistically different (p=0.004). Mean foveal thickness by OCT was 437.5±161.5 μm at the preoperative period and 252.8±84.9 μm three months postoperative, and this difference was statistically significant (p=0.017). As the foveal thickness decreased after removal of the remnant organized retinal hemorrhage in the postoperative period, BCVA improved at the final follow-up (p=0.048). According to the postoperative OCT, the photoreceptor disruption group presented a lower BCVA than that of the photoreceptor preservation group at the final follow-up (logMAR:1.4±0.4 vs. 0.3±0.2, p=0.009). Conclusions: Photoreceptor preservation as observed by OCT was significantly associated with better visual outcome after vitrectomy in patients with macular hemorrhage caused by rupture of a retinal arterial macroaneurysm.
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