양쪽머리 군날개의 수술적 치료에 대한 임상연구
Clinical Research on Surgical Treatment for Double-Head Pterygium
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목적: 양쪽머리 군날개(double-head pterygium)의 수술방법 중 양막이식술과 자가결막 분리이식술(split-conjunctival grafts)을 시행하여 수술 결과 및 재발률을 알아보고자 한다. 대상과 방법: 양쪽머리 군날개환자 14명 16안을 대상으로 군날개 절제술 후 양막이식술을 시행한 6명 7안과 자가결막 분리이식술을시행한 8명 9안을 술 후 군날개 재발유무와 시술에 따른 합병증을 비교 관찰하였다. 결과: 양막이식술군은 술 후 평균 21.9±3.5개월 추적관찰 기간 중 총 2안(29%)에서 각막재발, 3안(43%)에서 결막재발이 있었고 모두비측 부위에서 재발하였다. 각막재발까지의 평균 기간은 7.2±1.8개월이었다. 자가결막 분리이식술군은 술 후 평균 13.6±2.1개월 추적관찰 기간 중 모든 예에서 결막이나 각막재발은 관찰되지 않았고 미용적으로 안정적이었으나 1안에서 결막 공여부위에 가성군날개가발생하였다. 결론: 자가결막이식술이 금기되지 않는 양쪽머리 군날개의 수술적 치료로 양막이식술보다는 자가결막 분리이식술이 재발률을 낮출수 있고 미용적으로도 우수한 수술방법으로 사료된다.
Abstract
Purpose: To evaluate two surgical methods-amniotic membrane transplantation (AMT) and split-conjunctival grafts (SCG)-for double-head pterygium, with regard to the postoperative outcome and recurrence rate. Methods: In a total of 16 eyes (14 patients), 7 eyes (6 patients) receiving amniotic membrane transplantation and 9 eyes (8 patients)receiving split-conjunctival grafts were compared to evaluate recurrence and complications. Results: Within the amniotic membrane transplantation group, two eyes (29%) had corneal recurrence, and 3 eyes (43%) had conjunctival recurrence. The mean follow-up period was 21.9±3.5 months, and all recurrences were on the nasal side. The average period preceding the corneal recurrences was 7.2±1.8 months. Within the split-conjunctival grafts group, the mean follow-up was 13.6±2.1 months, and neither the corneal nor conjunctival recurrences were observed. In addition, the eyes of this group were more aesthetically stable, with only one eye exhibiting pseudo-pterygium at the donor site. Conclusions: In cases of double-head pterygium without contraindication of conjunctival autograft, the split-conjunctival grafts produced fewer recurrences and showed enhanced cosmetic results, as compared to the amniotic membrane transplantation,indicating that the split-conjunctival grafts is the superior choice over amniotic membrane transplantation.
참고문헌 (27)
- Kenyon KR, "Conjunctival autograft transplantation for advanced and recurrent pterygium", Ophthalmology, 92, pp.1461~1470 (1985)
- Prabhasawat P, "Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision", Ophthalmology, 104, pp.974~985 (1997)
- Sanchez-Thorin JC, "Meta-analysis on the recurrence rates after bare sclera resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium", Br J Ophthalmol, 82, pp.661~665 (1998)
- Ma DH, "Aminotic membrane graft for primary pterygium: comparision with conjunctival autograft and topical mitomycin C treatment", Br J Ophthalmol, 84, pp.973~978 (2000)
- Hirst LW, "Prospective study of primary pterygium surgery using pterygium extended removal followed by extended conjunctival transplantation", Ophthalmology, 115, pp.1663~1672 (2008)
- Solomon A, "Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia", Ophthalmology, 108, pp.449~460 (2001)
- Avisar R, "Outcome of double-head pterygium surgery", Cornea, 22, pp.501~503 (2003)
- Maheshwari S, "Split-conjunctival grafts for double-head pterygium", Indian J Ophthalmol, 53, pp.53~55 (2005)
- Wu WK, "Surgical management of double-head pterygium by using a novel technique: conjunctival rotational autograft combined with conjunctival autograft", Cornea, 26, pp.1056~1059 (2007)
- Rubinfeld RS, "10) Rubinfeld RS, Pfister RR, Stein RM, et al. Serious complications of topical mitomycin C after pterygium surgery", Ophthalmology, 99, pp.1647~1654 (1992)
- Safianik B, "Serious corneoscleral complications after pterygium excision with mitomycin C", Br J Ophthalmol, 86, pp.357~358 (2002)
- Ti SE, "Tectonic corneal lamellar grafting for severe scleral melting after pterygium surgery", Ophthalmology, 110, pp.1126~1136 (2003)
- Wan Norliza WM, "Scleral melting 16 years after pterygium excision with topical Mitomycin C adjuvant therapy", Cont Lens Anterior Eye, 29, pp.165~167 (2006)
- 장지훈, "양막 이식을 이용한 군날개의 치료 효과", 대한안과학회지, 46(4), pp.597~604 (2005), 대한안과학회
- Katircioglu YA, "Comparison of three methods for the treatment of pterygium: amniotic membrane graft, conjunctival autograft and conjunctival autograft plus mitomycin C", Orbit, 26, pp.5~13 (2007)
- Kim YI, "Ocular surface reconstruction with amniotic membrane transplantation in pterygium", J Korean Ophthalmol Soc, 40, pp.1178~1183 (1999)
- Kim MJ, "Treatment of pterygium with amniotic membrane transplantation", J Korean Ophthalmol Soc, 39, pp.59~64 (1998)
- Tananuvat N, "The results of amniotic membrane transplantation for primary pterygium compared with conjunctival autograft", Cornea, 23, pp.458~463 (2004)
- Hirst LW, "The treatment of pterygium", Surv Ophthalmol, 48, pp.145~180 (2003)
- John T, "Pterygium excision and conjunctival mini-autograft: Preliminary report", Eye, 15, pp.292~296 (2001)
- Dupps WJ Jr, "Narrow-strip conjunctival autograft for treatment of pterygium", Ophthalmology, 114, pp.227~231 (2007)
- Coroneo MT, "The pathogenesis of pterygia", Curr Opin Ophthalmol, 10, pp.282~288 (1999)
- 윤경철, "익상편에서 파이브린 글루를 이용한 자가결막이식술", 대한안과학회지, 47(2), pp.198~204 (2006), 대한안과학회
- Koranyi G, "Cut and paste: a no suture, small incision approach to pterygium surgery", Br J Ophthalmol, 88, pp.911~914 (2004)
- Uy HS, "Comparison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision", Ophthalmology, 112, pp.667~671 (2005)
- Hyun Ho Kim, "Conjunctivolimbal Autograft Using a Fibrin Adhesive in Pterygium Surgery", Korean Journal of Ophthalmology, 22(3), pp.147~154 (2008), 대한안과학회
- Dolezalova V, "Is the occurrence of a temporal pterygium really so rare?", Ophthalmologica, 174, pp.88~91 (1977)