황반부를 침범한 망막박리에서 술 후 중심와박리의 재유착 및 시력예후
Visual Prognosis and Foveal Reattachment After Reattachment Surgery in Macula-off Retinal Detachment
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목적: 황반부를 침범한 열공망막박리에서 성공적인 망막의 재유착 후 빛간섭단층촬영을 이용하여 수술방법과 술 전 인자에 따른 중심와 재유착의 시간적 경과를 관찰하고 시력예후에 대하여 알아보고자 하였다. 대상과 방법: 2006년 1월부터 2008년 8월까지 황반부를 침범한 열공망막박리 환자 중 술 후 12개월 이상 경과관찰이 가능하였고,안저검사상 망막이 성공적으로 재유착되었으며 빛간섭단층촬영을 시행한 47명, 47안을 대상으로 후향적인 연구를 시행하였다. 이 중30안은 공막돌륭술을 시행하였고 17안은 유리체절제술을 시행하였다. 술 전 및 술 후 1, 1.5, 3, 6, 12개월에 최대교정시력, 세극등현미경검사, 안저검사, 빛간섭단층촬영 등을 시행하였다. 결과: 수술방법의 비교에서 유리체절제술을 시행한 군에서 빛간섭단층촬영상 중심와 재유착시간이 공막돌륭술군보다 유의하게 짧았다(P＜0.05). 빛간섭단층촬영상 박리된 황반부 높이가 낮을수록 유의하게 최대교정시력이 좋았으나 중심와 재유착 시간과 시력 호전정도 사이에는 유의한 상관관계가 없었다. 결론: 빛간섭단층촬영은 성공적인 망막박리 수술 후 중심와박리의 유무를 알아보는데 유용하며 술 후 시력예후의 예측 및 황반부의변화를 알아보는데 유용할 것으로 생각된다.
Abstract
Purpose: To evaluate the visual prognosis and time course of the foveal reattachment according to operation methods and preoperative factors using optical coherence tomography (OCT) after successful reattachment surgery in cases of macula-off rhegmatogenous retinal detachment. Methods: From Jan 2006 to Aug 2008, 47 patients who underwent retinal reattachment surgery for macula-off retinal detachment who were followed up for more than 12 months were enrolled in this study. Thirty patients underwent vitrectomy, and 17 patients underwent a scleral buckle procedure. Ophthalmological examinations, including best-corrected visual acuity, slit-lamp examination,fundus examination, and OCT, were performed before surgery and at 1, 1.5, 3, 6, and 12 months after surgery. Results: The foveal reattachment time was shorter after vitrectomy than after the buckle procedure (p＜0.05). Postoperative visual acuity was better when the height of the detached fovea, as viewed by OCT, was shorter, although foveal reattachment time was not related to visual prognosis. Conclusions: OCT may help to predict visual outcome and to assess macular changes in patients with macula-off retinal detachment after successful reattachment surgery
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