안내 이물 제거의 접근방식에 대한 비교
Comparison of Approaches for the Removal of Metallic Intraocular Foreign Bodies
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목적: 금속성 안내 이물의 임상 양상과 치료에 대하여 알아보고, 접근방법을 비교하여 일차 수술 시 어떤 방법을 선택하는 것이 유용한지에 대하여 연구 하였다. 대상과 방법: 2003년 1월부터 2006년 12월까지 금속성 안내 이물을 동반한 안구천공 환자에서 수술적으로 제거한 49명 49안을 대상으로 의무기록을 후향적으로 분석하였다. 외적 접근에 의해 이물을 제거한 군 26안과 내적 접근에 의해 제거한 군 23안으로 나누어합병증 및 시력 개선에 대해 비교하였다. 결과: 49안 중 30안(61%)에서 시력 개선의 효과가 있었으며, 두 군 간에는 차이를 보이지 않았다. 수상 당시 유리체출혈, 안내염이동반되었을 때 외적 접근에 비해 내적 접근이 더 많이 시도되었다. 수술 후 안내염, 망막박리가 외적 접근에서 유의 있게 많이 발생하였으며, 재수술의 빈도는 안구 외적 접근에서 내적 접근에 비해 높았으나 통계적 유의성은 없었다. 결론: 금속성 안내 이물을 수술적으로 제거하는 것은 접근 방법과 무관하게 시력의 호전을 보였다. 수술 전에 심한 백내장, 유리체출혈,안내염 소견이 보이거나 수술 후 망막박리와 안내염의 위험 인자를 가지고 있는 경우에는 유리체절제술에 의한 내적 접근이 일차 수술로 고려되어야 할 것이다.
Abstract
Purpose: To review the management of posterior segment metallic intraocular foreign bodies (IOFB) and to compare the use of an external approach using a large electromagnet and an internal approach using vitrectomy and its tools for their removal. Methods: A retrospective review was performed on 49 eyes of 49 patients who underwent surgical removal of metallic IOFBs with either an internal or an external approach at a single institution between January 2003 and December 2006. We divided 49 eyes into two groups based on the type of approach: 26 external (n=26) and 23 internal (n=23). Visual acuity and the presence of any complications occurring with the two approaches were the main outcome measures studied. Results: Thirty of 49 eyes (61%) showed improvements in visual acuity. When we compared patients treated with an external versus an internal approach, we found no statistically significant difference in regard to visual outcome. Preoperative vitreous hemorrhage and endophthalmitis were more common in the internal approach group. A trend toward a higher rate of reoperation was more common in the external approach group, but they were not statistically significant. Postoperative complications found to be significantly different between the two groups were the rate of postoperative endophthalmitis and retinal detachment, which were more common in the external approach group. Conclusions: Surgical removal of metallic IOFBs results in significant visual improvement regardless of the approach method. The internal approach by vitrectomy is recommended as the first choice in preoperative conditions such as severe cataracts,vitreous hemorrhage and endophthalmitis, as well as in groups at high risk for postoperative endophalmitis and retinal detachment.
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