운동장애를 동반한 재발군날개에서 자가윤부결막이식술 후 안구운동진폭 변화
Changes in Eye Movement Amplitude after Conjunctivo-Limbal Autograft in Patients with Recurrent Pterygium, Ocular Motility Restriction
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목적: 운동장애를 동반한 재발군날개 치료에 있어서 결막 후전 및 자가윤부결막이식술 후 안구운동진폭의 변화를 알아보고자 하였다. 대상과 방법: 2011년 1월부터 2019년 12월까지 본원에서 안구운동장애를 동반한 재발군날개로 진단받고 자가윤부결막이식술을 시행한 후 6개월 이상 추적 관찰이 가능하였던 16명 18안을 대상으로 수술 전후 안구운동진폭, 최대교정시력, 나안시력, 각막난시, 각막곡률치 변화와 재발률 및 합병증을 후향적으로 조사하였다. 결과: 환자의 평균 나이는 63.9 ± 9.7세였고, 안구운동진폭은 수술 전 5.80 ± 1.70 mm에서 수술 후 7.02 ± 1.37 mm로 유의하게 증가하였다(p<0.001). 평균 나안시력(logMAR)은 수술 전 0.67 ± 0.46에서 수술 후 0.36 ± 0.35로 증가하였다(p<0.001). 평균 각막난시는 수술 전 3.51 diopters (D)에서 수술 후 1.22 D로 감소하였고(p=0.001). 난시벡터 분석 시 M, B는 수술 전과 비교하여 유의하게 감소하였으나 J0와 J45의 변화량은 유의하지 않았다. 군날개의 재발은 없었다. 결론: 운동장애를 동반한 심한 재발군날개 환자에서 안구운동진폭은 임상에서 정량적으로 안구운동 범위를 측정할 수 있고, 재발군날개의 중증도 판별과 수술 결과 예측에 적용될 수 있다고 생각한다. 자가윤부결막이식술은 술자의 숙련된 경험과 기술이 필요하며, 수술 시간이 오래 걸리는 단점이 있지만 유착으로 인한 안구운동장애를 해결할 수 있으며, 재발률도 낮아 안전하고 효과적인 수술법이라 생각된다.
Abstract
Purpose: To investigate changes in eye movement amplitude after conjunctival recession and conjunctivo-limbal autograft for treating recurrent pterygium with ocular motility restriction. Methods: We retrospectively analyzed 18 eyes of 16 patients who had recurrent pterygium with ocular motility restriction, who had received conjuntivo-limbal autografts from January 2011 to December 2019 and who had been followed-up for more than 6 months. We evaluated changes in eye movement amplitude, best corrected visual acuity, uncorrected visual acuity, corneal astigmatism and keratometry, and recurrence and complication rates before and after surgery. Results: The mean age of the patients was 63.9 ± 9.7 years. Eye movement amplitude increased significantly from 5.80 ± 1.70 mm preoperatively to 7.02 ± 1.37 mm postoperatively (p < 0.001). The mean UCVA increased from 0.67 ± 0.46 preoperatively to 0.36 ± 0.35 postoperatively (p < 0.001). The mean corneal astigmatism decreased from 3.51 diopters (D) preoperatively to 1.22 D postoperatively (p = 0.001). According to the power vector analysis, M and B were significantly reduced after the surgery, but the changes in J0 and J45 were not significant. No recurrence of pterygium was observed. Conclusions: Eye movement amplitude for severe recurrent pterygium with symblepharon or ocular motility restriction quantitatively measured the range of ocular movement clinically and was applied to determine the severity of recurrent pterygium and predict the surgical outcome. Conjunctivo-limbal autograft for severe recurrent pterygium is thought to be a safe and effective surgical method because it solves the ocular motility restriction caused by adhesions and has low recurrence rates, although it requires the skilled experience and techniques of the operator and a long operation time.
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