망막전막 환자에서 안저촬영검사를 이용한 망막검진의 효용성
Efficacy of Retinal Check-up Using Fundus Photography in Patients with Epiretinal Membrane
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목적: 안저촬영검사를 이용한 망막검진이 망막전막 환자의 수술 후 시력예후에 미치는 영향을 알아보고자 하였다. 대상과 방법: 2013년 1월부터 2019년 6월까지 본원에서 망막전막제거술을 받은 망막전막 환자 중 술 후 6개월 이상 경과 관찰이 가능하였던 환자들의 의무기록을 조사하였다. 시력과 관련된 증상의 호소 없이 안저촬영검사를 이용한 망막검진을 통해 망막전막을 진단받은 검진군(check-up group)과 시력저하 또는 변시증 같은 시력과 관련된 증상을 호소하여 안저촬영검사 등의 망막검사를 받고망막전막을 진단받은 검사군(work-up group)으로 나누고 최대교정시력, 빛간섭단층촬영검사 등을 비교하였다. 결과: 검진군 41안과 검사군 35안이 연구에 포함되었다. 수술 전 최대교정시력은 두 군 간에 차이가 없었으나(p=0.710), 빛간섭단층촬영검사에서 시세포 내외절경계부 결손은 검진군(14안, 34.1%)보다 검사군(24안, 68.6%)에서 보다 흔하게 관찰되었다(p=0.005). 수술6개월 이후에 최대교정시력은 검진군(0.07 ± 0.14 logMAR)이, 검사군(0.19 ± 0.19 logMAR)보다 유의하게 더 좋았으며(p=0.004), 나쁜 시력을 보인 비율도 검진군(2.4%)이 검사군(22.9%)보다 유의하게 낮았다(p=0.010). 결론: 본 연구는 망막검진이 망막전막을 조기에 발견하여 수술 후 시력예후에 도움을 줄 수 있음을 보여주었다. 본 연구의 결과는안저촬영검사를 이용한 망막검진의 필요성을 뒷받침한다.
Abstract
Purpose: To investigate whether retinal check-ups using fundus photography accurately predicted the visual outcomes of patients undergoing epiretinal membrane (ERM) removal. Methods: We reviewed the medical records of patients who underwent ERM removal by a single surgeon from January 2013 to June 2019. Patients were classified into two groups. The check-up group included patients who underwent fundus photography during their retinal check-ups, and were thus diagnosed with ERMs, even though they lacked any vision-related symptom. The work-up group included patients who underwent fundus photography to rule out retinal abnormalities, because they complained of vision-related symptoms such as decreased vision and metamorphopsia. The best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) findings were compared between the two groups before and 6 months after surgery. Results: The check-up group included 41 eyes and the work-up group 35 eyes. The preoperative BCVA did not differ significantly between the two groups (p = 0.710). However, the proportion of photoreceptor inner segment/outer segment (IS/OS) defects evident on OCT was significantly lower in the check-up than the work-up group (34.1% vs. 68.6%, p = 0.005). Six months after surgery, the BCVA was significantly better in the check-up group (0.07 ± 0.14 logMAR) than in the work-up group (0.19 ± 0.19 logMAR, p = 0.004) and the proportion of patients with poor visual acuity was also significantly lower in the check-up group (2.4%) than the work-up group (22.9%, p = 0.010). Conclusions: We found that a retinal check-up facilitates early detection of an ERM and improves the postoperative visual prognosis. This supports the necessity of fundus photography during retinal check-ups.
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