내경계막절편술 및 삽입술을 이용한 황반원공수술의 장기 임상결과
Long-term Clinical Outcomes of Macular Hole Surgery Using Internal Limiting Membrane Flap or Insertion
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 특발성 황반원공에서 내경계막절편술 또는 내경계막삽입술의 장기간 결과를 분석하고, 두 수술 기법 사이의 결과를 서로 비교하고자 한다. 대상과 방법: 특발성 황반원공으로 내경계막절편술(절편술군, 9안) 혹은 내경계막삽입술(삽입술군, 8안)을 시행받은 17안을 대상으로 의무기록을 분석하였다. 각 군에서 술 전 시력을 최종추적 관찰 시의 시력과 서로 비교하였다. 추가적으로 양 군 사이에 외경계막 및 타원체구역 회복 빈도와 최종추적 관찰 시의 시력을 서로 비교하였다. 결과: 술 후 평균 추적 관찰 기간은 25.1 ± 13.7개월이었으며, 모든 안에서 황반원공이 폐쇄되었다. 전체 17안의 logarithm of minimal angle of resolution 시력은 술 전 평균 0.88 ± 0.23에서 최종추적 관찰 시 0.42 ± 0.23으로 유의하게 호전되었다(p<0.001). 절편술군(0.92 ± 0.25에서 0.37 ± 0.29, p=0.007)과 삽입술군(0.83 ± 0.19에서 0.48 ± 0.15, p=0.018) 모두에서 시력은 유의하게 호전되었다. 양 군 사이에 최종추적 관찰 시 시력에는 유의한 차이가 없었다(p=0.075). 외경계막 및 타원체구역의 회복 빈도는 절편술군에서 77.8% (7안)로 삽입술군의 12.5% (1안)에 비해 유의하게 높았다. 결론: 내경계막절편술과 삽입술은 황반원공 치료에 효과적인 방법으로 생각된다. 술 후 망막외층의 회복은 절편술군에서 더 나은 결과를 보였다. 두 수술 방법의 장기 시력결과에 대해서는 향후 보다 많은 안을 대상으로 한 연구가 필요할 것이다.
Abstract
Purpose: To evaluate the long-term outcomes of inverted internal limiting membrane (ILM) flap and ILM insertion in idiopathic macular hole (MH) and to compare the outcomes between the two techniques. Methods: We retrospectively reviewed the medical records of 17 eyes that underwent an inverted ILM flap procedure (flap group, n = 9) or ILM insertion procedure (insertion group, n = 8) for idiopathic MH. Within each group, best-corrected visual acuity (BCVA) before surgery was compared with that at the final follow-up. The BCVA at the final follow-up was compared between the two groups. In addition, the incidence of restoration of the external limiting membrane (ELM) and ellipsoid zone was evaluated. Results: The mean follow-up period was 25.1 ± 13.7 months after surgery. All MHs were closed after the surgery. In all 17 eyes, the logarithm of minimal angle of resolution BCVA had improved significantly from a mean value of 0.88 ± 0.23 before surgery to 0.42 ± 0.23 at the final follow-up (p < 0.001). The BCVA was significantly improved in both the flap group (from 0.92 ± 0.25 to 0.37 ± 0.29, p = 0.007) and the insertion group (from 0.83 ± 0.19 to 0.48 ± 0.15, p = 0.018). There was no significant difference in BCVA at the final follow-up between the two groups (p = 0.075). The incidence of restoration of the ELM and ellipsoid zone was significantly higher in the flap group (seven eyes, 77.8%) than in the insertion group (one eye, 12.5%). Conclusions: Both inverted ILM flap and ILM insertion are effective in MH treatment. The restoration of retinal outer layers was better in the flap group. Further studies with a larger study population are needed to evaluate the long-term visual outcomes of the two methods.
참고문헌 (17)
- Cho SC, "Five-year nationwide incidence of macular hole requiring surgery in Korea", Br J Ophthalmol, 103, pp.1619~1623 (2019)
- Ando F, "Anatomic and visual outcomes after indocyanine green-assisted peeling of the retinal internal limiting membrane in idiopathic macular hole surgery", Am J Ophthalmol, 137, pp.609~614 (2004)
- Mester V, "Internal limiting membrane removal in the management of full-thickness macular holes", Am J Ophthalmol, 129, pp.769~777 (2000)
- Michalewska Z, "Inverted internal limiting membrane flap technique for large macular holes", Ophthalmology, 117, pp.2018~2025 (2010)
- Morizane Y, "Autologous transplantation of the internal limiting membrane for refractory macular holes", Am J Ophthalmol, 157, pp.861~869 (2014)
- Park JH, "Comparative analysis of large macular hole surgery using an internal limiting membrane insertion versus inverted flap technique", Br J Ophthalmol, 103, pp.245~250 (2019)
- 김경호, "큰 황반원공에서 시행한 내경계막 자가이식술", 대한안과학회지, 56(12), pp.1899~1905 (2015), 대한안과학회
- 송동훈, "다층 속말림 내경계막 절편술을 이용한 크기가 큰 황반원공의 치료", 대한안과학회지, 59(5), pp.428~436 (2018), 대한안과학회
- Tommaso Rossi, "Autologous internal limiting membrane transplant for recurrent idiopathic macular holes", European Journal of Ophthalmology, 31(2), pp.656~663 (2021), SAGE Publications[DOI]
- Iwasaki M, "Influence of inverted internal limiting membrane flap technique on the outer retinal layer structures after a large macular hole surgery", Retina, 39, pp.1470~1477 (2019)
- Zhu K, "Comparison of the internal limiting membrane insertion technique and the inverted internal limiting membrane flap technique with vitrectomy to treat macular hole-associated retinal detachment", Retina, 41, pp.37~44 (2021)
- De Novelli FJ, "Autologous internal limiting membrane fragment transplantation for large, chronic, and refractory macular holes", Ophthalmic Res, 55, pp.45~52 (2015)
- Shiode Y, "The role of inverted internal limiting membrane flap in macular hole closure", Invest Ophthalmol Vis Sci, 58, pp.4847~4855 (2017)
- Rizzo S, "Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes : a comparative study in a large series of patients", Retina, 38, pp.S73~S78 (2018)
- Kang SW, "Outer foveolar defect after surgery for idiopathic macular hole", Am J Ophthalmol, 150, pp.551~557 (2010)
- Wakabayashi T, "Foveal microstructure and visual acuity in surgically closed macular holes : spectral-domain optical coherence tomographic analysis", Ophthalmology, 117, pp.1815~1824 (2010)
- 이지은, "Reorganization of Photoreceptor Layer on Optical Coherence Tomography Concurrent with Visual Improvement after Macular Hole Surgery", Korean Journal of Ophthalmology, 22(2), pp.137~142 (2008), 대한안과학회