23게이지 미세절개유리체절제술 후 안구 표면 pH의 단기 변화
Short-term Changes in Ocular Surface pH after 23-gauge Microincision Vitrectomy Surgery
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목적: 23게이지 미세절개유리체절제술 후 안구 표면 pH의 변화를 알아보고자 하였다. 대상과 방법: 23게이지 미세절개유리체절제술을 시행한 42명의 환자를 대상으로 후향적 연구를 시행하였다. 유리체절제술 전과 후의 최대교정시력과 안압을 측정했으며 안저검사, 컬러안저촬영, 빛간섭단층촬영을 시행하였다. 수술 후 1일에 결막부종의 등급에 대하여 평가를 시행하였으며 안구표면 pH는 미세전극이 연결된 pH 측정기를 이용하여 수술 전날부터 수술 후 5일까지 양안에 매일 1회 측정하였다. 결과: 총 42명, 42안이 대상 연구에 포함되었다. 평균 연령은 63.7세였으며 수술의 적응증으로는 망막전막이 14안(33.3%), 유리체출혈이 11안(26.2%), 황반원공이 11안(26.2%), 열공망막박리가 6안(14.3%)을 차지했다. 안구 표면 평균 pH는 수술 후 1일째에 7.12 ± 0.04에서 7.55 ± 0.04로 증가하였으나(p<0.001), 수술 후 2일째부터 7.41 ± 0.03으로 점차 감소하여(p<0.001), 3일째에 7.33 ± 0.04 (p<0.001), 4일째에 7.23 ± 0.03 (p<0.001)로 측정되었다. 수술 후 5일째 안구 표면 pH는 7.15 ± 0.03 (p=0.152)으로 더욱 감소하여 수술 전 상태로 회복되었다. 또한, 수술 후 1일째 안구 표면 pH와 결막부종의 등급은 통계적으로 유의한 상관관계를 보였다(p=0.001). 결론: 23게이지 미세절개유리체절제술 후 안구 표면 pH는 일시적으로 알칼리성 변화를 보이며 이는 결막부종, 눈 속 충전물 삽입과 유의한 상관관계를 보인다.
Abstract
Purpose: This study aimed to investigate changes in ocular surface pH after 23-gauge microincision vitrectomy surgery. Methods: This retrospective study included 42 patients who underwent 23-gauge microincision vitrectomy. Best-corrected visual acuity and intraocular pressure were measured. Fundus examination, color fundus photography, and spectral-domain optical coherence tomography were performed. Chemosis was evaluated once a day after surgery, and the ocular surface pH was measured using a microelectrode on the day before surgery and every day up to day 5 after surgery. Results: A total of 42 eyes in 42 patients were examined. The average age was 63.7 years. The indications for surgery included epiretinal membrane in 14 eyes (33.3%), vitreous hemorrhage in 11 eyes (26.2%), macular hole in 11 eyes (26.2%), and rhegmatogenous retinal detachment in six eyes (14.3%). Although the mean ocular surface pH increased from 7.12 ± 0.04 to 7.55 ± 0.04 on the first day after surgery (p < 0.001), it gradually decreased to 7.41 ± 0.03 from the second day postoperatively (p < 0.001). It was subsequently measured as 7.33 ± 0.04 on the third day (p < 0.001) and 7.23 ± 0.03 on the fourth day (p < 0.001) postoperatively. On the fifth postoperative day, the ocular surface pH further decreased to 7.15 ± 0.03 (p = 0.152) and recovered to the preoperative state. A statistically significant correlation was found between the change in ocular surface pH and the chemosis grade (p = 0.001). Conclusions: After 23-gauge microincision vitrectomy surgery, the ocular surface pH shifted temporarily in the alkaline direction within a physiological range correlated with chemosis and intravitreal tamponade usage.
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