근시견인황반병증에서 유리체절제술 후 장기간 수술 결과
Long-term Outcomes of Vitrectomy Used to Treat Myopic Traction Maculopathy
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목적: 근시견인황반병증으로 유리체절제술 및 내경계막제거술을 받은 환자의 장기간 수술 결과를 알아보았다. 대상과 방법: 근시견인황반병증으로 유리체절제술을 받은 환자들의 의무기록을 후향적으로 분석하였고 첫 수술 시 황반원공 또는 망막박리가 동반된 경우는 제외하였다. 수술 전후 최대교정시력 및 중심망막두께를 분석하고 합병증 발병 여부를 확인하였다. 결과: 대상군은 총 23안(22명)이었고 첫 수술 시 평균 나이는 64.4 ± 11.1세였다. 술 전 평균 최대교정시력(logMAR)은 0.67 ± 0.50, 평균 중심망막두께는 431.8 ± 159.5 μm였고 술 후 평균 53.7 ± 19.3개월 경과 관찰하였다. 최대교정시력은 술 후 3, 6, 12, 24개월및 마지막 경과 관찰 시 0.42 ± 0.39, 0.41 ± 0.38, 0.39 ± 0.40, 0.42 ± 0.43, 0.51 ± 0.47로 모든 경과 관찰기간 동안 술 전에비해 유의하게 호전되었다(모두 p<0.05). 중심망막두께는 술 후 3, 6, 12, 24개월 및 마지막 경과 관찰 시 244.6 ± 72.3 μm, 210.5 ± 79.1 μm, 209.6 ± 91.6 μm, 219.8 ± 93.9 μm, 217.7 ± 81.3 μm로 모든 경과 관찰기간 동안 유의하게 감소하였다(모두 p<0.001). 18안(78.3%)은 일차 수술만으로 합병증 없이 중심와층간분리가 소실되고 마지막까지 안정적으로 유지되었다. 결론: 근시견인황반병증에서 유리체절제술 및 내경계막제거의 시행은 장기적으로 유의한 최대교정시력의 호전 및 해부학적 구조의안정화를 기대할 수 있다.
Abstract
Purpose: We investigated the long-term outcomes of vitrectomy with internal limiting membrane (ILM) peeling as treatment for myopic traction maculopathy (MTM). Methods: The medical records of patients who underwent vitrectomy to treat MTM were retrospectively evaluated. We excluded patients who exhibited macular holes (MHs) or retinal detachment at the time of primary surgery. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were analyzed preoperatively, at 3, 6, 12, and 24 months after surgery, and at the final visit. Complications including retinal detachment or an MH were noted during follow-up. Results: Twenty-three eyes of 22 patients were enrolled. At the time of primary surgery, the mean patient age was 64.4 ± 11.1 years and the baseline mean logMAR BCVA and CFT, 0.67 ± 0.50 and 431.8 ± 159.5 μm, respectively. The mean follow-up period was 53.7 ± 19.3 months. The mean logMAR BCVAs at 3, 6, 12, and 24 months postoperatively and at the final visit were 0.42 ± 0.39 (p = 0.001), 0.41 ± 0.38 (p = 0.001), 0.39 ± 0.40 (p < 0.001), 0.42 ± 0.43 (p < 0.001), and 0.51 ± 0.47 (p = 0.016), respectively, thus significantly better than the baseline value. The mean CFT at 3, 6, 12, and 24 months postoperatively and at the final visit were 244.6 ± 72.3, 210.5 ± 79.1, 209.6 ± 91.6, 219.8 ± 93.9, and 217.7 ± 81.3 μm, respectively, thus significantly less than baseline (all p < 0.001). MTM resolved in 18 eyes (78.3%) after primary surgery, without any complication, and remained stable to the final visit. Conclusions: Vitrectomy with ILM peeling afforded favorable long-term efficacy and safety in MTM patients.
참고문헌 (25)
- Edwards MH, "Myopia-historical perspectives and classification", Optician Sutton, pp.22~26 (1999)
- Zejmo M, "Etiopathogenesis and management of high-degree myopia. Part I", Med Sci Monit, 15, pp.RA199~RA202 (2009)
- Grossniklaus HE, "Pathologic findings in pathologic myopia", Retina, 12, pp.127~133 (1992)
- Takano M, "Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma", Am J Ophthalmol, 128, pp.472~476 (1999)
- Baba T, "Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia", Am J Ophthalmol, 135, pp.338~342 (2003)
- Panozzo G, "Optical coherence tomography findings in myopic traction maculopathy", Arch Ophthalmol, 122, pp.1455~1460 (2004)
- Shimada N, "Natural course of myopic traction maculopathy and factors associated with progression or resolution", Am J Ophthalmol, 156, pp.948~957.e1 (2013)
- Gaucher D, "Long-term follow-up of high myopic foveoschisis : natural course and surgical outcome", Am J Ophthalmol, 143, pp.455~462 (2007)
- VanderBeek BL, "The diversity of traction mechanisms in myopic traction maculopathy", Am J Ophthalmol, 153, pp.93~102 (2012)
- Johnson MW, "Myopic traction maculopathy: pathogenic mechanisms and surgical treatment", Retina, 32(Suppl 2), pp.S205~S210 (2012)
- Kobayashi H, "Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis", Ophthalmology, 110, pp.1702~1707 (2003)
- Ikuno Y, "Vitrectomy and internal limiting membrane peeling for myopic foveoschisis", Am J Ophthalmol, 137, pp.719~724 (2004)
- Qi Y, "Vitrectomy without inner limiting membrane peeling for macular retinoschisis in highly myopic eyes", Retina, 36, pp.953~956 (2016)
- Kwok AK, "Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis", Br J Ophthalmol, 89, pp.1180~1183 (2005)
- Kumagai K, "Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis", Retina, 30, pp.874~880 (2010)
- Taniuchi S, "Vitrectomy with or without internal limiting membrane peeling for each stage of myopic traction maculopathy", Retina, 33, pp.2018~2025 (2013)
- Shin JY, "Visual prognosis and spectral-domain optical coherence tomography findings of myopic foveoschisis surgery using 25-gauge transconjunctival sutureless vitrectomy", Retina, 32, pp.486~492 (2012)
- Gao X, "Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis", Am J Ophthalmol, 155, pp.1021~1027.e1 (2013)
- Lehmann M, "Preoperative factors influencing visual recovery after vitrectomy for myopic foveoschisis", Retina, 39, pp.594~600 (2019)
- Rizzo S, "Vitrectomy with internal limiting membrane peeling and air tamponade for myopic foveoschisis", Retina, 39, pp.2125~2131 (2019)
- Shimada N, "Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy", Am J Ophthalmol, 154, pp.693~701 (2012)
- Ho TC, "Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery", Retina, 32, pp.631~634 (2012)
- Figueroa MS, "Long-term outcomes of 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for myopic traction maculopathy : a prospective study", Retina, 35, pp.1836~1843 (2015)
- Panozzo G, "Vitrectomy for myopic traction maculopathy", Arch Ophthalmol, 125, pp.767~772 (2007)
- Ruiz-Medrano J, "Myopic maculopathy : current status and proposal for a new classification and grading system(ATN)", Prog Retin Eye Res, 69, pp.80~115 (2019)