특발 망막앞막에서 막제거술 과정 중 발생하는 중심와 견인
Intraoperative Foveal Traction in Patients with Epiretinal Membrane
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목적: 특발 망막앞막 환자에서 막제거술을 시행하는 과정에서 발생한 중심와 견인이 수술 결과에 미치는 영향에 대해 분석해 보고자 하였다. 대상과 방법: 2015년 2월부터 9월까지 본원에서 특발 망막앞막으로 진단받고 유리체절제술 및 막제거술을 시행받은 환자 46명 46안을 대상으로 후향적으로 분석하였다. 수술영상을 판독하여 막제거술 과정에서 중심와에 견인이 발생하였는지를 확인하였고, 술 전, 술 후 1개월, 3개월, 6개월, 12개월에 최대교정시력 및 빛간섭단층촬영상에서 중심망막두께, 중심오목형태, 시세포 내절/외절 상태의 변화를 조사하였다. 결과: 술 중 중심와 견인이 발생한 22안은 견인이 발생하지 않은 24안에 비해 술 전 볼록형 형태가 많았고 중심망막두께가 두꺼웠으며 술 전 시력이 낮았다. 술 후 6개월까지 견인이 발생했던 군에서 시력이 낮고 중심망막두께가 두꺼웠으나 12개월에는 두 군의 차이가 없었다. 술 후 황반의 형태가 편평형 또는 오목형으로 회복되는 기간은 견인이 발생한 군에서 5.4개월, 견인이 발생하지 않은 군에서 2.4개월이었다(p<0.01). 결론: 특발 망막앞막 환자에서 수술 전 중심망막두께가 두껍고 볼록형 형태일수록 막제거술 과정 중 중심와 견인이 발생할 가능성이 높으며, 막제거술 과정 중 중심와 견인의 발생 유무에 따른 장기적 시력 및 해부학적 결과는 차이가 없었다.
Abstract
Purpose: To determine influences of intraoperative foveal traction during membrane peeling in idiopathic epiretinal membrane (ERM) surgery. Methods: This retrospective observational study included 46 eyes of 46 patients with idiopathic ERM who underwent pars plana vitrectomy with ERM and internal limiting membrane peeling from February 2015 to September 2015. The presence of intraoperative foveal traction during membrane peeling was reviewed using video records. The main outcome measures were best-corrected visual acuity (BCVA), central foveal thickness (CFT), foveal contour, and photoreceptor inner segment/outer segment junction disruption using optical coherence tomography at baseline and at 1, 3, 6, and 12 months after surgery. Results: Group 1 (ERM with intraoperative foveal traction) included 22 eyes, and group 2 (ERM without intraoperative foveal traction) included 24 eyes. Preoperatively, convex pattern ERM was observed more often in group 1. Group 1 had a significantly thicker CFT and a lower BCVA compared to group 2 at baseline and during the first 6 months, but the final postoperative BCVA and CFT were not significantly different between the groups at 12 months. Among 22 eyes, 12 eyes (54.5%) were restored to flat or concave ERM patterns at an average of 5.4 months after surgery in group 1, and 18 out of 24 eyes (75%) recovered at 2.4 months (p < 0.01) in group 2. Conclusions: Preoperative thick CFT and convex pattern ERM indicated a high possibility of intraoperative foveal traction in idiopathic ERM surgery. There were no differences in long-term BCVA and restoration of foveal configuration according to foveal traction during membrane peeling.
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