양막을 이용한 재발 군날개수술에서 마이토마이신 C의 효과
Effectiveness of Mitomycin C Combined with Amniotic Membrane Transplantation to Treat Recurrent Pterygia
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목적: 재발 군날개수술에서 양막이식술을 시행한 경우, 수술 중 마이토마이신 C 사용의 효과를 알아보고자 하였다. 대상과 방법: 2007년 12월부터 2015년 7월 사이에 양막을 이용하여 수술받고, 술 후 12개월 이상 추적관찰이 가능했던 재발 군날개 환자 39명(40안)을 대상으로 의무기록을 후향적으로 분석하였다. 마이토마이신 C를 사용한 A군 22안, 사용하지 않은 B군 18안 간에 재발률과 합병증을 비교하였다. 결과: 평균 22.6개월의 경과관찰 기간 동안 A군에서는 22안 중 결막재발 2안, 각막재발이 4안(27.3%), B군은 18안 중 결막재발 4안, 각막재발이 3안(38.9%)으로, 두 군 간에 유의한 차이를 보이지 않았다(p=0.545). 수술 전에 검구유착이 있던 증례 5안 중에서 마이토마이신을 사용하지 않은 경우(2안)에는 수술 후 유착이 재발되었으나, 사용한 경우(3안)는 유착이 재발되지 않았다. 두 군 모두 괴사성공막염, 공막연화증, 각막궤양 등의 심각한 수술 후 합병증은 관찰되지 않았다. 결론: 양막이식술을 이용한 재발 군날개수술 시 마이토마이신 C를 술 중 보조요법으로 사용하면, 수술 후 군날개 재발을 유의하게 억제하지 못하였으나, 검구유착의 재발은 억제할 수도 있으리라 사료된다.
Abstract
Purpose: We evaluated a combination of intraoperative mitomycin C (MMC) and amniotic membrane transplantation (AMT) for treating recurrent pterygia. Methods: We retrospectively analyzed 40 eyes of 39 patients with recurrent pterygia who underwent AMT from December 2007 to July 2015 and who were followed-up for a minimum of 12 months. In all, 22 eyes received intraoperative MMC (group A) and 18 did not (group B). Recurrence rates and complications were compared between the two groups. Results: Conjunctival recurrence was noted in two and corneal recurrence was noted in four eyes of group A (27.3%); the figures for group B were four and three (38.9%). These recurrence rates were not significantly different (p = 0.545). In five cases with preoperative symblepharon, this condition recurred when MMC was not used (two eyes) but not when MMC was used (three eyes). No major complications such as necrotizing scleritis, scleromalacia, or corneal ulcer were observed in either group after surgery. Conclusions: Intraoperative adjunct MMC therapy did not significantly inhibit recurrence after AMT for treating recurrent pterygia but may reduce the recurrence rate of symblepharon.
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