재발 군날개 치료에 있어서 하측 구결막피판회전술의 치료 효과
The Effect of Inferior Conjunctival Transposition Flap for Recurrent Pterygium
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목적: 본 연구에서는 재발 군날개 치료에 있어서 하측 구결막피판회전술의 치료 효과를 알아보고자 하였다. 대상과 방법: 재발 군날개로 진단되어 하측 구결막피판회전술을 시행 받은 60명 63안을 대상으로 하였다. 재발된 섬유혈관조직을 절제한 뒤 하측 구결막에서 회전 피판을 만들어 섬유혈관조직이 제거되어 노출된 공막에 흡수성 봉합사(8-0 VICRYLⓇ)로 봉합하여 고정하였다. 수술 후 6개월 이상 경과관찰 가능했던 환자들을 대상으로 재발률 및 합병증을 후향적으로 조사하였다. 결과: 평균 경과관찰 기간은 5년 8개월(6개월-14년)로 63안 중 4안(6.3%)에서 각막 재발을 보였으며 2안(3.1%)에서 결막 재발이 있었다. 결막 재발을 보인 2안 중 1안은 윤부까지, 다른 1안은 피판 봉합부위에 국한되어 있었고 더 진행하지는 않았다. 각막 재발을 보인 1안에서 추가적인 결막붙음분리술과 자가결막이식술이 필요했다. 이 외 수술 후 초기에 피판의 울혈, 출혈 및 결막 육아종이 관찰되었으나 경과관찰 중에 호전되었다. 결론: 재발 군날개 치료법에 있어서 하측 구결막피판회전술은 효과적이고 안전한 수술법이라 생각된다.
Abstract
Purpose: In the present study, the effect of the inferior conjunctival transposition flap in patients with recurrent pterygium was evaluated. Methods: This study included 60 patients (63 eyes) that received pterygium surgery with inferior conjunctival transposition flap and diagnosed with recurrent pterygium. The inferior conjunctival transposition flap obtained from lower bulbar conjunctiva was secured with 8-0 VICRYL® after removal of recurrent fibrovascular tissues. This study was retrospectively reviewed for recurrence and postoperative complications in patients with a minimum follow-up period over 6 months. Results: The mean follow-up period was 5 years and 8 months (range; 6 months to 14 years). Corneal recurrence occurred in 4 eyes (6.3%) and conjunctival recurrence was observed in 2 eyes (3.1%) among a total of 63 eyes. Conjunctival recurrence was not the progressive type and limited to the limbus and suture site. One case of corneal recurrence required additional symblepharolysis and auto conjunctival graft. Although mild flap congestion, hemorrhage and granuloma were observed, these cases improved during the follow-up period. Conclusions: The inferior conjunctival transposition flap procedure can be regarded as an effective surgical treatment option for recurrent pterygium.
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