고도근시 열공망막박리 공막돌륭술의 해부학적 성공의 예후인자
Prognostic Factors of Anatomical Success in Scleral Buckling for High Myopic Rhegmatogenous Retinal Detachment
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목적: 고도근시 열공망막박리 환자의 공막돌륭술에서 해부학적 성공에 영향을 주는 인자를 알아보고자 하였다. 대상과 방법: 2009년 1월부터 2013년 10월 사이 안축장 26.0 mm 이상 혹은 -6.0디옵터 이하의 고도근시 환자들 중 열공망막박리로 공막돌륭술을 시행한 환자의 의무기록을 후향적으로 분석하였다. 백내장과 유리체절제술을 포함한 안내 수술 병력이 있는 환자는 대상에서 제외하였다. 해부학적 성공과 나이, 성별, 술 전 최대교정시력, 안축장, 큰열공 유무, 마제형 열공의 유무, 열공의 개수, 중심와 침범 여부 및 망막박리범위와의 연관성을 조사하였다. 결과: 80명 80안이 포함되었다. 평균 나이는 32.3 ± 13.4세, 평균 안축장 길이는 26.753 ± 0.961 mm였다. 총 69안(86.3%)에서 일차수술 후 성공적으로 유착되었다. 단일변수 로지스틱 회귀분석에서 나이(p=0.011), 큰 열공의 존재(p=0.002)와 마제형 열공(p=0.044) 의 존재가 해부학적 성공과 관련이 있었으며 다변수 로지스틱 회귀분석에서 나이만이 해부학적 성공에 영향을 미치는 단일 인자였다(odds ratio=1.086, 95% confidence interval=1.022-1.154, p=0.004). 결론: 고도근시 열공망막박리에서 공막돌륭술을 시행할 경우 나이가 어릴수록 일차수술 후 해부학적 재유착률이 높은 경향을 보였다. 고도근시 열공망막박리에서 나이가 어린 경우는 공막돌륭술을 우선적으로 고려할 수 있다.
Abstract
Purpose: To assess the prognostic factors associated with anatomical success of scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) in high myopia patients. Methods: The medical records of RRD in highly myopic eyes treated with SB from January 2009 to December 2013 were reviewed retrospectively. Cases with history of intraocular surgery including phacoemulsification and vitrectomy were excluded. Correlations between anatomical success and the parameters of age, sex, preoperative visual acuity, axial length, presence of large tear, presence of horseshoe tear, the number of tears, involved fovea, and extent of detachment were analyzed. Results: This study included 80 eyes of 80 patients. Average age and axial length were 32.3 ± 13.4 and 26.753 ± 0.961 mm, respectively. Sixty-nine eyes (86.3%) were reattached following primary surgery. Univariate analysis revealed that age (p = 0.011), presence of large tear (p = 0.002), and presence of horseshoe tear (p = 0.044) were correlated with anatomical success after SB. Based on multivariate logistic regression analysis, age was the sole independent prognostic factor (odds ratio = 1.086, 95% confidence interval = 1.022~1.154, p = 0.004). Conclusions: A younger age is associated with a higher rate of primary anatomical success of SB for RRD in highly myopic eyes. In young, highly myopic patients with RRD, SB should be considered as the primary procedure.
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