황반원공 수술 후 빛간섭단층촬영을 통한 황반구조의 회복과정
Recovery Course of Macular Structure after Macular Hole Surgery: Using a Spectral Domain Optical Coherence Tomography Image
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목적: 전층 황반원공으로 수술을 시행한 환자에서 빛간섭단층촬영을 이용하여 수술 후 황반폐쇄가 이루어지는 망막내 ․ 외층의 구조적변화를 통해 폐쇄단계를 추적하고 각 회복 과정에서 시력에 중요한 영향을 미치는 구조물에 대해 알아보고자 하였다. 대상과 방법: 2011부터 2014년까지 특발성 황반원공으로 수술 받은 34안을 대상으로 후향적으로 분석하였다. 수술 전, 수술 후 1, 3, 6, 12개월째 빛간섭단층촬영을 분석하여 원공이 남은 경우(H1,3,6,12), 외과립층까지 회복된 경우(O1,3,6,12), 외경계막까지 회복된 경우(E1,3,6,12), 시세포내외절경계선까지 관찰되는 경우(P1,3,6,12)로 나누어 시간에 따른 회복 과정을 확인하였으며, 각 단계별 시력변화와 회복 기간을 알아보았다. 또한 최종 경과일에 관찰된 망막내 ․ 외층의 최종 회복 정도에 따른 네 개의 군(H, O, E, P)의 특징과 시력변화를 분석하였다. 결과: 1년 동안 황반원공 폐쇄과정을 추적한 결과, 외과립층까지 회복되는 평균 기간은 1.85 ± 2.59개월, 외경계막까지 회복되는 평균기간은 3.78 ± 3.83개월이었고, 시세포내외절경계선까지 관찰되는 평균 기간은 7.40 ± 3.56개월이었다. 최종 경과일에 관찰된 회복상태를 기준으로 원공이 남은 군(H), 외과립층까지 회복된 군(O), 외경계막까지 회복된 군(E), 시세포내외절경계선까지 회복된 군(P)으로 나누어 비교한 결과, E와 P군이 H와 O군보다 유의하게 시력이 좋았다(p＜0.05). 또한 H군 이외 모든 군에서 12개월째 시력이술 전에 비해 유의하게 호전되었다(p＜0.05). 결론: 특발성 황반원공에서 수술 후 망막층의 회복 과정은 외과립층, 외경계막, 시세포내외절경계선 순으로 회복되었으며, 외경계막과시세포내외절경계선의 두 구조물 회복 여부가 시력 향상에 중요함을 알 수 있었다.
Abstract
Purpose: To analyze the recovery course of foveal microstructures and evaluate the important structures for visual improvement after vitrectomy for full thickness macular hole (MH) using optical coherence tomography (OCT). Methods: We retrospectively reviewed the medical records of 34 cases with idiopathic macular hole. We investigated the healing process of foveal microstructures and visual acuity pre- and post-operatively at 1, 3, 6, 12 months after surgery. We evaluated the integrity of four factors by OCT image: existence of MH (Hole, H1,3,6,12), recovery of outer nuclear layer (ONL, O1,3,6,12), recovery of external limiting membrane (ELM, E1,3,6,12), and recovery of inner segment-outer segment (IS/OS) line of the photoreceptor (Photoreceptor, P1,3,6,12). We compared the recovery course and visual acuity of the four groups based on postoperative 12 months. Results: The mean observed period was 1.85 ± 2.59 months at recovery of ONL, 3.78 ± 3.83 months at recovery of ONL and ELM, and 7.40 ± 3.56 months at recovery of ONL, ELM and IS/OS line. At postoperative 12 months, the best corrected visual acuity (BCVA) of Groups E and P were better than that of Groups H and O (p < 0.05). Except for group H, all groups had improved BCVA at postoperative 12 months compared to preoperative BCVA (p < 0.05). Conclusions: Recovery sequences of foveal microstructures were ONL, ELM and IS/OS line after vitrectomy for idiopathic MH. The most important structures for visual acuity were restorations of both ELM and IS/OS line.
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