특발성 황반원공 수술 중 안 내 공기충전술 후 3일간 독서자세만 취한 환자의 수술 결과
Surgical Outcomes of Taking a Reading Position after Air Tamponade in Idiopathic Macular Hole
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목적: 특발성 황반원공 환자의 유리체절제술과 안내가스충전술 후 일주일간 안면하자세를 취한 군과 액체공기교환술 후 독서자세를취한 군 간의 수술 후 원공폐쇄율과 평균시력을 비교하고자 한다. 대상과 방법: 특발성 황반원공 2, 3기로 진단 받은 환자 25안을 대상으로 하였다. 유리체절제술 중 액체공기교환술 후 14% C3F8 가스안내충전술 후 일주일간의 안면하체위를 시행한 군과 액체공기교환술 후 독서자세를 3일간 시행한 군의 수술 6개월 후 원공의 폐쇄율과 최대교정시력을 각각 비교하였다. 결과: 평균 원공의 크기는 1군과 2군에서 456.2 ± 164.1 μm, 411.2 ± 105.7 μm로 두 군 간의 통계적 차이는 없었고(p=0.647) 원공의폐쇄율은 수술 6개월째 1군에서 93%, 2군이 100%였다(p=0.616). 최대교정시력(logMAR)은 수술 전, 수술 6개월 후 1군의 경우 0.92 ± 0.35에서 0.82 ± 0.29였고 2군은 0.97 ± 0.33에서 0.71 ± 0.39로 두 군 모두 향상되었으나 두 군 간에 통계적 차이는 없었다(p=0.809, p=0.267). 결론: 특발성 황반원공 환자의 유리체절제술 중 액체공기교환술 후 3일간 독서자세만 취한 군의 6개월째 원공의 폐쇄율과 최대교정시력의 개선 정도가 안내가스충전술 후 1주일간 안면하자세를 취한 군과 비교해서 큰 차이가 없었다. 이 수술 방법을 통해 황반원공의수술 후 안면하자세로 인한 불편함을 경감시키는 데 도움이 될 수 있다고 생각한다.
Abstract
Purpose: In this study we compared the postoperative hole closure rate and average vision between a group who assumed a face-down position for a week using gas and a group who assumed a reading position after fluid air exchage (FAX), both after receiving internal limiting membrane (ILM) peeling during vitrectomy in patients with idiopathic macular hole. Methods: This study included 25 eyes of patients diagnosed with idiopathic macular hole that underwent vitrectomy. Group I assumed a face-down position for a week after intraocular gas tamponade after FAX during vitrectomy and Group II assumed a reading position for 3 days after only FAX. The hole closure rate and the best-corrected visual acuity (BCVA) were compared between the 2 groups 6 months postoperatively. Results: The preoperative mean macular hole size was 456.2 ± 164.1 μm in Group I and 411.2 ± 105.7 μm in Group II and the differences between the 2 groups were not statistically significant (p = 0.647). At 6 months after surgery, the macular hole closure rate was 93% in Group I and 100% in Group II (p = 0.571) and the BCVA (log MAR) was 0.82 ± 0.29 preoperatively and 0.92 ± 0.35 postoperatively in Group I and 0.71 ± 0.39 and 0.97 ± 0.33 in Group II, respectively. The differences between the 2 groups (p = 0.09, p = 0.058) were not statistically significant (p = 0.809, p = 0.267). Conclusions: There was no significant differences in the macular hole closure rate and BCVA improvement after 6 months in patients with idiopathic macular hole who had FAX during vitrectomy and maintained only a reading position for 3 days compared with those with gas tamponade and who maintained a face-down position for a week. This surgical method is considered helpful for easing discomfort caused by a face-down position after the macular hole surgery.
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