내경계막제거술 시 인도시아닌그린 최소 노출 후 임상양상
Clinical Outcomes of Minimal Exposure to Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 망막앞막 환자의 수술 중 내경계막 제거 시 인도시아닌그린(indocyanine green, ICG) 노출을 최소화한 후 ICG 미노출군과 ICG 최소 노출군의 수술 후 임상양상 차이를 비교하여 이를 평가하고자 하였다. 대상과 방법: 본원에서 망막앞막으로 유리체절제술을 시행 받은 33안을 대상으로 ICG 염색을 사용하여 내경계막 제거술을 시행한18안(ICG군), ICG 염색을 사용하지 않고 내경계막제거술을 시행한 15안(ND군)으로 나누었다. ICG 염색은 관류액을 잠근 상태에서0.25% 농도로 후극부 황반부위에 점적 후 3-5초 후 되쏘기 바늘로 제거하였다. 수술 전후 교정시력, 중심황반두께, 험프리 자동시야계의 동적시야검사, 시신경유두 주위 망막신경섬유층 두께의 차이가 있는지를 알아보았다. 결과: 수술 전과 수술 후 6개월에서 두 군 간에 교정시력, 중심황반두께, 망막신경섬유층 두께의 유의한 차이를 보이지 않았다(p=0.125 for visual acuity, p=0.734 for central macular thickness, p=0.615 for retinal nerve fiber layer [RNFL] thickness). ICG군에서는 수술 후 6개월째를 수술 전과 비교했을 때 의미 있는 시야 결손을 보이지 않았다(p=0.392). ND군에서는 수술 후 6개월째상측 시야의 의미 있는 호전을 보였다(p=0.042). 수술 후 6개월째 두 군 모두에서 이측 망막신경섬유층의 두께 감소가 관찰되었다(p=0.011 for ICG group, p=0.042 for ND group). 결론: ICG 염색 유무에 따라 수술 전후로 두 군 간 시력, 중심황반두께, 시야, 망막신경섬유층 두께의 유의한 차이를 보이지 않았다. 내경계막 제거 시 ICG 노출을 최소화함으로써 ICG 염색의 부작용을 줄일 수 있을 것으로 판단된다.
Abstract
Purpose: To evaluate the clinical outcomes of epiretinal membrane (ERM) surgery with minimal exposure to indocyanine green (ICG) dye-assisted internal limiting membrane (ILM) peeling compared with no ICG dye. Methods: We divided 33 eyes with ERM treated by vitrectomy into 2 groups. ICG dye was used in the first group of 18 eyes (ICG group) but not in the second group of 15 eyes (no dye [ND] group). In the ICG group, 0.25% diluted ICG dye was injected into the fluid-filled eye and removed with a back-flushing needle after 3-5 seconds to peel ILM. Value changes in several parameters including visual acuity, central macular thickness, Humphrey automated kinetic perimetric analysis, and peripapillary retinal nerve fiber layer (RNFL) thickness were followed up and compared according to ICG dye use. Results: No differences were found between the 2 groups in terms of visual acuity, central macular thickness, and peripapillary RNFL thickness preoperatively and at 6 months postoperatively (p = 0.125 for visual acuity, p = 0.734 for central macular thickness, p = 0.615 for RNFL thickness). Six months after surgery, no significant increase was found in any region of visual field in the ICG group (p = 0.392). The visual field was significantly increased in the superior region in the ND group (p = 0.042). The RNFL thickness in the temporal quadrant was significantly reduced at 6 months postoperatively compared to baseline values in both groups (p = 0.011 for ICG group, p = 0.042 for ND group). Conclusions: ICG dye-assisted ILM peeling does not aggravate clinical outcomes of ERM surgery in terms of visual acuity, central macular thickness, visual fields, or RNFL thickness and can be safely utilized with proper techniques.
참고문헌 (27)
- Klein R., "The epidemiology of epiretinal membranes", Trans Am Ophthalmol Soc, 92, pp.403~425 (1994)
- de Bustros S., "Vitrectomy for idiopathic epiretinal membranes causing macular pucker", Br J Ophthalmol, 72, pp.692~695 (1988)
- Machemer R., "The surgical removal of epiretinal macular membranes(macular puckers)", Klin Monbl Augenheilkd, 173, pp.36~42 (1978)
- Grewing R., "Results of surgery for epiretinal membranes and their recurrences", Br J Ophthalmol, 80, pp.323~326 (1996)
- Shimada H., "Double staining with brilliant blue G and double peeling for epiretinal membranes", Ophthalmology, 116, pp.1370~1376 (2009)
- Lee JE., "Toxicity of indocyanine green injected into the subretinal space : subretinal toxicity of indocyanine green", Retina, 23, pp.675~681 (2003)
- Da Mata AP., "Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair", Ophthalmology, 108, pp.1187~1192 (2001)
- Ando F., "Anatomic and visual outcomes after indocyanine green-assisted peeling of the retinal internal limiting membrane in idiopathic macular hole surgery", Am J Ophthalmol, 137, pp.609~614 (2004)
- Gass CA., "Functional outcome of macular hole surgery with and without indocyanine green-assisted peeling of the internal limiting membrane", Graefes Arch Clin Exp Ophthalmol, 241, pp.716~720 (2003)
- Uemura A., "Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green-assisted internal limiting membrane peeling", Am J Ophthalmol, 136, pp.252~257 (2003)
- Kanda S., "Visual field defects after intravitreous administration of indocyanine green in macular hole surgery", Arch Ophthalmol, 122, pp.1447~1451 (2004)
- Nagai N., "Surgical effects and complications of indocyanine green-assisted internal limiting membrane peeling for idiopathic macular hole", Acta Ophthalmol Scand, 85, pp.883~889 (2007)
- Sekiryu T., "Long-term observation of fundus infrared fluorescence after indocyanine green-assisted vitrectomy", Retina, 27, pp.190~197 (2007)
- von Jagow B., "Functional outcome of indocyanine green-assisted macular surgery : 7-year follow-up", Retina, 29, pp.1249~1256 (2009)
- Gandorfer A., "Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage", Am J Ophthalmol, 132, pp.431~433 (2001)
- Yam HF., "Effect of indocyanine green and illumination on gene expression in human retinal pigment epithelial cells", Invest Ophthalmol Vis Sci, 44, pp.370~377 (2003)
- Murata M., "The effect of indocyanine green on cultured retinal glial cells", Retina, 25, pp.75~80 (2005)
- Gandorfer A., "Retinal damage from indocyanine green in experimental macular surgery", Invest Ophthalmol Vis Sci, 44, pp.316~323 (2003)
- Haritoglou C., "Histology of the vitreoretinal interface after indocyanine green staining of the ILM, with illumination using a halogen and xenon light source", Invest Ophthalmol Vis Sci, 46, pp.1468~1472 (2005)
- 송병용, "특발황반원공에 있어 Indocyanine green 염색을 이용한 내경계막제거술", 대한안과학회지, 45(3), pp.15~15 (2004), 대한안과학회
- 이지은, "Indocyanine Green 염색을 이용한 내경계막 제거여부에 따른 황반원공 수술결과", 대한안과학회지, 44(11), pp.15~2559 (2003), 대한안과학회
- 남동흔, "인도사이아닌그린 염색을 이용한 내경계막 제거여부에 따른 특발성 황반원공 수술결과", 대한안과학회지, 45(7), pp.7~7 (2004), 대한안과학회
- Hillenkamp J., "Surgical removal of idiopathic epiretinal membrane with or without the assistance of indocyanine green : a randomised controlled clinical trial", Graefes Arch Clin Exp Ophthalmol, 245, pp.973~979 (2007)
- Wu Y., "Indocyanine green-assisted internal limiting membrane peeling in macular hole surgery : a meta-analysis", PLoS One, 7, pp.e48405~ (2012)
- Schmid-Kubista KE., "Comparison of macular function and visual fields after membrane blue or infracyanine green staining in vitreoretinal surgery", Graefes Arch Clin Exp Ophthalmol, 248, pp.381~388 (2010)
- Lee SB., "Longitudinal changes in retinal nerve fiber layer thickness after vitrectomy for epiretinal membrane", Invest Ophthalmol Vis Sci, 55, pp.6607~6611 (2014)
- Kim CY., "Visual field defect caused by nerve fiber layer damage associated with an internal limiting lamina defect after uneventful epiretinal membrane surgery", Am J Ophthalmol, 133, pp.569~571 (2002)