유리체절제술 중 0.025% Brilliant Blue G를 이용한 내경계막 제거
Internal Limiting Membrane Peeling Using 0.025% Brilliant Blue G During Vitrectomy
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목적: 유리체수술에서 내경계막 염색에 사용되는 0.025% Brilliant Blue G (BBG)에 대하여 알아보고자 한다. 대상과 방법: 2011년 1월부터 2013년 8월 사이 유리체절제술과 함께 0.025% BBG 용액을 사용하여 내경계막 제거술을 시행한 환자중 6개월 이상 경과관찰이 가능했던 111명의 의무기록을 후향적으로 분석하였다. 염색을 위한 용액은 BBG를 평형염액에 용해하여0.025%로 희석한 다음 0.22 μm 필터를 통과시켜 소독하여 준비하였다. 유리체절제술 중 유리체를 제거한 다음 황반부위 가까이 유리체강에 주사하여 내경계막을 염색하고 여분의 염색약은 즉시 흡입하여 제거하였다. 결과: 모든 증례에서 내경계막이 성공적으로 제거되어 다른 약제의 추가 사용이 필요하지 않았다. 평균 시력은 술 전 0.80 ± 0.44 (logMAR)에서 술 후 6개월째 0.40 ± 0.39 (p＜0.001)로 유의하게 호전되었다. 술 후 합병증으로 안내염과 시신경병증이 각각 1예가발생하였으나 같은 날 동일한 BBG 용액을 사용한 다른 환자에서는 합병증의 발생이 없어 BBG 용액의 사용과 연관성을 확인할 수없었다. 원발성 망막앞막 수술 6개월 후 술 전보다 두 줄 시력이 감소한 환자 1명이 관찰되었다. 그 외 BBG 용액의 사용과 관련이의심되는 합병증은 경과 관찰기간 동안 발견되지 않았다. 결론: 0.025% BBG 용액은 유리체절제술 중 내경계막을 염색하는 데 효과적이었으며 BBG 용액의 사용과 상관성이 확인된 합병증은 관찰되지 않았다.
Abstract
Purpose: To evaluate 0.025% brilliant blue G (BBG) for staining the internal limiting membrane (ILM) during vitrectomy. Methods: In a retrospective, non-comparative clinical case series, we analyzed consecutive 111 patients who underwent pars plana vitrectomy and removal of the ILM after staining using BBG solution. BBG was dissolved and diluted with balanced salt solution at a concentration of 0.025% and then sterilized by filtering through a 0.22 μm millipore filter. The prepared BBG solution was injected into the vitreous cavity over the macula after removal of the vitreous and excessive solution was removed immediately. Results: The ILM was successfully removed without use of additional adjuvant in all cases. Mean best corrected visual acuity (log MAR) was significantly improved from 0.80 ± 0.44 at baseline to 0.40 ± 0.39 at 6 months postoperatively (p < 0.001). One case each of endophthalmitis and diabetic papillopathy developed. The relationship when using BBG solution was not identified as complications were not observed in the other patients who underwent vitrectomy using the same BBG solution on the same day. One idiopathic epiretinal membrane patient had visual acuity loss more than 2 lines. During the follow-up period, other complications suspected to be associated with the use of BBG solution were not observed. Conclusions: A BBG solution (0.025%) was effective in staining the ILM for removal. Complications associated with the use of BBG solution were not observed.
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