열공망막박리 환자에서 25게이지 플러스 시스템을 이용한 경결막유리체절제술의 결과
Surgical Outcomes of Transconjunctival 25-Gauge Plus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment
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목적: 열공망막박리의 일차적 수술 치료로서 25게이지 플러스를 이용한 경결막 유리체절제술의 치료 성적을 알아보고자 하였다. 대상과 방법: 본원에서 2013년 1월부터 2013년 5월까지 25게이지 플러스를 이용한 경결막 유리체절제술을 시행한 후 3개월 이상 경과관찰이 가능하였던 열공망막박리 환자 46명 46안을 대상으로 해부학적 및 기능적 성공률 및 합병증을 분석하였다. 결과: 남자 30명, 여자 16명이었고 평균 연령은 54.3세였다. 망막열공의 위치는 상측부 24안(52.2%), 하측부 15안(32.6%), 상하측 모두에 위치한 경우가 7안(15.2%)이었으며, 황반을 침범한 경우가 25안(54.3%), 황반을 침범하지 않은 경우는 21안(45.7%)이었다. 33안(71.7%)에서 과불화탄소(C3F8), 13안(28.3%)에서 실리콘 기름(1,300 cs 11안, 5,700 cs 2안)을 안내충전물로 사용하였으며, 평균수술시간은 48.8 ± 13.2분으로 18안(39.1%)에서 백내장 동시수술을 시행하였다. 술 후 3개월째 46안 중 45안(97.8%)에서 해부학적 성공을 보였으며, 최대교정시력은 술 전 logMAR 1.33 ± 1.20에서 logMAR 0.68 ± 0.94로 유의한 시력 향상을 보였다(p ＜0.001). 합병증으로 일시적 안압상승 6안(13.1%), 후낭혼탁 3안(6.5%) 등이 있었다. 결론: 열공망막박리에서 25게이지 플러스를 이용한 경결막 유리체절제술은 절개창의 크기를 줄이면서 기존의 수술법과 견줄 만한해부학적, 기능적 성공률을 거둘 수 있는 술식으로 판단된다.
Abstract
Purpose: To evaluate anatomical and visual results of transconjunctival 25‐gauge plus pars plana vitrectomy (PPV) in the managementof primary rhegmatogenous retinal detachment (RRD). Methods: A retrospective analysis of 46 eyes of 46 patients who underwent transconjunctival 25-gauge plus PPV for primaryRRD repair between January 2013 and May 2013 with a minimum of 3-month follow-up was performed. Data collected for thestudy included patient demographics, lens status, preoperative visual acuity, macular status, and location and number of primarybreaks. Main outcome measures were anatomical reattachment rate, postoperative visual acuity, operation time, and postoperativecomplications. Results: The study included 30 men and 16 women. The mean age of the patients was 54.3 years. The locations of retinal breakswere 24 (52.2%) eyes in the superior half, 15 (32.6%) eyes in the inferior half, and 7 (15.2%) eyes on both sides. The macula-onRRD was present preoperatively in 21 (45.7%) of 46 eyes. Of the 33 (71.7%) phakic eyes, 18 (39.1%) underwent combined phacoemulsification,intraocular lens implantation, and PPV. Two different tamponades, C3F8 gas and silicone oil were used in thisstudy. C3F8 gas was injected in the 33 (71.7%) eyes, and the remaining eyes were filled with silicone oil (1,300 centistokes for 11eyes, 5,700 centistokes for 2 eyes). Mean operation time was 48.8 ± 13.2 minutes. Retinal reattachment was achieved in 45(97.8%) of 46 eyes at 3 months. Mean best-corrected visual acuity improved from 1.33 ± 1.20 log MAR preoperatively to 0.68 ±0.94 log MAR postoperatively (p < 0.001). Postoperative complications included transient intraocular pressure elevation in 6(13.1%) eyes and posterior capsular opacity in 3 (6.5%) eyes. Conclusions: It seems that transconjunctival 25-gauge plus PPV can be a safe and effective option for surgical management of RRD.
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