황반원공수술에서 내경계막제거술의 크기와 술 후 중심와조직 신장의 연관성
ILM Peeling Size and Postoperative Foveal Tissue Elongation in Macular Hole Surgery
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목적: 특발성 황반원공 환자에서 내경계막제거술의 크기와 중심와 조직의 신장(Elongation)과의 연관성을 알아보고자 하였다. 대상과 방법: 특발성 황반원공으로 유리체절제술, 내경계막제거술 및 가스주입술을 받은 후 시행한 빛간섭단층촬영에서 중심와 조직신장을 보인 29안을 대상으로 후향적으로 연구하였다. 내경계막제거술의 크기에 따라 2 disc diameter (DD)보다 작게 제거한 군(9안,A군), 2 DD보다 크고 혈관궁 경계보다 작게 제거한 군(12안, B군), 혈관궁 경계까지 제거한 군(8안, C군)으로 나누어 술 후 1개월,3개월, 18안에서는 술 후 6-8개월에 외망상층사이 거리를 측정하였다. 비대칭 신장은 외망상층사이 거리가 특정 방향으로 더 많이늘어난 정도로 정의하였다. 결과: 술 후 1개월에 수평과 수직 외망상층사이 거리는 B군, A군, C군 순으로 길었고, 각각의 거리는 436.58 ± 88.54 / 404.92 ±78.55, 421.33 ± 109.97 / 404.14 ± 120.9, 389.25 ± 48.75 / 400 ± 52.23 (μm)였다. 술 후 3개월까지 수평과 수직 거리의 증가값은 B군이 136.83 ± 65.64 / 103.92 ± 73.37, A군 88.11 ± 41.57 / 75.89 ± 53.18, C군이 140.25 ± 68.51 / 83.63 ± 56.62(μm)였다. 외망상층사이 거리, 거리의 변화량, 비대칭 신장은 수평방향과 수직방향 모두에서 3군 사이 유의한 차이는 없었다. 결론: 중심와 조직의 신장과 비대칭 신장은 내경계막제거술의 크기와 유의한 상관관계가 없었다.
Abstract
Purpose: To evaluate the relationship between the size of internal limiting membrane (ILM) peeling and the elongation of fovealtissue after macular hole (MH) surgery. Methods: The medical records of 29 patients (29 eyes) who developed elongation of foveal tissue on spectral domain optical coherencetomography (OCT) after vitrectomy with ILM peeling and gas tamponade for idiopathic MH were retrospectivelyreviewed. These eyes were classified into 3 subgroups by the size of ILM peeling: group A (9 eyes), smaller than 2 disc diameter(DD); group B (12 eyes), larger than 2 DD and within the major temporal vascular arcade, and group C (8 eyes), till the edge ofthe major temporal vascular arcade. Inter-outer plexiform layer (OPL) distance, representing elongation of foveal tissue, wasmeasured 1, 3, and 6-8 months (only 18 eyes) postoperatively. ‘Asymmetric elongation’ was defined as non-uniform elongationof the foveal tissue in certain directions. Results: Horizontal/vertical inter-OPL distances 1 month postoperative, in descending order, were: group B, 436.58 ± 88.54 /404.92 ± 78.55 μm; group A, 421.33 ± 109.97 / 404.14 ± 120.9 μm; and C group, 389.25 ± 48.75 / 400 ± 52.23 μm. Variations inthe horizontal/vertical inter-OPL distance 3 months after MH surgery were: group B, 136.83 ± 65.64 / 103.92 ± 73.37 μm; groupA, 88.11 ± 41.57 / 75.89 ± 53.18 μm; and group C, 140.25 ± 68.51 / 83.63 ± 56.62 μm. There were no significant differences ininter-OPL distance, variation in inter-OPL distance, or percent asymmetry in both horizontal and vertical directions among thesegroups. Conclusions: Elongation of the foveal tissue and asymmetric elongation after MH surgery were not associated with the size ofILM peeling.
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