공막 석회화 절제 가위를 이용한 미용적 결막절제술 후의 공막석회화 제거
Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy
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목적: 미용적 결막절제술 후 발생한 공막석회화에 대한 결막피판술 시행 시 Calcium plaque scissors를 이용하는 방식의 장점을 연구하고자 하였다. 대상과 방법: 미용적 결막절제술 후 발생한 공막석회화로 결막피판술을 받은 55안을 분석하였다. Surgical blade만을 이용한 30안을Group 1, Calcium plaque scissors를 이용한 25안을 Group 2로 하여 미백 수술 후 기간, 병변 크기, 수술 소요 시간, 전후 시력을비교하였다. 또한 추가적인 수술 시행 여부를 비교하고 전안부 빛간섭단층촬영계로 수술 전후 공막의 상태를 확인하였다. 결과: 55안은 결막피판술을 받을 때까지 3.9 ± 1.0년이 지났으며, 수술 후 5.2 ± 3.8개월까지 관찰되었다. 두 군에서 미백 수술 후기간 및 병변 크기는 차이가 없었다(p=0.87, 0.49). 수술 시간이 Group 2는 17.5 ± 6.3분으로 Group 1보다(21.9 ± 8.5분) 짧았다(p=0.03). 나안시력은 두 군에서 모두 수술 전후 유의한 차이가 없었다(p=0.53, p=0.20). Group 1에서만 공막이식수술이 1안,OlogenTM 삽입수술이 3안 시행되었다. 빛간섭단층촬영계 소견상 Calcium plaque scissors는 공막 손상을 최소화하면서 석회화 병변을 제거할 수 있는 방법으로 확인되었다. 결론: 미용적 결막절제술 후 발생한 공막석회화에 대해 결막피판술을 시행할 때 Calcium plaque scissors를 이용하여 제거하는 방법은 공막 손상을 최소화하여 추가 수술의 필요성을 줄여주었고, 수술시간을 단축하는 장점을 갖고 있다.
Abstract
Purpose: To research the advantage of using calcium plaque scissors in conjunctival flap surgery for calcified scleromalacia aftercosmetic conjunctivectomy. Methods: We analyzed 55 eyes that had undergone conjunctival flap surgery for calcified scleromalacia occurring after cosmeticconjunctivectomy. Surgical blade was used in 30 eyes (Group 1) and calcium plaque scissors in 25 eyes (Group 2). Time afterconjunctivectomy, plaque size, operation time and visual acuity before and after the flap surgery were analyzed and compared. Additionally, necessity of additional scleral surgery was evaluated. Optical coherence tomography (OCT) of the sclera was performedboth pre- and postoperatively and the results were compared. Results: An average of 3.9 ± 1.0 years elapsed until conjunctival flap surgery and follow-up time was 5.2 ± 3.8 months. Post conjunctivectomytime and plaque size were similar in both groups (p = 0.87 and 0.49, respectively). The surgery time in Group 2was shorter than in Group 1 (17.5 ± 6.3 minutes and 21.9 ± 8.5 minutes, respectively, p = 0.20). Uncorrected visual acuity wassimilar in both groups before and after conjunctival flap surgery (p = 0.53 and p = 0.20, respectively). In Group 1, one scleratransplantation and three OlogenTM insertion surgeries were performed as an additional scleral surgery. Based on OCT, calciumplaque scissors were confirmed as a new surgical tool for calcium plaque removal with minimal scleral damage. Conclusions: Using calcium plaque scissors when performing conjunctival flap surgery for calcium plaque removal that occurredafter cosmetic conjunctivectomy reduces the necessity of an additional scleral surgery and surgery time.
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