가성층판황반원공형 망막전막에서 내경계막 제거의 효과
The Effect of Internal Limiting Membrane Peeling in Epiretinal Membrane Including Pseudolamellar Macular Hole
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목적: 가성층판황반원공형 망막전막 환자에서 망막전막제거술과 동시에 내경계막제거술을 시행한 경우의 시력예후를 알아보고자 하였다. 대상과 방법: 가성층판황반원공형 망막전막으로 진단받은 27안 중에서 유리체절제술 및 가스충전술을 시행하여 술 후 7일간 안면하체위를 하였고, 14안은 망막전막제거술만, 13안은 내경계막제거술도 동시에 시행하였다. 내경계막제거에 따라 두군으로 나누어 술전과술후 12개월 최대교정시력과 빛간섭단층촬영 소견을 후향적으로 조사하여 비교하였다. 결과: 해부학적 폐쇄는 망막전막제거술만 시행한 경우 14안 중 11안(78.6%), 내경계막제거술도 시행한 경우 13안 중 12안(92.3%)으로높은 성공률을 보였다. 망막전막제거술만 시행한 경우 수술 전, 후 시력이 0.41 ± 0.31 (logMAR)에서 0.33 ± 0.21로 호전되었으나통계학적으로 유의하지 않았고, 내경계막제거술을 시행한 경우 0.46 ± 0.41에서 0.28 ± 0.25로 유의한 결과를 보였다(p=0.001). 결론: 가성층판황반원공형 망막전막에서 유리체절제술 및 가스충전술 시행시 망막전막제거술과 동시에 내경계막제거술을 시행한 경우 유의한 시력호전을 보이며 해부학적 및 기능적 성공에 영향을 미친다고 볼 수 있다.
Abstract
Purpose: To report the effect and visual improvement of internal limiting membrane (ILM) peeling, and epiretinal membrane (ERM) peeling in symptomatic ERM with pseudolamellar macular hole. Methods: This study included 27 eyes in 26 consecutive patients with ERM including pseudolamellar macular hole that underwent vitrectomy, ERM peeling, intravitreal gas tamponade, and maintained a face-down position for 7 days. ILM peeling was performed only in 13 eyes of 13 patients. The patients were divided into 2 groups: eyes with or without ILM peeling (14 eyes and 13 eyes, respectively) and the follow-up period was 12 months or more in all cases. The postoperative anatomic results based on optical coherence tomography (OCT) and improvement of best corrected visual acuity (BCVA)were retrospectively compared between the 2 groups. Results: Anatomic closure after surgery was achieved in 11 eyes (78.6%) in the ILM without peeling group and in 12 eyes (92.3%) in the ILM with peeling group (p = 0.596). The BCVA improved from 0.41 ± 0.31 (log MAR) to 0.33 ± 0.21 in the ILM without peeling group (p = 0.479) and from 0.46 ± 0.41 (log MAR) to 0.28 ± 0.25 in the ILM with peeling group (p = 0.001). Conclusions: ILM peeling with the addition of ERM peeling is an effective technique for BCVA improvement in the ERM with pseudolamellar macular hole. Vitrectomy, ERM peeling, gas tamponade, and ILM peeling are important for anatomic and functional success in the ERM with pseudolamellar macular hole.
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