황반전막환자에서 빛간섭단층촬영 형태에 따른 수술결과
Surgical Outcome According to Morphology in Epiretinal Membrane Based on Optical Coherence Tomography (OCT)
0
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
목적: 황반전막 환자에서 빛간섭단층촬영(Optical Coherence Tomography, OCT)을 이용한 형태학적 분류에 따라 수술결과를 비교해보고 그 의의를 알아보고자 하였다. 대상과 방법: 황반전막으로 황만전막제거술을 시행 받은 77안을 대상으로 의무기록을 후향적으로 분석하였다. OCT를 이용해 술 전황반부 형태에 따라 미만형(DIF), 낭포황반부종형(CME), 가성층판원공형(PLH), 유리체황반견인형(VMT)으로 분류하고 술 후 황반중심두께 변화, 시력변화를 비교해 보았다. 결과: 술 후 6개월째 시력은 특발성, 속발성 모두 DIF˃PLH˃CMT˃VMT순이었고, 시력호전 정도는 VMT˃DIF˃CME˃PLH순으로 PLH type에서는 의미 있는 시력호전을 보이지 않았다. 특발성의 경우 시세포 내절/외절 접합부의 파열이 없는 경우, 파열이 있는 경우에비해 각 형태에 따른 시력호전 정도 차이가 더 뚜렷하게 나타났다. 결론: 황반전막 환자에서 OCT를 이용한 형태학적 분류에 따라 시력호전 정도가 차이가 있었으며, 특히 시세포 내절/외절 접합부의파열이 없는 경우 황반전막의 형태가 시력호전 정도를 예측하는데 도움이 되는 인자가 될 수 있을 것이다.
Abstract
Purpose: To determine the influence of morphologic classification based on optical coherence tomography (OCT) on epiretinal membrane (ERM) surgery outcomes. Methods: We retrospectively reviewed the medical records of 77 eyes with ERM treated by vitrectomy with ERM peeling. By using OCT, the preoperative ERM was classified into four types: diffuse (DIF), cystoids macular edema (CME), pseudolamellar hole (PLH), and vitreomacular traction (VMT). The postoperative changes of central macular thickness (CMT) and best-corrected visual acuity (BCVA) were compared. Results: Approximately six months postoperatively, the DIF type had the best BCVA for both idiopathic and secondary ERM, followed by the PLH, CME, and VMT types. On the other hand, regarding the mean BCVA improvement, the VMT type was the best, followed by the DIF, PLH, and CME types. When comparing the difference in BCVA improvement by each type, idiopathic ERM showed a clearer distinction when the inner segment/outer segment (IS/OS) junction was not disrupted. Conclusions: BCVA improvement was significantly different depending on the morphologic classification of ERM by using OCT. Especially in cases of ERM with an intact IS/OS junction, the morphologic classification can help predict surgical outcomes.
참고문헌 (24)
- Margherio RR, "Removal of epimacular membranes", Ophthalmology, 92, pp.1075~1083 (1985)
- Michels RG, "Vitrectomy for macular pucker", Ophthalmology, 91, pp.1384~1388 (1984)
- Wise GN, "Clinical features of idiopathic preretinal macular fibrosis. Schoenberg Lecture", Am J Ophthalmol, 79, pp.349~347 (1975)
- Hillenkamp J, "Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green", Br J Ophthalmol, 89, pp.437~443 (2005)
- Arndt C, "Quantification of metamorphopsia in patients with epiretinal membranes before and after surgery", Graefes Arch Clin Exp Ophthalmol, 245, pp.1123~1129 (2007)
- Wong JG, "Visual outcomes following vitrectomy and peeling of epiretinal membrane", Clin Experiment Ophthalmol, 33, pp.373~378 (2005)
- Hassenstein A, "OCT in epiretinal gliosis", Ophthalmologe, 102, pp.127~132 (2005)
- Park SJ, "Clinical feature of macular preretinal membrane and visual changes after vitrectomy", J Korean Ophthalmol Soc, 35, pp.824~829 (1994)
- Rice TA, "Prognostic factors in vitrectomy for epiretinal membranes of the macula", Ophthalmology, 93, pp.602~610 (1986)
- Niwa T, "Function and morphology of macula before and after removal of idiopathic epiretinal membrane", Invest Ophthalmol Vis Sci, 44, pp.1652~1656 (2003)
- Wilkins JR, "Characterization of epiretinal membranes using optical coherence tomography", Ophthalmology, 103, pp.2142~2151 (1996)
- Massin P, "Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery", Am J Ophthalmol, 130, pp.732~739 (2000)
- 김치훈, "황반전막에서 술 전 빛간섭단층촬영 형태와 시력호전과의 상관성 분석", 대한안과학회지, 48(1), pp.75~82 (2007), 대한안과학회
- Suh MH, "Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal", Am J Ophthalmol, 147, pp.473~480 (2009)
- Kinoshita T, "Morphologic differences in epiretinal membranes on ocular coherence tomography as a predictive factor for surgical outcome", Retina, 31, pp.1692~1698 (2011)
- Green WR, "Ultrastructure of epiretinal membranes causing macular pucker after retinal reattachment surgery", Trans Ophthalmol Soc U K, 99, pp.65~77 (1979)
- Smiddy WE, "Vitrectomy for macular traction caused by incomplete vitreous separation", Arch Ophthalmol, 106, pp.624~628 (1988)
- Smiddy WE, "Idiopathic epiretinal membranes. Ultrastructural characteristics and clinic pathologic correlation", Ophthalmology, 96, pp.811~820 (1989)
- Gastaud P, "Ultrastructural findings of epimacular membrane and detached posterior hyaloid in vitreomacular traction syndrome", J Fr Ophthalmol, 23, pp.587~593 (2000)
- Puliafito CA, "Imaging of macular diseases with optical coherence tomography", Ophthalmology, 102, pp.217~229 (1995)
- Koizumi H, "Three-dimensional evaluation of vitreomacular traction and epiretinal membrane using spectral-domain optical coherence tomography", Am J Ophthalmol, 145, pp.509~517 (2008)
- Mori K, "Comparison of epiretinal membranes of differing pathogenesis using optical coherence tomography", Retina, 24, pp.57~62 (2004)
- Dugas B, "Idiopathic epiretinal macular membrane and cataract extraction: combined versus consecutive surgery", Am J Ophthalmol, 149, pp.302~306 (2010)
- Muselier A, "Macular hole surgery and cataract extraction: combined vs consecutive surgery", Am J Ophthalmol, 150, pp.387~391 (2010)