표층황반원공에서 수술적 치료의 결과
Visual and Surgical Outcomes of Lamellar Macular Hole
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목적: 증상이 있는 표층황반원공에서 수술적 치료의 결과에 대해 알아보고자 하였다. 대상과 방법: 시력 저하를 호소하는 표층황반원공 10명(10안)에서 유리체절제술, 망막앞막 및 내경계막 제거술, 가스충전술(5안)을 시행하였다. 술 전 및 술 후에 빛간섭단층촬영으로 원공의 변화를 확인하였다. 결과: 평균 경과관찰 기간은 7.5개월이었고, 교정시력은 술 전 logMAR 0.67 ± 0.38에서 술 후 logMAR 0.30 ± 0.28로 호전되었다. 중심와두께는 술 전 441 ± 184 μm에서 술 후 291 ± 64 μm으로 통계적으로 유의하게 감소하였다. 모든 안에서 빛간섭단층촬영상망막내층간의 분리 소실을 확인하였다. 1안에서 술 후 경과관찰 중 백내장 수술을 시행하였으며, 1안에서 유리체절제술 2개월째 망막박리가 발생하여 가스충전술 및 광응고술로 치료하였다. 결론: 증상이 있는 표층황반원공에서 유리체절제술, 망막앞막 및 내경계막 제거술은 효과적인 치료 방법이었다. 그러나 표층황반원공의 수술 적응증, 수술 시기, 수술 방법에 대한 더 많은 연구가 필요하겠다.
Abstract
Purpose: To investigate the visual and anatomical results of surgical treatment for symptomatic lamellar macular hole. Methods: Ten eyes of ten patients with decreased visual acuity and lamellar macular hole were diagnosed using optical coherence tomography (OCT). Pars plana vitrectomy, epiretinal membrane removal, internal limiting membrane peeling,and gas tamponade (5 eyes) were performed for the treatment of lamellar hole. The resolution of the lamellar hole was assessed in relation to each OCT image at baseline. Results: The mean postoperative follow-up duration was 7.5 months, and best corrected visual acuity improved from log MAR 0.67 ± 0.38 to log MAR 0.30 ± 0.28. Central foveal thickness decreased from 441 ± 184 μm to 291 ± 64 μm. The OCT of all eyes demonstrated improvement in macular contour. However, retinal detachment in one eye occurred at two months after the operation and was reattached with gas tamponade and photocoagulation. Conclusions: Vitrectomy, epiretinal membrane removal and internal limiting membrane peeling showed benefit in the treatment of symptomatic lamellar macular hole. However, large and prospective studies are necessary regarding the surgical indication, time and procedure for lamella macular hole.
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