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원발군날개에 대한 군날개절제술 후 일시양막이식술의 효과

Effects of Temporary Amniotic Membrane Patch after Surgical Excision of Primary Pterygium

이상범|구병영
대한안과학회 (The Korean Ophthalmological Society)|2012.06|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제53권 제6호|pp. 749-760|DOI http://dx.doi.org/10.3341/jkos.2012.53.6.749

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참고문헌

키워드

Amniotic membranePrimary pterygiumRecurrence rateTemporary amniotic membrane patchPermanent amniotic membrane graft
주제분류안과학

초록

목적: 원발군날개에서 군날개절제술 후 일시양막이식술을 시행한 경우의 임상성적과 재발률, 재발영향인자를 기존의 보고된 연구결과와 비교하여 그 유용성을 알아보고자 하였다. 대상과 방법: 원발군날개 73안을 대상으로 수술 후 평균 15.5개월(9-56개월) 경과관찰하여 재발정도를 평가하였다. G0/G1은 수술성공으로, 재발은 G2 (결막재발)와 G3 (각막재발)로 나누었다. 성별, 나이, 수술 전 분류, 군날개의 수평 ․ 수직길이 및 각막침범크기, 양막의조기탈락 여부, 상피재생완료일 등에 따라 재발률에 차이가 있는지 분석하였다. 수술성공의 누적발생빈도를 알아보았다. 결과: G0/G1이 58안(79.5%)/9안(12.3%), 임상적 재발인 G2/G3가 4안(5.5%)/2안(2.7%)이었다. 수술 후 2년에 수술성공의 통합누적발생빈도는 0.83 ± 0.08이었다. 로지스틱 회귀분석에서 G1 이상의 재발영향인자로 수술 전 T3분류가 유의하였으며(p=0.02), G2 이상은 유의인자가 없었다. 결론: 본 연구의 재발률은 8.2%로 기존의 보고된 연구들의 재발률 9.1-56.1%에 비해 우수한 성적을 보였다. 일시양막이식술은 술기가용이하며 수술 합병증과 군날개의 재발률을 낮추는 장점을 가져 원발군날개에서 군날개절제술 후 효과적인 수술로 생각한다.

Abstract

Purpose: To investigate the clinical results, recurrence rates, and recurrence-related risk factors of temporary amniotic membrane patch (TAMP) after excision of primary pterygium. Methods: Recurrence grade was evaluated for 73 eyes with a mean follow-up of 15.5 months (range 9 to 56 months). Surgical results were classified into surgical success (G0/G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender, age, Tan’s preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, planned or unplanned removal of amniotic membrane, and epithelial healing time. Using Kaplan-Meier survival analysis, the cumulative proportion of integrated G0/G1 was evaluated. Results: In the postoperative grading, 58 (79.5%) and 9 (12.3%) eyes were graded as clinically recurrence-free G0 and G1, respectively; 4 (5.5%) and 2 (2.7%) eyes were graded as clinically recurrence-occurred G2 and G3, respectively. The cumulative proportion of integrated recurrence-free G0/G1 at 24 months after surgery was 0.83 ± 0.08. T3 of Tan’s preoperative grading system was identified as the only risk factor for recurrence above G1 through multivariate logistic regression analysis (p = 0.02). Conclusions: The recurrence rate of the present TAMP study showed better results in comparison with 9.1 to 56.1% of recurrence rates in other studies. The TAMP has advantages of surgical procedure with ease, low complications, and low recurrence rates. Therefore, after surgical excision of primary pterygium, the authors concluded the TAMP is highly recommended for good clinical outcomes and low recurrence rates.

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