양막이식술을 이용한 군날개 제거술에서 마이토마이신 C의 효과
The Effectiveness of Mitomycin C on Pterygium Surgery with Amniotic Membrane Transplantation
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목적: 원발 군날개 제거술에서 양막이식술을 시행한 경우, 마이토마이신 C를 사용한 경우와 사용하지 않은 경우의 재발률을 비교해보았다. 대상과 방법: 수술 후 6개월 이상 추적관찰이 가능했던 환자 43명 45안 중, 마이토마이신 C를 사용한 18명 19안, 사용하지 않은 25명26안을 대상으로 후향적 연구를 시행하였다. 결과: 마이토마이신 C를 사용하지 않은 양막이식술에서는 26안 중 결막재발이 6안, 각막재발 3안에 나타났으며(34.6%), 마이토마이신C를 사용한 양막이식술에서는 19안 중 결막재발이 2안, 각막재발 1안에서 나타나(15.8%) 두 군 간에 통계학적으로 유의한 차이를 보였다. 또한 양막이식술만 시행한 군에서 마이토마이신 C를 같이 사용한 군에 비해 통계적으로 유의한 높은 결막재발률을 보였다. 마이토마이신C 사용에 따른 심각한 합병증은 발생하지 않았다. 두 군 모두 술 후 양막하출혈, 육아종, 상처벌어짐 등의 합병증이 있었으나 경과관찰후 회복되었다. 결론: 양막이식술을 이용한 원발 군날개 수술 시 마이토마이신 C는 결막재발을 효과적으로 억제함으로써 미용상의 문제로 인한 환자의불편을 줄이는 데 효과적인 방법이라 생각한다.
Abstract
Purpose: To compare postoperative recurrence rates of pterygium surgery with amniotic membrane transplantation with and without mitomycin C. Methods: A retrospective analysis of 45 eyes of 43 patients who underwent pterygium surgery with amniotic membrane transplantation with a minimum of six months of follow-up. Nineteen eyes underwent mitomycin C application, while the remaining 26 eyes did not. Recurrence rates and complications were evaluated. Results: With a minimum of six months of follow-up, fibrovascular tissue in the excised area not invading the cornea (conjunctival recurrence) was noted in two eyes (10.5%), and fibrovascular tissue invading the cornea (corneal recurrence)was noted in one eye (5.4%) in the amniotic membrane transplantation with mitomycin C group. Conjunctival recurrence was noted in six eyes (23.1%) and corneal recurrence in three eyes (11.5%) in the amniotic membrane transplantation without mitomycin C group. Recurrence rate in the amniotic membrane transplantation with mitomycin C group (15.9%) was significantly lower (p = 0.014) than that in the amniotic membrane transplantation without mitomycin C group (34.6%). Complications included sub-amniotic membrane hemorrhage in two eyes, granuloma in one eye, and wound dehiscence in one eye in each group. There were no specific complications related to usage of mitomycin C. Conclusions: In pterygium surgery with amniotic membrane transplantation, application of mitomycin C is an effective method to reduce recurrence rates, especially conjunctival recurrences that are related to cosmetic problems. This method may also be helpful to reduce patient discomfort.
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