안구표면질환에서 실리콘 링을 이용한 일시적 양막반의 치료 효과
Efficacy of the Sutureless Amniotic Membrane Patch for the Treatment of Ocular Surface Disorders
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목적: 안구표면질환에서 봉합 없이 실리콘 링을 이용한 일시적 양막반의 치료 효과를 알아보고자 한다. 대상과 방법: 안구표면질환에서 실리콘 링을 이용한 일시적 양막반을 삽입하여 각막과 결막의 완전한 상피재생에 걸리는 시간, 반복적인 링 삽입 개수, 그리고 삽입된 링의 돌출 등과 같은 합병증을 평가하였다. 결과: 신경영양성 궤양 4안, 지속성 상피결손 2안, 쉴드궤양 1안, 화학손상 4안, 스티븐스-존슨증후군 4안이었다. 완전한 상피화가 이루어지는 평균(표준편차) 시간은 신경영양성 궤양 13 (7.2)일, 지속성 상피결손 17.5 (7.7)일, 쉴드궤양 5일, 화학손상 10.6 (6.6)일, 스티븐스-존슨증후군 13.5 (0.7)일이었다. 실리콘 링의 돌출이나 링에 의한 기계적 손상은 없었다. 15안 중 4안에서 양막이 탈락한 후에도완전한 상피재생이 되지 않아 새로운 양막 링을 재삽입하였다. 화학손상과 스티븐스-존슨증후군 환자에서 안검유착이나 결막구석구축 등의 합병증은 없었다. 결론: 실리콘 링을 이용한 일시적 양막반은 안구표면질환의 급성 염증기에 수술로 인한 안구표면의 외과적 손상 없이 양막을 적용할수 있는 효과적이고 안전한 치료방법이라 생각한다.
Abstract
Purpose: To evaluate the efficacy of the sutureless amniotic membrane (AM) patch for the treatment of ocular surface disorders. Methods: A sutureless AM patch using a silicone ring was utilized to treat neurotrophic ulcer, persistent epithelial defect (PED), Shield ulcer, chemical injury and Stevens-Johnson syndrome. Primary outcome was the time to complete corneal and conjunctival epithelialization. Secondary outcome was the number of repeated insertions and complications of the inserted ring. Results: Neurotrophic ulcer was observed in 4 eyes, PED in 2 eyes, Shield ulcer in 1 eye, chemical injury in 4 eyes and Stevens-Johnson syndrome in 4 eyes. The mean (SD) time to complete epithelialization was 13 (7.2) days (6-20 days) in neurotrophic ulcer, 17.5 (7.7) days (12-23) in PED, 5 days in Shield ulcer, 10.6 (6.6) days (3-15) in chemical injury and 13.5(0.7) days (13-14) in Stevens-Johnson syndrome. There were no protrusion or mechanical trauma of the inserted ring. In 1 case of neurotrophic ulcer and 1 refractory case of chemical injury, repeated insertion was performed due to incomplete healing after dissolution of the AM. In 2 eyes with Stevens-Johnson syndrome, repeated insertion was necessary with heavy accumulation of inflammatory debris on the AM. No symblepharon or fornix contracture was found in chemical injury or Stevens-Johnson syndrome patients. Conclusions: The sutureless AM patch using a silicone ring was shown to be effective and safe for the treatment of ocular surface disorders. The patch can help surgeons avoid suture-related trauma to the ocular surface during the acute inflammatory period.
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