황반하출혈에서 유리체강내 조직플라스미노겐 활성체 및 SF6 가스충전술, 유리체절제술의 치료효과
Vitrectomy-Assisted Intravitreal Tissue Plasminogen Activator and SF6 Gas Injection on Submacular Hemorrhage
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목적: 황반하출혈에서 유리체절제술과 유리체강내 tissue plasminogen activator (tPA), SF6 가스충전술의 치료효과에 대해 알아보았다. 대상과 방법: 황반하출혈이 발생한 31안, 30명을 대상으로 유리체절제술과 유리체강내 tPA (50 μg /0.1 ml) 및 SF6 가스충전술을 시행한 후 12개월 이상 경과관찰을 시행하였다. 결과: 증상발현기간은 평균 4.1일이었고 술 후 31안 모두에서 혈액의 이동이 나타났다. 술전시력(logMAR)은 1.15 ± 0.51에서 12개월에 0.56 ± 0.46으로 호전되었다(P=0.002). 12개월 시력과 연관이 있는 인자로는 원인질환이 있었으며 술 후 3개월의 시력 또한 상관관계 가 있었다(P=0.003, P=0.000). 나이, 성별, 술 전 유리체출혈이나 내경계막하출혈의 유무, 술전시력, 증상발현기간, 황반하출혈의 크 기는 유의한 관련성이 없었다. 경과관찰기간 동안 망막박리나 황반재출혈의 합병증은 발생하지 않았다. 결론: 유리체절제술과 유리체강내 tPA, SF6 충전술은 큰 합병증 없이 효과적으로 출혈을 이동시킬 수 있었다. 12개월 후 시력은 술 후 3개월 시력으로 예측할 수 있었으며 시력예후는 원인질환에 의하였다.
Abstract
Purpose: To evaluate the results of vitrectomy-assisted intravitreal tissue plasminogen activator (tPA) and SF6 gas injection in the treatment of submacular hemorrhage. Methods: Thirty-one eyes of 30 consecutive patients with submacular hemorrhages undergoing vitrectomy with intravitreal tPA (50 μg/0.1 ml) and SF6 gas injection and completed 12 months of follow-up were evaluated. Results: The mean duration of visual symptoms was 4.1 days. Submacular blood was completely displaced in all 31 eyes after surgery. The best corrected visual acuity (logMAR) improved to 0.56 ± 0.46 at 12 months from 1.15 ± 0.51 at baseline (P = 0.002). The most important factors related to visual acuity at the 12-month follow-up were the underlying etiology for the submacular hemorrhage and visual acuity 3 months after surgery (P = 0.003 and P = 0.000, respectively). The 12-month visual acuity was independent of age, gender, presence of vitreous hemorrhage, sub-ILM hemorrhage, baseline visual acuity, duration of symptoms, and the diameter of the submacular hemorrhage. No retinal detachment or re-submacular hemorrhage developed during the follow-up period. Conclusions: This surgical technique can effectively displace submacular hemorrhage without complications. The 3-month visual acuity appears to predict the 12-month visual acuity. The final visual acuity was associated with the primary etiology for the submacular hemorrhage
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