무안구증 환자에서 안와 삽입물 삽입과 진피-지방 이식 동시수술의 결과
Clinical Outcomes Following Simultaneous Orbital Implant Insertion Operation and Dermo-Fat Graft for Anophthalmos Patients
4
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 의안을 착용할 수 없을 정도로 결막낭이 부족한 안구로 환자나 심한 안와 삽입물의 노출이 있는 환자를 대상으로 안와 삽입물삽입술과 진피-지방 이식을 동시에 시행한 경우의 임상적 효과에 대해 알아보고자 하였다. 대상과 방법: 2007년부터 2012년까지 본원 안과 방문한 환자 중 안와 삽입물 삽입술 시 부족한 결막낭을 보충하기 위해 진피-지방이식을 동시에 시행한 후 2년 이상 경과 관찰한 환자를 대상으로 후향적 의무기록조사를 하였다. 대상은 총 8안이었으며 모두 안구로혹은 안와 삽입물 노출에 대한 치료 위해 내원한 환자였다. 결과: 총 8안 중 삽입물 노출로 진단받은 환자 5안(62.5%)에서 삽입물 교체술 및 진피-지방 이식술을 시행하였고 2안(25%)은 무안구증 함몰 환자로 삽입물의 2차적 삽입술 시 진피-지방 이식을 하였고 안구로 환자 1안(12.5%)은 안구내용제거술 시 삽입물 삽입술과진피-지방 이식술을 같이 시행하였다. 술 후 평균 경과 관찰 기간은 46.3개월이었다. 창상 치유 과정 결과는 8안 중 7안(87.5%)에서는 합병증 없이 창상이 결막화되었으며 1안(12.5%)은 삽입물 제거 후 재삽입술 및 진피-지방 이식술을 시행 후 5개월째 삽입물 재노출로 진피-지방 재이식술을 시행하였고 이후 노출은 관찰되지 않았다. 이후 모든 환자군에서 의안 착용과 전체적인 미용적 외관에서만족하였다. 결론: 안와 삽입물 삽입술과 동시에 시행한 진피-지방 이식술은 결막낭 보충과 함께 안구 용적 보충에 효과적인 것을 알 수 있었다.
Abstract
Purpose: To investigate the clinical results of patients who have undergone simultaneous dermo-fat graft and insertion of orbitalimplants in patients who are unable to put on an ocular prosthesis due to severe conjunctival sac contracture or large orbital implantexposure. Methods: A retrospective analysis was performed of patients who underwent dermo-fat graft simultaneously with orbital implantinsertion for replacement of the conjunctival sac from 2007 to 2012. Eight eyes were enrolled in this study and all patients werefollowed up for phthisis bulbi or implant exposure. Results: Among the eight eyes, five eyes (62.5%) that were diagnosed with orbital implant exposure underwent orbital implantexchange and dermo-fat graft, and two eyes (25%) were anophthalmic enophthalmic patients and underwent secondary orbitalimplant insertion and dermo-fat graft. One patient (12.5%) underwent orbital implant insertion and dermo-fat graft simultaneouslyduring the evisceration operation. We followed the progress for 46.3 months. For seven out of eight eyes, the results of the wound healing process were successful. One patient underwent removal and reinsertionof the orbital implant with dermo-fat graft, and the wound in this case healed well. However, after five months, dermo-fatre-graft was performed for orbital implant re-exposure and it was not exposed thereafter. Overall cosmetic appearance was satisfactoryin each patient, and all patients were able to comfortably retain a prosthesis. Conclusions: We found that undergoing dermo-fat graft simultaneously when performing orbital implant insertion is effective forreplacement of the conjunctival sac and orbital volume.
참고문헌 (24)
- 윤경철, "노출된 하이드록시아파타이트 안와삽입물에서 동종진피이식술의 효과", 대한안과학회지, 46(6), pp.927~932 (2005), 대한안과학회
- 박민수, "자가 진피 이식술을 이용한 노출된 다공성 안와 삽입물의 치험", 대한안과학회지, 42(8), pp.1127~1132 (2001), 대한안과학회
- Sohn KS., "Clinical observation on reconstruction of the anophthalmic contracted socket in 28 eyes", J Korean Ophthalmol Soc, 27, pp.471~474 (1986)
- Gougelmann HP., "The evolution of the ocular motility implant", International Ophthalmology Clinics, 10, pp.689~711 (1970)
- Soll DB., "The anophthalmic socket", Ophthalmology, 89, pp.407~423 (1982)
- Perry AC., "Integrated orbital implants", Adv Ophthalmic Plast Reconstr Surg, 8, pp.75~81 (1990)
- Kostick DA., "Evisceration with hydroxyapatite implant. Surgical technique and review of 31 case reports", Ophthalmology, 102, pp.1542~1548 (1995)
- You YS., "Incidence and clinical course of implant exposure after hydroxyapatite implantation in anophthalmic socket", J Korean Ophthalmol Soc, 38, pp.1694~1699 (1997)
- Dutton JJ., "Coralline hydroxyapatite as an ocular implant", Ophthalmology, 98, pp.370~377 (1991)
- Li T., "Exposure rates of wrapped and unwrapped orbital implants following enucleation", Ophthal Plast Reconstr Surg, 17, pp.431~435 (2001)
- McNab A., "Hydroxyapatite orbital implants. Experience with 100 cases", Aust N Z J Ophthalmol, 23, pp.117~123 (1995)
- Oestreicher JH., "Complications of hydroxyapatite orbital implants. A review of 100 consecutive cases and a comparison of Dexon mesh(polyglycolic acid)with scleral wrapping", Ophthalmology, 104, pp.324~329 (1997)
- Custer PL., "Porous implant exposure : Incidence, management, and morbidity", Ophthal Plast Reconstr Surg, 23, pp.1~7 (2007)
- Nunery WR., "Exposure rate of hydroxyapatite spheres in the anophthalmic socket : histopathologic correlation and comparison with silicone sphere implants", Ophthal Plast Reconstr Surg, 9, pp.96~104 (1993)
- Remulla HD., "Complications of porous spherical orbital implants", Ophthalmology, 102, pp.586~593 (1995)
- Yoon JS., "Exposure rate of hydroxyapatite orbital implants a 15-year experience of 802 cases", Ophthalmology, 115, pp.566~572.e2 (2008)
- Baek SH., "Clinical effect of porous polyethylene(Medpor(r))orbital implant", J Korean Ophthalmol Soc, 41, pp.1858~1863 (2000)
- Karcioglu ZA., "Porous polyethylene orbital implant in patients with retinoblastoma", Ophthalmology, 105, pp.1311~1316 (1998)
- Rosen HM., "The biologic behavior of hydroxyapatite implanted into the maxillofacial skeleton", Plast Reconstr Surg, 85, pp.718~723 (1990)
- Goldberg RA., "Exposed hydroxyapatite orbital implants. Report of six cases", Ophthalmology, 99, pp.831~836 (1992)
- Kim YD., "Management of exposed hydroxyapatite orbital implants", Ophthalmology, 101, pp.1709~1715 (1994)
- Lee MJ., "Dermis-fat graft for treatment of exposed porous polyethylene implants in pediatric postenucleation retinoblastoma patients", Am J Ophthalmol, 152, pp.244~250.e2 (2011)
- Lee BJ., "Exposed porous orbital implants treated with simultaneous secondary implant and dermis fat graft", Ophthal Plast Reconstr Surg, 26, pp.273~276 (2010)
- Smith B., "Dermis-fat graft as a movable implant within the muscle cone", Am J Ophthalmol, 85, pp.62~66 (1978)