열공망막박리에서 자가플라스민을 이용한 유리체절제술의 효과
Efficacy of Autologous Plasmin-Assisted Vitrectomy for Rhegmatogenous Retinal Detachment
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목적: 열공망막박리의 유리체절제술 전 유리체강 내 주입한 자가플라스민의 효과와 부작용을 알아보고자 하였다. 대상과 방법: 후유리체박리가 일어나지 않은 열공망막박리의 수술 20분 전 자가플라스민을 유리체강 내에 주입하였다. 수술 시작 전후유리체박리 범위를 평가하고 후유리체박리 유발 및 피질 제거 용이성을 등급화했으며 수술 중 의인성 망막열공 발생 여부를 조사하여 대조군과 비교하였다. 부작용 평가를 위해 활성화부분트롬보플라스틴시간을 측정하고 주입액의 균배양을 시행했으며 수술 후 안내출혈 빈도를 조사했고, 장기적 수술성적 평가를 위해 시력변화, 망막재유착률 등을 비교하였다. 결과: 피험군에서 후유리체박리 범위가 넓고 유리체 피질제거가 더 용이한 경향을 보였으나, 후유리체박리 유발의 용이성과 의인성망막열공 발생 빈도는 대조군과 차이가 없었다. 수술 후 안내 출혈이나 전신적인 혈액응고 이상이 발생한 경우는 없었고, 수술 후안내염 발생, 주입액 균배양의 양성도 없었다. 두 군에서 시력변화, 망막재유착률의 유의한 차이는 없었다. 결론: 자가플라스민의 유리체강 내 주입은 열공성망막박리에서 유리체절제술을 보다 용이하게 하였고, 망막의 재유착률에는 영향을주지 않았다.
Abstract
Purpose: To evaluate the efficacy and complication of autologous plasmin (AP) injected before vitrectomy for rhegmatogenous retinal detachment (RRD). Methods: Intravitreal AP injection (0.2 ml) was performed on the eyes without posterior vitreous detachment (PVD) 20minutes before the vitrectomy for RRD. The extent of PVD was evaluated intraoperatively. Surgical PVD induction was performed and the ease of the procedure was graded. The extent of PVD, ease of PVD induction, and complications (including incidence of iatrogenic retinal break) were compared to those of the control eyes. In order to evaluate complications and measure activated partial thromboplastin time, a microbial culture of injected AP was performed and the rate of postoperative intraocular hemorrhage was investigated. Change in visual acuity and the rate of retinal reattachment were compared in order to evaluate the long-term surgical outcome. Results: The extent of PVD was greater in the AP group than in the control group, and vitreal separation was facilitated by intravitreal AP injection. However, ease of PVD induction and frequency of iatrogenic retinal break found were not significantly different between cases and controls. Neither postoperative intraocular hemorrhage nor systemic coagulation abnormality occurred. Postoperative endophthalmitis and positive microbial culture of the AP solution were also not reported. There was no significant difference in the change in visual acuity and the rate of retinal reattachment between the two groups. Conclusions: Intravitreal AP injection can facilitate vitrectomy for RRD and has no effect on the rate of retinal reattachment.
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