증식유리체망막병증 환자에서 이완 망막절개술의 결과
Outcomes of Relaxing Retinectomy in Patients with Proliferative Vitreoretinopathy
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목적: 증식유리체망막병증을 동반한 망막박리 환자에게 시행한 이완 망막절개술의 결과에 대해 보고하고자 한다. 대상과 방법: 증식유리체망막병증을 동반한 망막박리로 이완 망막절개술을 받은 64안의 의무기록을 후향적으로 검토하였다. 6개월이상 경과 관찰 후 망막유착 상태, 증식유리체망막병증 재발, 추가 수술 횟수, 최종 교정시력, 합병증 발생 여부를 확인하였으며, 수술중 수정체 상태, 망막절개술 범위, 공막돌륭술 여부, 실리콘-가스 충전과 일차 수술 결과의 연관성을 분석하였다. 결과: 47안(73.4%)에서 추가 수술 없이 망막이 성공적으로 재유착되었다. 19안(29.7%)에서 증식유리체망막병증이 재발하였으며, 재수술이 17안(26.6%)에서 시행되었다. 최종 경과 관찰 시 57안(89.1%)에서 망막 유착이 유지되었으며, 40명(62.5%)의 환자에서 0.02 이상의 최대교정시력을 보였다. 주요한 합병증으로 10안(15.6%)에서 5 mmHg 이하의 저안압 상태가 되었다. 망막절개를 180˚ 미만으로시행한 경우가 180˚ 이상으로 시행한 경우보다 일차적인 해부학적 성공률이 높았으며(p=0.043), 실리콘기름을 충전한 경우가 가스를충전한 경우보다 성공률이 유의하게 높았다(p=0.013). 결론: 이완 망막절개술은 증식유리체망막병증을 동반한 망막박리 환자에게 효과적으로 시행될 수 있지만, 재증식 및 저안압 발생에대해 충분히 고려하고 시행해야 한다.
Abstract
Purpose: To report the outcomes of relaxing retinectomy for retinal detachment in patients with proliferative vitreoretinopathy (PVR). Methods: Sixty-four cases of relaxing retinectomy for PVR with a minimum follow-up of 6 months were retrospectively reviewed. The outcomes included achievement of complete retinal reattachment, PVR recurrence, the mean number of additional operations, visual acuity and incidence of postoperative complications. We analyzed the influence of intraoperative factors including lens status, retinectomy extent, additional scleral buckling, and tamponade agent on primary retinal reattachment. Results: Complete retinal reattachment was achieved in 47 eyes (74.3%) without an additional surgery. PVR recurred in 19 eyes (29.7%) and an additional operation was performed in 17 eyes (26.6%). Fifty-seven (89.1%) eyes showed complete retinal reattachment and 40 eyes (62.5%) had visual acuity of 0.02 or more at the final follow-up visit. Hypotony was the major complication and developed in 10 eyes (15.6%). Eyes undergoing smaller (< 180°) retinectomy or silicone oil tamponade had higher primary anatomical success rates than larger (≥ 180°) retinectomy or gas tamponade (p = 0.043 and 0.013, respectively). Conclusions: Relaxing retinectomy is a useful technique for retinal detachment with PVR, but risk of recurrent proliferation or hypotony should be considered.
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