특발성 황반원공에서 유리체절제술 후 자세에 따른성적 비교
Comparison of Prone and Seated Position after Vitrectomy for Idiopathic Macular Hole Surgery
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목적: 특발성 황반원공에서 수술적 치료 후 안면하체위의 시행 여부에 따른 해부학적 및 기능적 결과를 비교해 보고자 하였다. 대상과 방법: 특발성 황반원공으로 유리체절제술 및 광범위한 내경계막 제거를 시행한 71안을 대상으로 하였다. 술 후 일주일간 엎드린자세를 취한 1군 36안과 앙와위를 제외한 자유로운 자세를 취한 2군 35안 사이의 황반원공 폐쇄 여부와 술 후 6개월째 및 최종경과관찰시 최대교정시력을 분석하였고, 황반원공의 크기, 수정체유화술 동시시행 여부에 따른 두 군의 술 후 성적을 비교하였다. 결과: 최종경과관찰시 황반원공의 폐쇄는 1군에서 91.7%, 2군에서 88.6%이었고(p=0.710), 최대교정시력은 1군에서 4.75 ± 3.83줄,2군에서 4.76 ± 2.96줄 상승하여 통계적으로 차이가 없었다(p=0.988). 수정체유화술 동시시행을 받은 경우가 1군에서 27안, 2군에서30안이었고 각각에서 황반원공의 크기에 따른 황반원공 폐쇄율과 시력호전 정도는 유의한 차이가 없었다. 결론: 특발성 황반원공 환자에서 유리체절제술과 수정체유화술 동시수술을 시행하고 광범위한 내경계막 제거 및 안내가스 충전을 시행한 경우 술 후 자세 제한 여부는 수술 성적에 영향을 미치지 않는 것으로 생각한다.
Abstract
Purpose: To compare the anatomical and functional results of vitrectomy for macular hole with and without prone posture. Methods: We retrospectively reviewed the medical records of 71 eyes of 71 patients who received macular hole repair and were followed up for at least 6 months. The anatomical success, complications, and best corrected visual acuity at postoperative 6 months and last follow-up between patients who were advised to take a prone posture for 1 week (group 1) and patients who were advised to simply avoid the supine position right from the surgery (group 2) were analyzed. Subgroup division analysis according to macular hole size and concurrent phacoemulsification was performed. Results: Macular hole closure rate was 91.7% (33 of 36 eyes) in group 1 and 88.6% (31 of 35 eyes) in group 2 (p=0.710). The mean visual acuity at final follow-up increased in both groups by 4.75 ± 3.83 and 4.76 ± 2.96 lines, respectively and revealed no statistically significant difference (p = 0.988). Twenty-seven of 36 eyes (75%) in group 1 and 30 of 35 eyes (85.7%) in group 2 underwent concurrent phacoemulsification, and no difference in macular hole closure rate and visual acuity improvement between the two postures was observed. Conclusions: Favorable anatomical and functional outcomes were achieved without postoperative face-down posturing in the case of phacovitrectomy with wide internal limiting membrane peeling and gas tamponade.
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