망막색소상피변성 환자에서 백내장수술의 장기 임상결과
Long-term Clinical Outcomes of Cataract Surgery in Patients with Retinitis Pigmentosa
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 망막색소상피변성 환자를 대상으로 한 백내장수술의 장기 임상 결과를 보고하고 시력예후를 예측할 수 있는 인자를 분석하고자 한다. 대상과 방법: 망막색소상피변성 환자들 중 백내장수술을 시행 받은 경우를 대상으로 후향적 의무기록 분석을 시행하였다. 술 전 최대교정시력을 술 후 1개월 및 최종 추적 관찰 시의 값과 서로 비교하였다. 술 후 낭포황반부종이 발생하거나 악화된 비율, 인공수정체탈구/아탈구가 나타난 비율을 확인하였다. 빛간섭단층촬영을 시행한 안을 대상으로 술 후 1개월에 0.5 이상의 시력과 연관된 술 전 인자를 분석하였다. 결과: 전체 133안을 대상으로 연구를 시행하였으며, 평균 추적 관찰 기간은 술 후 58.7개월이었다. 최대교정시력은 백내장수술 전 평균 logarithm of minimal angle of resolution 시력은 0.69 ± 0.65에서 1개월에 평균 0.51 ± 0.47로 유의하게 호전되었으나(p<0.001), 최종 추적 관찰 시에는 평균 0.70 ± 0.81로 술 전 시력과 차이가 없었다(p=1.000). 8안(6.0%)에서 낭포황반부종이 발생하거나 악화되었으며, 인공수정체 탈구/아탈구는 4안(3.0%)에서 나타났다. 108안을 대상으로 한 분석에서 술 전 시력(p<0.001)과 타원체구역 상태(p=0.001)는 술 후 시력과 연관된 인자로 나타났다. 결론: 망막색소상피변성 환자에서 백내장수술 후 단기적으로는 좋은 결과를 얻을 수 있었으나 질병의 진행에 따라 장기적으로는 시력저하가 나타났다. 술 전 시력과 타원체구역 상태는 술 후 단기 시력 예측에 유용할 것으로 생각된다.
Abstract
Purpose: The long-term clinical outcomes of cataract surgery in patients with retinitis pigmentosa (RP) were evaluated. Methods: A retrospective analysis of medical records was performed for patients who were diagnosed with RP and underwent cataract surgery. Preoperative best-corrected visual acuity (BCVA) was compared with BCVA at 1 month postoperatively and at the final visit. The proportion of patients with cystoid macular edema development or aggravation after surgery was evaluated, as was the proportion of patients with intraocular lens subluxation/dislocation. For patients who underwent optical coherence tomography, factors associated with a BCVA of 0.5 or better at 1 month were analyzed. Results: In total, 133 eyes were included and the mean follow-up period was 58.7 months. The mean logarithm of minimal angle of resolution BCVA was 0.69 ± 0.65 at diagnosis. The BCVA was significantly improved to 0.51 ± 0.47 at 1 month postoperatively (p < 0.001). However, the BCVA at the final visit (0.70 ± 0.81) was similar to the baseline value (p = 1.000). Cystoid macular edema development or aggravation was noted in 8 eyes (6.0%) and intraocular lens subluxation/dislocation was noted in 4 eyes (3.0%). A subgroup analysis involving 108 eyes revealed that preoperative BCVA (p < 0.001) and ellipsoid zone status (p = 0.001) were associated with postoperative visual acuity. Conclusions: Short-term outcomes of cataract surgery in patients with RP were comparatively good. However, long-term visual deterioration was noted with disease progression. Preoperative BCVA and ellipsoid zone status are useful markers for predicting short-term visual outcomes.
참고문헌 (16)
- Birch DG, "Yearly rates of rod and cone functional loss in retinitis pigmentosa and cone-rod dystrophy", Ophthalmology, 106, pp.258~268 (1999)
- Berson EL, "Natural course of retinitis pigmentosa over a three-year interval", Am J Ophthalmol, 99, pp.240~251 (1985)
- Xu M, "Visual field progression in retinitis pigmentosa", Invest Ophthalmol Vis Sci, 61, pp.56~ (2020)
- 서제현, "Assessment of Functional Vision Score and Vision-Specific Quality of Life in Individuals With Retinitis Pigmentosa", Korean Journal of Ophthalmology, 23(3), pp.164~168 (2009), 대한안과학회
- Rim TH, "Four-year nationwide incidence of retinitis pigmentosa in South Korea : a population-based retrospective study from 2011 to 2014", BMJ Open, 7, pp.e015531~ (2017)
- 김민석, "Genetic Mutation Profiles in Korean Patients with Inherited Retinal Diseases", Journal of Korean Medical Science, 34(21), pp.1~11 (2019), 대한의학회
- Fishman GA, "Prevalence of posterior subcapsular lens opacities in patients with retinitis pigmentosa", Br J Ophthalmol, 69, pp.263~266 (1985)
- Fujiwara K, "Risk factors for posterior subcapsular cataract in retinitis pigmentosa", Invest Ophthalmol Vis Sci, 58, pp.2534~2537 (2017)
- 이선호, "Hereditary and Clinical Features of Retinitis Pigmentosa in Koreans", Journal of Korean Medical Science, 25(6), pp.918~923 (2010), 대한의학회
- Dikopf MS, "Cataract extraction outcomes and the prevalence of zonular insufficiency in retinitis pigmentosa", Am J Ophthalmol, 156, pp.82~88 (2013)
- Nakamura Y, "Relationship between retinal microstructures and visual acuity after cataract surgery in patients with retinitis pigmentosa", Br J Ophthalmol, 99, pp.508~511 (2015)
- Jackson H, "Outcome of cataract surgery in patients with retinitis pigmentosa", Br J Ophthalmol, 85, pp.936~938 (2001)
- Yoshida N, "Factors affecting visual acuity after cataract surgery in patients with retinitis pigmentosa", Ophthalmology, 122, pp.903~908 (2015)
- Cideciyan AV, "In vivo dynamics of retinal injury and repair in the rhodopsin mutant dog model of human retinitis pigmentosa", Proc Natl Acad Sci U S A, 102, pp.5233~5238 (2005)
- Young A Kwon, "Bilateral Spontaneous Anterior Lens Dislocation in a Retinitis Pigmentosa Patient", Korean Journal of Ophthalmology, 21(2), pp.124~126 (2007), 대한안과학회
- Lee HJ, "Bilateral spontaneous dislocation of intraocular lenses within the capsular bag in a retinitis pigmentosa patient", Korean J Ophthalmol, 18, pp.52~57 (2004)