내경계막제거술 후 신경절세포-내망상층 두께 변화
Analysis of Ganglion Cell-Inner Plexiform Layer Thickness after Internal Limiting Membrane Peeling
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목적: 망막전막 또는 황반원공 환자에서 유리체절제술과 내경계막제거술을 시행한 후 신경절세포-내망상층 두께를 분석하여 그 상관관계를 알아보고자 하였다. 대상과 방법: 망막전막 또는 황반원공으로 유리체절제술과 내경계막제거술을 시행한 환자 40명과 내경계막제거술을 시행하지 않고 유리체절제술과 망막전막제거술만 시행한 환자 40명을 후향적으로 분석하였다. 내경계막제거술의 시행 유무, 유리체강내 가스주입술의 시행 유무, 후유리체박리의 수술적 유도 유무에 따라 대상군을 나누었다. 빛간섭단층촬영기로 신경절세포-내망상층 두께를 측정하였고 평균 두께와 부채꼴 구역별 두께를 비교하였다. 결과: 내경계막제거술을 시행한 군에서 신경절세포-내망상층의 평균 두께가 유의하게 감소하였고(-13.80 ± 22.63 μm; p<0.001) 망막전막제거술만 시행한 군에서는 평균 두께가 증가하였지만 통계학적으로 유의하지는 않았다(+1.21 ± 22.53 μm; p=0.546). 이 두 군 간의 차이는 유의하였다(p=0.038). 내경계막제거술을 시행한 군에서 유리체강내 가스주입술을 시행에 따른 신경절세포-내망상층평균 두께의 차이는 유의하지 않았고(-17.41 ± 23.92 μm vs. -7.25 ± 19.05 μm; p=0.109), 후유리체박리를 유도한 군에서 평균두께가 의미 있게 감소하였다(-23.06 ± 23.92 μm vs. -7.25 ± 19.05 μm; p=0.020). 부채꼴 구역별 두께를 비교하였을 때 이측의 두께가 가장 많이 감소하였고, 비측의 두께에 비해 유의한 차이를 보였다(-19.73 ± 28.55 μm vs. -7.42 ± 19.90 μm; p=0.005). 결론: 내경계막제거술과 후유리체박리의 수술적 유도는 신경절세포에 손상을 줄 수 있다. 따라서 내경계막제거술과 후유리체박리의수술적 유도 시 최대한 조심하고 부드럽게 술기를 진행하는 것이 신경절세포 손상을 최소화하는 데 도움이 될 것이며 특히 내경계막제거술을 시행했을 경우나 망막신경섬유층의 손상이 있는 녹내장 환자에서는 더 세심한 주의가 요할 것으로 사료된다.
Abstract
Purpose: To evaluate the ganglion cell-inner plexiform layer (GCIPL) thickness after internal limiting membrane (ILM) peeling with or without intravitreal gas injection (IVGI) or surgical induction of posterior vitreous detachment (PVD). Methods: Eighty patients who were diagnosed with epiretinal membrane (ERM) or macular hole and who received surgical intervention were retrospectively reviewed. Forty patients were treated with ILM peeling and forty patients were treated with ERM removal, but not with ILM peeling. The patients were categorized according to ILM peeling, IVGI, and surgical induction of PVD. The GCIPL thickness was measured using optical coherence tomography, and the average and sectorial thickness of GCIPL were compared. Results: The GCIPL thickness in the ILM peeling group significantly decreased (-13.80 ± 22.63 μm; p < 0.001), but was not significantly different in the ERM removal without ILM peeling group, compared with the preoperative GCIPL thickness (+1.21 ± 22.53 μm; p = 0.546). The difference was statistically significant between the two groups (p = 0.038). In the ILM peeling group, GCIPL thickness was not significantly different in the IVGI group (-17.41 ± 23.92 μm vs. -7.25 ± 19.05 μm; p = 0.109) and was significantly decreased in the surgical induction of the PVD group (-23.06 ± 23.92 μm vs. -7.25 ± 19.05 μm; p = 0.020). On sectorial analysis, reduction of the temporal GCIPL thickness was the largest and was significantly different compared with the nasal GCIPL thickness in ILM peeling group (-19.73 ± 28.55 μm vs. -7.42 ± 19.90 μm; p = 0.005). Conclusions: ILM peeling and surgical induction of PVD may damage ganglion cells. Therefore, gentle ILM peeling and surgical induction of PVD may be needed to minimize ganglion cell damage, especially when ILM peeling is performed in glaucomatous patients.
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