일차 수술로 폐쇄되지 않은 난치성 황반원공에서 자가 혈소판 농축액 주입술의 효과
Effects of Autologous Platelet Concentrate Injection on Persistent Macular Hole
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목적: 일차 수술로 폐쇄되지 않은 난치성 황반원공 환자들을 대상으로 자가 혈소판 농축액 주입술을 동반한 이차 유리체절제술을 시행하여 원공 폐쇄 및 시력 회복에 유의한 효과가 있는지 확인하고자 하였다. 대상과 방법: 2021년 2월부터 2023년 7월까지 황반원공 진단 하에 일차 수술로 유리체절제술 및 내경계막제거술을 시행 받았으나 해부학적 원공 폐쇄에 실패하여, 자가 혈소판 농축액 주입술을 동반한 이차 유리체절제술을 시행 받은 10명 10안을 대상으로 하였다. 일차 및 이차 수술 전 원공의 최소 직경과 바닥 직경을 측정하였고 이차 수술 후 6개월간 원공의 폐쇄 여부 및 최대교정시력의 변화를 조사하였다. 결과: 대상환자의 평균 나이는 61.6 ± 9.5세였다. 일차 수술 전 평균 최대교정시력(LogMAR)은 1.6 ± 0.7이었고, 원공의 최소 직경의 평균은 654.4 ± 98.9 μm, 바닥 직경의 평균은 1,135.4 ± 276.5 μm였다. 이차 수술 전 평균 최대교정시력(LogMAR)은 1.3 ± 0.7이었고 원공의 최소 직경의 평균은 666.8 ± 270.2 μm, 바닥 직경의 평균은 845.4 ± 292.4 μm였다. 이차 수술 후 6개월째, 10안 모두에서 원공 폐쇄가 관찰되었으며, 최대교정시력(LogMAR)은 0.9 ± 0.6으로 통계적으로 유의하게 호전되었다(p=0.007). 결론: 자가 혈소판 농축액 주입술을 동반한 유리체절제술을 통해 일차 수술로 폐쇄되지 않은 황반원공을 성공적으로 폐쇄하였고, 유의한 시력 호전을 확인할 수 있었다.
Abstract
Purpose: To evaluate the effects of secondary pars plana vitrectomy (PPV) with autologous platelet concentrate (APC) injection in patients with a persistent macular hole that failed to close after the primary surgery. Methods: This study included 10 eyes of 10 patients who required secondary PPV and APC injection due to unsuccessful hole closure following primary macular hole surgery between February 2021 and July 2023. We measured the minimum and base diameters of the holes before primary and secondary PPV, respectively. Furthermore, we evaluated the anatomical closure of the holes and changes in best corrected visual acuity (BCVA) for 6 months following secondary PPV. Results: The mean age of the 10 patients was 61.6 ± 9.5 years. Prior to the primary PPV, the mean BCVA (LogMAR) was 1.6 ± 0.7, the mean minimum diameter of the hole was 654.4 ± 98.9 μm, and the mean base diameter of the hole was 1,135.4 ± 276.5 μm. Prior to the secondary PPV with APC injection, the mean BCVA (LogMAR) was 1.3 ± 0.7, the mean minimum diameter of the hole was 666.8 ± 270.2 μm and the mean base diameter of the hole was 845.4 ± 292.4 μm. Following secondary surgery, all holes were successfully closed, the mean BCVA (LogMAR) was 0.9 ± 0.6 and the BCVA was significantly improved (p = 0.007). Conclusions: PPV with APC injection can be an effective therapeutic option for persistent macular hole that failed to close following primary surgery both in terms of anatomical and functional outcomes.
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