데스메막 각막내피이식술 후의 1년 임상결과
Clinical Outcomes of Descemet's Membrane Endothelial Keratoplasty: A 1-Year Retrospective Study
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목적: 저자들은 국내 최초로 데스메막 각막내피이식술 후의 1년 임상결과를 보고하고자 한다. 대상과 방법: 2012년 1월부터 2013년 12월까지 본원에서 데스메막 각막내피이식술을 시행 받은 9명, 10안을 대상으로 하였으며, 12개월이상 추적관찰 후 의무기록을 분석하였다. 결과: 각막부종이 감소한 8안을 분석 시 술 전 최대 교정시력은 평균 1.64 ± 0.21 (logMAR)이었으며 술 후 1개월에 0.35 ± 0.22로통계적으로 유의한 향상을 보여주었다(p=0.012, Wilcoxon signed ranks test). 술 후 3개월, 6개월, 12개월에 측정한 최대 교정시력은0.25 ± 0.23, 0.20 ± 0.17, 0.16 ± 0.17 logMAR로 호전되는 양상을 보였다. 내피세포 수는 술 후 1개월에 1,996 ± 528/mm2로측정되었고 3개월, 6개월, 12개월에 1,564 ± 174/mm2, 1,463 ± 541/mm2, 1,205 ± 358/mm2로 감소하는 양상을 보였으나 통계적으로 유의하지 않았다. 술 전과 술 후 3개월째 각막 전면 난시값은 평균 3.32 ± 2.36 diopter, 2.57 ± 1.44 diopter로 유의한 차이를보이지 않았다. 10안 중 2안에서 일차 각막절편 생착실패를 보였으며, 1안에서 재수술을 시행하였다. 1안에서 각막절편의 완전 분리가발생하였다. 결론: 데스메막 각막내피이식술 후 장기 경과 관찰 결과 빠른 시력 호전을 보이고 12개월 이상 이를 유지하였다. 데스메막 각막내피이식술은 각막내피세포 질환의 치료에 있어 유용한 술기가 될 것으로 보인다.
Abstract
Purpose: To evaluate the 1-year results of Descemet's membrane endothelial keratoplasty (DMEK) in Korea. Methods: The medical records of 9 patients (10 eyes) with endothelial disease who underwent DMEK from January 2012 to December 2013, and were followed up for more than 12 months were reviewed retrospectively. Results: In 8 eyes with successful results after surgery, best corrective visual acuity (BCVA) was significantly improved from 1.64 ± 0.21 (log MAR, mean) to 0.35 ± 0.22 at 1 month and was maintained at 12 months (p = 0.012, Wilcoxon signed ranks test). BCVA at postoperative 3, 6 and 12 months were gradually increased (0.25 ± 0.23, 0.20 ± 0.17 and 0.16 ± 0.17 log MAR). Endothelial cell counts were 1,996 ± 528/mm2, 1,564 ± 174/mm2 and 1,463 ± 541/mm2, 1,205 ± 358/mm2 at 1, 3, 6, and 12 months after surgery, tended to decrease but showed no statistical significance. There was no statistical difference in astigmatism before and 3 months after the operation (3.32 ± 2.36 diopter and 2.57± 1.44 diopter). Primary graft failure occurred in 2 eyes and 1 received reoperation. Total detachment was found in 1 eye. Conclusions: The 1-year results of DMEK showed fast visual recovery which was maintained for 12 months. DMEK may be a very efficient option for the surgical management of corneal endothelial disease.
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