망막박리로 유리체절제술을 시행받은 고도근시 환자의 과도한 안구 확장 1예
A Case of Excessive Axial Length Elongation Following Retinal Detachment Vitrectomy
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목적: 열공망막박리로 유리체절제술과 가스충전술 시행 후 과도한 안축장의 길이 증가를 확인한 증례를 보고하고자 한다. 증례요약: 21세의 남자 환자가 이틀 전부터 발생한 시력저하로 내원하였다. 내원 3년 전 외상으로 본원 응급실에서 컴퓨터단층촬영을시행받은 기록이 있었으며 당시 안축장 길이는 우안 27.23 mm, 좌안 27.62 mm로 확인되었다. 내원 당시 안저검사상 좌안에 황반박리를 포함한 망막박리 소견과 저안압성 망막병증 소견이 함께 관찰되었다. 따라서 망막박리수술을 하였으며 수술 익일부터 좌안 안압이증가된 소견을 보여 안압을 조절하였다. 술 후 3개월째 추가로 발견된 우안 망막박리로 수술을 하였고 술 후 안압은 잘 조절되었다. 환자의 안구돌출이 의심되어 안축장 길이를 확인해본 결과 양안의 안축장 길이가 우안 27.76 mm, 좌안 31.41 mm로 3년 전과 비교하였을 때 우안의 안축장 길이는 그대로이나 좌안의 갈이는 증가하였음을 확인하였다. 결론: 젊은 연령층의 고도근시 환자에게서 발생한 열공망막박리의 경우, 유리체절제술과 가스충전술, 수술 전의 저안압증, 수술 후의고안압증이 과도한 안축장 길이 증가와 연관이 있을 것으로 생각된다.
Abstract
Purpose: To report a case of excessive axial length elongation following vitrectomy for rhegmatogenous retinal detachment. Case summary: A 21-year-old male patient presented to our hospital with visual impairment. The patient had previously undergone computed tomography in our emergency room for a facial contusion 3 years prior to his current visit. Axial lengths of 27.23 mm in the right eye and 27.62 mm in the left eye were recorded at that time. The patient had no previous ocular history. Fundus examination revealed extensive retinal detachment with macular involvement and hypotony retinopathy in the left eye. Retinal detachment surgery was subsequently performed on the left eye. Following the surgery, intraocular pressure in the left eye increased and intraocular pressure-lowering medications were administered. At 3 months postoperatively, the patient developed additional retinal detachment in the right eye, prompting retinal detachment surgery. Unlike the contralateral eye, the intraocular pressure remained well-controlled postoperatively. Axial length measurement was performed due to the complaint of left eye protrusion. The axial lengths were 27.76 mm and 31.41 mm in the right and left eyes, respectively. There was a significant increase in the axial length of the left eye but not in that of the right eye compared to 3 years prior. Conclusions: Gas tamponade, preoperative ocular hypotension, and postoperative ocular hypertension can cause excessive axial length elongation in cases of rhegmatogenous retinal detachment in young patients with high myopia.
참고문헌 (15)
- Madi HA, "Increasing frequency of hospital admissions for retinal detachment and vitreo-retinal surgery in England 2000-2018", Eye(Lond), 36, pp.1610~1614 (2022)
- Radeck V, "Retinal detachment surgery : trends over 15 years", Ophthalmologe, 119(Suppl 1), pp.64~70 (2022)
- Kang TS, "Long-term reproducibility of axial length after combined phacovitrectomy in macula-sparing rhegmatogenous retinal detachment", Sci Rep, 8, pp.15856~ (2018)
- Liu R, "Changes in ocular biometric measurements after vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment repair", BMC Ophthalmol, 20, pp.360~ (2020)
- Mukhtar A, "Change in central corneal thickness, corneal endothelial cell density, anterior chamber depth and axial length after repair of rhegmatogenous retinal detachment", Pak J Med Sci, 33, pp.1412~1417 (2017)
- Huang C, "Changes in axial length, central cornea thickness, and anterior chamber depth after rhegmatogenous retinal detachment repair", BMC Ophthalmol, 16, pp.121~ (2016)
- Shi J, "Change in axial length after vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment", BMC Ophthalmol, 22, pp.257~ (2022)
- Park SJ, "Five year nationwide incidence of rhegmatogenous retinal detachment requiring surgery in Korea", PLoS One, 8, pp.e80174~ (2013)
- Li X, "Incidence and epidemiological characteristics of rhegmatogenous retinal detachment in Beijing, China", Ophthalmology, 110, pp.2413~2417 (2003)
- Kim MS, "Different mechanistic association of myopia with rhegmatogenous retinal detachment between young and elderly patients", Biomed Res Int, 2019, pp.5357241~ (2019)
- Brazitikos PD, "Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment : a randomized clinical trial", Retina, 25, pp.957~964 (2005)
- Cho KH, "Changes in postoperative refractive outcomes following combined phacoemulsification and pars plana vitrectomy for rhegmatogenous retinal detachment", Am J Ophthalmol, 158, pp.251~256 (2014)
- Zhang N, "The effect of prior trabeculectomy on refractive outcomes of cataract surgery", Am J Ophthalmol, 155, pp.858~863 (2013)
- Schmid KL, "The expandability of the eye in childhood myopia", Curr Eye Res, 26, pp.65~71 (2003)
- Ohsugi H, "Axial length changes in highly myopic eyes and influence of myopic macular complications in Japanese adults", PLoS One, 12, pp.e0180851~ (2017)