유리체절제술이 Nd:YAG 레이저 후낭절개술의 빈도에 미치는 영향

이진철,김유철 대한안과학회 2014 대한안과학회지 Vol.55 No.12

Purpose: This study aimed to investigate factors that cause after-cataract such as diabetes, intravitreal gas injection during vitrectomy, and other factors in relation to the vitrectomy. Methods: The relationship between the vitrectomy and the frequency of Nd:YAG laser posterior capsulotomy was investigated in a sample of 947 monitored patients’ eyes that underwent cataract surgery. The patients’ eyes were classified into Group 1, which comprised 715 patients’ eyes that underwent cataract surgery only, Group 2, which comprised 152 eyes that underwent both vitrectomy and cataract surgery at the same time, and Group 3, which comprised 80 eyes that underwent cataract surgery after vitrectomy. The age, gender, diabetes status, gases injected during the vitrectomy, and other factors were investigated. Results: It was found that 50 eyes (6.99%) in Group 1 received the posterior capsulotomy, 28 eyes (18.4%) had the procedure in Group 2, and 16 eyes (20.00%) had the procedure in Group 3, respectively. In Group 1, 21 eyes (8.86%) that received the posterior capsulotomy were from diabetic patients, 20 eyes (19.8%) were diabetic in Group 2, and 10 eyes (21.73%) were diabetic in Group 3. In Group 1, 29 eyes (6.06%) were from non-diabetics that received posterior capsulotomy, 8 eyes (15.68%) were from non-diabetic patients in Group 2, and 6 eyes (17.64%) were from non-diabetic patients in Group 3. In the group that had vitrectomy with gas injection, 6 eyes (25%) received the posterior capsulotomy in Group 2, and 10 eyes (24.39%) had the procedure in Group 3, respectively, while those in the group that had vitrectomy without gas injection included 22 eyes (17.46%) in Group 2 and 6 eyes (15.38%) in Group 3. Conclusions: The Nd:YAG laser posterior capsulotomy was more frequently applied to patients who underwent vitrectomy, younger patients, diabetes patients, and patients who had vitrectomy with gas injection. J Korean Ophthalmol Soc 2014;55(12):1787-1792

Proliferative Diabetic Retinopathy Requiring Vitrectomy Over Clinic Management During COVID-19: Impact of Delayed Care

Bennett E. Ahearn,Huy Nguyen,Jeong-Hyeon Sohn 대한안과학회 2023 Korean Journal of Ophthalmology Vol.37 No.4

Purpose: This study aimed to investigate the impact of delayed retinal clinical care during the COVID-19 pandemic on the severity of proliferative diabetic retinopathy (PDR) and drivers of follow-up delay. We compared disease severity and follow-up rates of PDR patients requiring vitrectomy to those managed nonsurgically, and identified factors associated with need for vitrectomy. Methods: The study included 739 patients diagnosed with PDR between January 1, 2018, and March 4, 2021, categorized into two groups based on outcome: vitrectomy nonvitrectomy. Statistical methods such as t-tests and chi-square tests were used to analyze differences in disease severity and follow-up rates before and after COVID-19 shutdown. A multivariate regression evaluated factors leading to vitrectomy by comparing initial ETDRS (Early Treatment of Diabetic Retinopathy Study) DR staging, disease stability, DR progression, proliferative complications, appointment intervals, follow-up variance, rescheduling rate, and no-show rate. Results: Of the 739 patients, 202 required vitrectomy, 537 were managed nonsurgically. The vitrectomy group had more severe or unstable disease before shutdown. The interval between patient visits preshutdown was 29.76 ± 45.11 days in the vitrectomy group and 40.23 ± 56.73 days in the nonvitrectomy group (p < 0.001). Both groups experienced a significant increase in appointment intervals after shutdown, with the vitrectomy group having a greater increase. Both groups had significantly increased rescheduling rate and minimally increased no-show rate. Patient-directed rescheduling was the main driver of appointment delays. Disease factors, such as tractional retinal detachment and higher ETDRS DR staging, increased the odds of vitrectomy, while appointment burden and follow-up variability had a minimal impact. Conclusions: Patients with more severe PDR and greater delay in appointments due to the pandemic were more likely to require vitrectomy for proliferative complications. Patient-directed rescheduling was identified as the main driver of care delays, as opposed to clinic-directed rescheduling. This study highlights the importance of maintaining regular follow-up appointments for PDR patients during pandemics.

유리체절제술 후 발생한 황반원공: 예방이 가능한가?

김리브가,김유철,김광수,Rebecca Kim,MD,Yu Cheol Kim,MD,Kwang Soo Kim,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.2

Purpose: To evaluate the causes of secondary macular hole after vitrectomy and the possibility of their prevention. Methods: 27 patients (28 eyes) who experienced macular hole formation after vitrectomy were reviewed retrospectively. Age, sex, operation methods, duration between the vitrectomy and the secondary macular hole surgery and causes of the primary vitrectomy were recorded. Best-corrected visual acuity (BCVA) before and after primary vitrectomy; preoperative and postoperative macular findings with optical coherence tomography and fundus examination; and BCVA before and after macular hole surgery were analyzed. Results: Of the 2945 eyes that had undergone vitrectomy, 28 eyes (0.96%) experienced macular hole formation. As causes of primary vitrectomy, 12 eyes had proliferative diabetic retinopathy, 6 eyes had rhegmatogenous retinal detachment, 2 eyes had branch retinal vein occlusion, 3 eyes had age-related macular degeneration and 5 eyes had trauma such as eyeball rupture or intraocular foreign body. The mean duration between primary vitrectomy and macular hole formation was 20.4 months (4 days-115 months). The estimated causes of macular hole formation included cystoid macular edema (CME) (n = 13), thinning of the macula (n = 6), thickening of internal limiting membrane or recurrence of preretinal membrane (PRM) (n = 7), recurrence of subretinal hemorrhage (n = 1) and macular damage during vitrectomy (n = 2). Final BCVA after macular hole surgery decreased in most cases compared to BCVA before macular hole formation except in 7 eyes (25%). Conclusions: Close observation of the macula after primary vitrectomy especially in eyes with continuous CME, and recurrent PRM and proper management on them including timely removal of the tangential traction force are necessary for preventing macular hole formation. In addition, surgeons should make efforts not to exert excessive tractional force on the macula to avoid iatrogenic damage during removal of the preretinal membrane. J Korean Ophthalmol Soc 2014;55(2):230-236

유리체절제술 후 시행한 백내장 수술에서 유리체절제술이 인공수정체 도수 결정에 미치는 영향

김의연,안재홍,유호민,양홍석,Eui Yon Kim,M,D,Jae Hong Ahn,M,D,Ho Min Lew,M,D,Hong Seok Yang,M,D 대한안과학회 2008 대한안과학회지 Vol.49 No.11

Purpose: To evaluate the effect of vitrectomy in IOL power calculation for cataract surgery in the eyes that previously performed vitrectomy. Methods: This study comprised 41 eyes of 37consecutive patients who underwent cataract surgery after previous vitrectomy. IOL power calculation with the measurement of axial length and corneal power was conducted before vitrectomy and before cataract surgery. Target refractions at each surgery, assuming that the same power of IOL was implanted, were compared to actual manifest refraction after cataract surgery. Results: There was no statistically significant change in both axial length and corneal power after vitrectomy (p>0.05). Before vitrectomy, target refraction was -0.22±0.61D compared to -0.37±0.52D before cataract surgery. The actual refraction after cataract surgery was -0.47±0.94D, and there were no significant differences among the three refractions (p>0.05). Conclusions: In the eyes that underwent vitrectomy, vitrectomy itself does not have an influence on calculating IOL power for cataract surgery. J Korean Ophthalmol Soc 2008;49(11):1759-1764

공막 봉합 인공수정체 삽입술시 병행한 유리체 절제술의 의의

장보현,안민,이동욱,조남천,Bo-Hyun Jang,Min Ahn,Dong-Wook Lee,Nam-Chun Cho 대한안과학회 2005 대한안과학회지 Vol.46 No.3

Purpose: To evaluate the role of vitrectomy in transscleral fixation of posterior chamber intraocular lens (IOL) compared to scleral fixation without vitrectomy. Methods: We reviewed the medical records of 8 eyes which had undergone transscleral fixation with vitrectomy using the three-port-system and 13 eyes which had undergone transscleral fixation only. The postoperative visual acuity, best-corrected visual acuity and changes in astigmatism were compared between the groups. Results: Postoperative uncorrected and best corrected visual acuities were 0.68 and 0.8 in the vitrectomy group and 0.48 and 0.63 in the non-vitrectomy group, respectively. Changes in the amount of astigmatism were significantly less in the vitrectomy group (0.38 diopter) compared to those of the non-vitrectomy group (1.67 diopter). Conclusions: Transscleral fixation of IOL along with three-port-system vitrectomy resulted in good vision with a smaller degree of astigmatism. Adopting three-port-system vitrectomy seems to have caused the good results, because more complete removal of the lens and capsule remnants and adequate maintenance of IOP with accurate needling and IOL positioning was possible using the system.

유리체절제술 중 공막 렌즈 사용이 술 후 각막 상태에 미치는 영향

정현철(Hyun Chul Jeong),정우진(Woo Jin Jung) 대한안과학회 2016 대한안과학회지 Vol.57 No.8

목적: 유리체절제술로 인해 생길 수 있는 각막 합병증을 예방하기 위해 수술 중 공막 렌즈를 사용하여 그 효과를 알아보고자 하였다. 대상과 방법: 2014년 11월부터 2015년 6월까지 본원에서 유리체절제술을 시행 받은 환자 42명(42안)을 대상으로 후향적으로 연구를 진행하였다. 유리체절제술 중 직경 15.8 mm의 공막 렌즈를 사용한 환자군과 사용하지 않은 환자군을 나누어 유리체절제술 전, 수술 1일, 7일, 28일 후에 각막의 상태를 세극등 현미경검사 및 전안부 OCT (RTVue 100, Optovue, Fremont, CA, USA)를 이용해 평가하였다. 공막 렌즈 사용 여부에 따른 술 후 각막 상태의 변화를 분석하였다. 결과: 42안 중 18안에서 유리체절제술 중 공막 렌즈를 사용하였다. 환자의 평균 나이는 56.8 ± 11.4세, 남자 22명, 여자 20명이었다. 유리체절제술 후 모든 환자에서 각막의 두께는 증가하였다. 수술 1일 후 공막 렌즈를 사용한 환자군의 평균 각막 두께 증가량은 23.9 ± 9.7 μm, 공막 렌즈를 사용하지 않은 환자군의 평균 각막 두께 증가량은 43.0 ± 19.5 μm로 공막 렌즈를 사용한 군에서 각막 부종이 적게 나타났다(p<0.001). 수술 7일 후 평균 각막 두께 증가량은 각각 8.1 ± 7.2 μm, 32.3 ± 19.2 μm로, 마찬가지로 공막 렌즈를 사용한 군에서 각막 부종이 적게 나타났다(p<0.001). 수술 1일 및 7일 후 각막 두께의 증가량은 두 군 간에 유의한 차이를 보였다. 모든 기간에 걸쳐 점상각막염의 정도는 두 군 간에 유의한 차이를 보이지 않았다. 결론: 유리체절제술 중 공막 렌즈의 사용은 수술 중 시야를 가리지 않고 수술로 인해 생기는 각막 부종을 감소시키는 방법이 될 수 있다. Purpose: To analyze the effect of scleral lens application for preventing corneal edema during vitrectomy on postoperative corneal status using anterior segment OCT (RTVue 100, Optovue, Fremont, CA, USA). Methods: The medical records of 42 eyes (42 patients) who underwent total vitrectomy with no appreciable corneal disease between November 2014 and June 2015 were retrospectively reviewed. Evaluations were performed at 1 day, 1 week, and 1 month after total vitrectomy. Corneal status was noted at every follow-up visit using anterior segment OCT. An analysis was performed to define the changes in corneal status in association with scleral lens application during the surgery. Results: 18 of 42 eyes were treated with a scleral lens during total vitrectomy. The corneal thickness increased after vitrectomy in all cases. The mean corneal thickness increment was 23.9 ± 9.7 μm in the scleral lens group and 43.0 ± 19.5 μm in the non-scleral lens group at 1 day after vitrectomy (p < 0.001). At 1 week after vitrectomy, the mean corneal thickness increment was 8.1 ± 7.2 μm in the scleral lens group and 32.3 ± 19.2 μm in the non-scleral lens group (p < 0.001). The difference in superficial punctate keratitis grade between the two groups was not statistically significant. Conclusion: Scleral lens application during vitrectomy seems to prevent postoperative corneal edema. More cases and a longer period of study is needed to draw definitive conclusions.

고위험 증식당뇨망막병증에서 범망막광응고 대신에 시행한 유리체절제술

조형훈,최광주,Hyung Hun Cho,M,D,Gwang Ju Choi,M,D 대한안과학회 2007 대한안과학회지 Vol.48 No.1

Purpose: This research is to evaluate the effectiveness of vitrectomy on early vision recovery compared to that of panretinal photocoagulation for the high-risk proliferative diabetic retinopathy (PDR) patients. Methods: A retrospective chart review of 84 high-risk PDR patients (100 eyes) who had undergone panretinal photocoagulation or vitrectomy under the diagnosis the high-risk PDR and followed up at least 12 months. Authors divided them into two different groups ; one with who received PRP, and another with vitrectomy. We investigated both groups` vision change every 3, 6, and 12 months after the treatment. Results: The Vitrectomy group patients showed higher percentage of vision improvement and lower percentage of vision decrease (p≤0.05) than the PRP group patients in 3rd and 6th month. Macular edema decreased in the Vitrectomy group and increased in the PRP group in the 3rd month. Need for additional surgery due to complication showed 26% in the PRP group, and 12% in the Vitrectomy group. Conclusions: We conclude the vitrectomy is more efficient method than PRP for high-risk PDR patients who are in need of early vision recovery.

Giant Retinal Tear by Jamming of 23-gauge Instrument in the Cannula during Vitrectomy for Dense Vitreous Hemorrhage

Sun Jung Eum,Jae Pil Shin 대한검안학회 2015 Annals of optometry and contact lens Vol.14 No.4

Purpose:We report a rare case of intraoperative giant retinal tear caused by completely jammed 23-gauge instrument in the cannula during vitrectomy for dense vitreous hemorrhage. Case summary: A 41-year-old man presented with visual disturbance in the left eye. Uncorrected visual acuity was 20/20 for right eye and hand motion in the left eye which was not corrected. The patient was diagnosed with dense vitreous hemorrhage related to branch retinal vein occlusion in the left eye. We performed 23-gauge vitrectomy, and the vitreous cutter was firmly jammed inside the cannula intraoperatively. The jammed cannula had to be removed along with the cutter and a new cannula was reinserted through the sclerotomy site. A giant retinal break was detected around the replaced cannula during peripheral vitrectomy. Perfluorocarbon liquid was used to unfold the inverted flap of the retinal tear and the operation was finished by applying laser photocoagulation and silicone oil tamponade. Conclusions: The 23-gauge vitrectomy instrument may be jammed in the cannula during vitrectomy for dense vitreous hemorrhage, and the trapped vitreous can cause retinal break by traction. Therefore, dense vitreous hemorrhage around the cannula should be carefully removed to prevent iatrogenic intraoperative retinal break prior to core vitrectomy.

증식성 초자체 망막증에 대한 초자체 절제술의 효과 : 제1보:초자체 절제술을 받은 망막박리 422눈에 대한 임상적 분석

이재홍,임진옥 최신의학사 1994 最新醫學 Vol.37 No.4

침술에 의한 양안 안구천공

이경용,길태영,정호길,신승주 대한안과학회 2020 대한안과학회지 Vol.61 No.4

Purpose: To report a case of both ocular perforation due to periocular acupuncture therapy with vitrectomy in the right eye and barrier laser photocoagulation without vitrectomy in the left eye. Case summary: A 58-year-old female presented with ocular pain and decreased visual acuity in both eye. She had received periocular acupuncture therapy 4 days earlier. Dilated fundoscopy revealed vitreous hemorrhage. B-scan ultrasonography revealed vitreous opacity. Thus, at the request of the patient, vitrectomy was performed in only the right eye, and did not performed in the left eye. Intraoperatively, we identified retinal laceration in the temporal and inferior retina. In the left eye, the sites of retinal hemorrhage were observed in the temporal and inferior retina in the fundus examination, and a barrier laser photocoagulation was performed around the lesion. At the three-month postoperative follow-up, the patient’s visual acuity was 0.5 in the right eye without macular edema. In the left eye, visual acuity was 0.01 with macular edema observed on optical coherence tomography. Conclusions: Authors present a case of a patient with vitreous hemorrhage and ocular perforations caused by periocular acupuncture therapy in both eye, able to compare the results of eyes that performed vitrectomy and that did not performed vitrectomy in a same patient. The recovery of visual acuity in eye that performed vitrectomy was better than eye that did not performed vitrectomy. Therefore, we consider performing vitrectomy in patients with eye perforation. 목적: 안구주위 침술에 의해 양안 안구천공 및 유리체출혈이 발생한 환자의 우안에 유리체절제술을 시행하고, 좌안에 유리체절제술 없이 레이저광응고술 치료를 시행한 증례를 보고하고자 한다. 증례요약: 58세 여자 환자가 양안의 통증 및 시력저하를 주소로 내원하였다. 내원 4일 전 무자격자에 의하여 양안 안구 주위에 침을 맞았다고 하였다. 안저검사에서 양안 유리체출혈, 초음파검사에서 유리체혼탁이 관찰되었다. 침에 의해 발생한 안구천공 및 유리체출혈을 진단하였다. 우안은 유리체절제술을 시행하였고, 좌안은 환자 요청하에 유리체절제술을 시행하지 않았다. 수술 중 우안 망막이측 및 하측에 열상 부위를 확인할 수 있었다. 좌안은 안저검사에서 망막 이측 및 하측에 망막출혈 부위를 확인하고, 병변 주변에레이저광응고술을 시행하였다. 3개월 후 우안은 황반부종 없이 시력 0.5로 측정되었고, 좌안은 황반부종 소견이 관찰되며 시력 0.01로 측정되었다. 결론: 침술에 의한 안구천공으로 양안 유리체출혈이 발생한 환자의 증례를 목격하였으며, 동일 환자에서 각각 유리체절제술을 시행한 눈과 유리체절제술을 시행하지 않은 눈의 결과를 비교할 수 있는 경험을 하였기에 이를 보고하는 바이다. 유리체절제술을 시행하지 않은 눈에 비해 시행한 눈의 시력 회복에 더 좋은 경과를 보였다. 따라서 안구천공 환자에서 유리체절제술 시행을 고려해야 한다.