안압하강제가 근시 망막층간분리에 미치는 효과

이정화,장규환,이수찬,공민귀,손준홍 대한안과학회 2020 대한안과학회지 Vol.61 No.4

목적: 안압하강제가 근시 망막층간분리에 미치는 영향을 알아보고자 하였다. 대상과 방법: 2014년 4월부터 2018년 12월까지 근시 망막층간분리를 동반한 병적 근시(굴절력<-8.0디옵터 또는 안축장>26.5 mm)로 내원한 환자 중 녹내장 시신경병증이 의심되어 안압하강제를 사용한 환자를 대상으로 하였다. 안압하강제를 사용하고 6개월 후 망막층간분리의 진행 여부를 빛간섭단층촬영을 이용하여 후향적으로 분석하였으며 망막층간분리의 진행 여부는 망막 부피 변화를 분석하여 평가하였다. 전체 망막 부피가 감소하면서 부피 5구역 중 한 구역 이상 10% 이상의 부피 감소가 있으며 10% 이상 부피 증가가 있는 구역이 없을 때 층간분리가 호전되었다고 보았으며 반대되는 경우를 악화되었다고 평가하였다. 결과: 총 15명 환자의 17안을 분석하였다. 6개월 경과 관찰 시 17안 중 6안(35.3%)에서 망막층간분리가 호전되었으며 2안(11.8%)에서 진행되었다. 1년 이상 추적 관찰된 14안 중 7안(50%)에서 호전, 2안(14%)에서 진행되었다. 호전된 7안 중에 호전 과정에서 후유리체박리가 발생하거나 황반원공이 발생한 경우는 없었다. 초기 안압의 절대값, 안축장 길이, 안압하강 정도와 망막층간분리 호전 정도는 연관관계가 없었다. 결론: 망막층간분리를 동반한 고도근시안에서 안압하강제를 사용한 경우 기존의 연구 결과들에 비하여 호전되는 비율이 높았다. 이러한 결과는 안압하강제가 근시 망막층간분리의 자연 경과를 늦추거나 호전시킬 가능성을 시사하며 추가적인 연구가 필요할 것으로 생각된다. Purpose: To investigate the influence of intraocular pressure (IOP)-lowering eye drops on myopic retinoschisis. Methods: We investigated myopic retinoschisis patients with high myopia (defined as a myopic refractive error more than -8.0 diopters or an axial length longer than 26.5 mm), who were suspected of having glaucomatous optic neuropathy, using IOP-lowering eye drops between April 2014 and December 2018. We retrospectively analyzed the changes in optical coherence tomography findings after 6 months using IOP-lowering eye drops. The progression of retinoschisis was assessed by analyzing retinal volume changes. A decrease in the total retina volume and a decrease in volume more than 10% in one section out of five without more than a 10% volume increase in any other section was defined as resolution of myopic retinoschisis. The opposite case was defined as an aggravation. Results: We analyzed 17 eyes of 15 patients with high myopia. Six of 17 eyes (35.3%) showed a resolution of myopic retinoschisis at 6 months after using IOP-lowering eye drops. Of the 17 eyes, two (11.8%) experienced progression of myopic retinoschisis. Seven out of 14 eyes (50.0%) who were followed-up over 1 year showed resolution of myopic retinoschisis, and two eyes (14.3%) experienced progression of myopic retinoschisis. There was no macular hole development or posterior vitreous detachment during the follow-up period in the seven eyes, and there was no significant correlation between the absolute value of the initial IOP, axial length, IOP change, and degree of improvement of myopic retinoschisis. Conclusions: The use of IOP-lowering eye drops on highly myopic eyes with retinoschisis showed a significant improvement of myopic retinoschisis, when compared to previous studies. These findings suggest the possibility of IOP-lowering eye drops delaying or improving the natural course of myopic retinoschisis.

근시성 맥락막신생혈관에서 유리체 내 베바시주맙 주입술 후 망막층간분리 악화의 위험인자

송지윤,김종민 대한안과학회 2024 대한안과학회지 Vol.65 No.5

목적: 베바시주맙 주입술을 시행받은 근시성 맥락막신생혈관 환자에서 망막층간분리를 발생 혹은 진행시키는 인자를 밝히고자 한다. 대상과 방법: 근시성 맥락막신생혈관으로 진단된 후 유리체 내 베바시주맙 주입술을 시행받고 12개월 이상 경과 관찰이 된 54안을대상으로 후향적 의무기록 분석을 시행하였다. 초진 시와 최종 방문 시 빛간섭단층촬영 결과를 비교하여 망막층간분리의 발생 및진행 여부를 평가하고, 망막층간분리 발생 및 진행의 위험인자를 분석하였다. 결과: 평균 42.82 ± 27.12개월의 경과 관찰 기간 동안 11안(20.3%)에서 망막층간분리가 악화되었으며(발생 7안, 진행 4안) 망막층간분리가 악화되지 않은 군에서 안축장은 29.21 ± 1.64 μm였고 악화된 군에서는 31.21 ± 2.52 μm로 통계적으로 유의한 차이를 보였다(p=0.011). 망막층간분리의 악화에 영향을 미치는 요인을 분석한 결과, 단변량 로지스틱 회귀분석에서는 안축장(p=0.041) 및 빛간섭단층촬영에서 외측 망막층간분리가 있는 경우(p=0.018)가 연관된 인자로 나타났다. 다변량 분석에서는 안축장(p=0.038, odds ratio =2.63)이 망막층간분리의 악화와 연관된 인자로 나타났다. 결론: 근시성 맥락막신생혈관 환자에서 안축장이 증가할수록 베바시주맙 주입술 후 망막층간분리 발생 및 진행의 위험도가 증가되는것으로 확인되었다. 안축장이 긴 근시성 맥락막신생혈관 환자에서 베바시주맙 주입술을 시행할 경우 망막층간분리에 대해서도 주의깊은 관찰이 필요할 것으로 생각된다. Purpose: We evaluated the factors associated with the development and progression of retinoschisis in patients with myopic choroidal neovascularization (CNV) treated with intravitreal bevacizumab injections. Methods: We conducted a retrospective analysis of 54 eyes with myopic CNV treated with intravitreal bevacizumab injections. We compared optical coherence tomography findings at baseline and final follow-up visits to assess the occurrence and progression of retinoschisis. Furthermore, we analyzed potential risk factors associated with the occurrence and progression of retinoschisis. Results: During a mean follow-up of 42.82 ± 27.12 months, retinoschisis worsened in 11 eyes (20.3%), including 7 eyes with new-onset disease and 4 with progression. The aggravated group demonstrated a significantly longer baseline axial length compared to the non-aggravated group (31.21 ± 2.52 μm vs. 29.21 ± 1.64 μm, p = 0.011). Univariate logistic regression analysis identified axial length (p = 0.041) and pre-existing outer retinoschisis (p = 0.018) as potential predictors of retinoschisis aggravation. In a multivariate analysis, axial length remained significantly associated with retinoschisis aggravation (p = 0.038, odds ratio = 2.63). Conclusions: Our study emphasized that a longer axial length is a risk factor for the development or progression of retinoschisis in myopic CNV patients treated with intravitreal bevacizumab injections. Therefore, closer monitoring during treatment may be warranted for myopic CNV patients with long axial length at baseline.

특발망막전막에서 망막층간분리 유무에 따른 수술 전후 시력 및 해부학적 차이

이민수,방찬우,송도윤,방종욱,전혜민,윤희성 대한안과학회 2019 대한안과학회지 Vol.60 No.11

Purpose: To present differences in visual acuity and macular structure before and after surgery in patients with idiopathic epiretinal membrane (ERM) according to the presence of retinoschisis. Methods: This retrospective observational study included 324 eyes with idiopathic ERM, that underwent pars plana vitrectomy with ERM and internal limiting membrane peeling, and were followed for more than 6 months. Subjects were classified into two groups according to the presence of retinoschisis using preoperative optical coherence tomography (OCT; group 1, ERM with retinoschisis; group 2, ERM without retinoschisis). Preoperative and postoperative macular structure changes and surgical outcomes were compared. Results: Group 1 included 61 eyes, and group 2 included 263 eyes. Group 1 had a significantly higher preoperative and final postoperative best-corrected visual acuity compared with group 2 (p = 0.01, p = 0.02). Preoperative disorganization of retinal inner layers (DRIL) was significantly less in group 1 than group 2 (p = 0.01). Preoperative central macular thickness was not significantly different between the two groups. However, postoperative central macular thickness was significantly lower in group 1 than group 2 (p = 0.02, p = 0.01, p < 0.01). The ratio of the inner or outer layer in the total retinal thickness before surgery was significantly smaller in group 1 than in group 2 (p = 0.02, p = 0.04). Conclusions: Preoperative visual acuity was better and the occurrence of DRIL was less in idiopathic ERM with retinoschisis than without retinoschisis. Postoperative visual and structural outcome was better in idiopathic ERM with retinoschisis than without retinoschisis. Retinoschisis may have played a role in reducing the tractional force given to the inner and outer retina. 목적: 특발망막전막환자에서 수술 전 망막층간분리의 동반 유무에 따른 수술 전후 시력 및 망막층 구조의 차이에 대해서 알아보고자 하였다. 대상과 방법: 2015년 1월부터 2017년 12월까지 특발망막전막으로 진단받고 유리체절제술과 망막전막제거술 및 내경계막제거술을 시행 받은 환자 중 6개월 이상 경과 관찰이 가능하였던 연속된 환자를 대상으로 의무기록을 후향적으로 분석하였다. 술 전 빛간섭단층촬영으로 망막층간분리의 동반 유무에 따라 두 군으로 나누어 수술 전과 후 시력예후 및 망막 형태 변화를 비교 분석하였다. 결과: 전체 324안 중 망막층간분리를 동반한 1군은 61안, 망막층간분리를 동반하지 않은 2군은 263안이었으며, 술 전 및 최종 시력이 1군에서 유의하게 좋았다(p=0.01, p=0.02). 수술 전 망막내층 조직의 손상(disorganization of retinal inner layers, DRIL)은 1군에서 2군에 비해 유의하게 낮았다(p=0.01). 수술 전 중심황반두께는 두 군에 차이가 없었으나, 술 후 3개월, 6개월 및 최종에서 1군이 2군보다 유의하게 얇은 결과를 보였다. 수술 전 전체 망막두께에서 내층 및 외층이 차지하는 비율은 1군이 2군에 비해 유의하게 작았다. 결론: 특발망막전막에서 망막층간분리가 동반된 경우가 동반되지 않은 경우보다 수술 전 시력이 좋고 DRIL의 빈도가 낮았으며, 수술 후 중심황반두께가 얇고 시력예후도 우수하였다. 이는 망막층간분리가 망막전막의 지속적인 견인력에 대한 완충적 작용을 하여 망막층의 구조가 비교적 보존되었기 때문이라 생각한다.

비녹내장안에서 발견된 시신경유두주위 망막층간분리

진선영,송미령,김민경,황영훈 대한안과학회 2015 대한안과학회지 Vol.56 No.1

Purpose: To investigate the characteristics of non-glaucomatous eyes with peripapillary retinoschisis. Methods: Six non-glaucomatous eyes with peripapillary retinoschisis were enrolled. Age, sex, refractive error, intraocular pressure, location and changes of peripapillary retinoschisis, and the presence of accompanied abnormalities were assessed. To determine possible abnormalities of the optic nerve head and macula, fundus photographs and cross-sectional images of the optic nerve head and macula obtained by optical coherence tomography were inspected. Results: Three males and 3 females were enrolled. Age of the subjects ranged from 11 to 59 years (median, 45 years). Refractive error ranged from -6.25 to +1.00 diopter (median, -0.50 diopter). Peripapillary retinoschisis was located in the superior quadrant in four eyes, in the nasal quadrant in one eye, and in the inferior quadrant in one eye, respectively. No additional abnormalities were found in fundus photographs or in the cross-sectional images of the optic nerve head and macula that were obtained by optical coherence tomography. Longitudinal follow-up was available for two eyes and spontaneous resolution of peripapillary retinoschisis was observed in these eyes 6 and 9 months later, respectively. Conclusions: Peripapillary retinoschisis was observed in non-glaucomatous eyes. This finding was observed in subjects of various ranges of age and refractive error, and in both sexes, without any other accompanying abnormalities. J Korean Ophthalmol Soc 2015;56(1):80-85

Effect of Anti-glaucoma Agents on Myopic Retinoschisis

Kyuhwan Jang,Junghwa Lee,Kyungmin Lee,Mi Jeung Kim,Joonhong Sohn 대한안과학회 2020 Korean Journal of Ophthalmology Vol.34 No.6

Purpose: To evaluate the effect of intraocular pressure (IOP)-lowering medications on myopic retinoschisis. Methods: The medical records of 33 patients (36 eyes) with myopic retinoschisis associated with pathologic myopia werereviewed retrospectively. The patients were divided into two groups: the study group comprising patients undergoing treatmentwith anti-glaucoma medications for suspected glaucoma; the control group comprising patients who did not use anyIOP lowering medications. The changes in retinoschisis in the two groups were compared using the Spectralis domain opticalcoherence tomography thickness map protocol. Results: The study group included 18 eyes (17 patients), and the control group included 18 eyes (16 patients). There were nosignificant differences between the 6-month and 12-month improvement or aggravation rates of the two groups (p = 0.513and 0.137, respectively). However, after 18 months, the aggravation rate of retinoschisis was significantly lower in the studygroup (p = 0.003). The improvement / aggravation rate was 58.33% / 16.67% in the study group and 0% / 57.14% in the controlgroup. Conclusions: The use of IOP-lowering medications for more than a year may be useful for the management of retinoschisisassociated with pathologic myopia.

시신경유두주위 망막층간분리가 동반된 중심장액맥락망막병증

김종헌,김임규,김용일,이규원,강현구 대한안과학회 2019 대한안과학회지 Vol.60 No.6

목적: 시신경유두주위 망막층간분리가 동반된 중심장액맥락망막병증 1예를 보고하고자 한다. 증례요약: 64세 남자 환자가 6개월 전부터 시작된 좌안의 색깔이 달라 보이는 증상으로 내원하였다. 안저검사상 좌안 시신경유두비측 및 시신경유두 이측과 황반부 사이에 장액성 망막박리를 의심하게 하는 망막의 융기가 관찰되었고, 스펙트럼영역 빛간섭단층촬영에서 좌안 시신경유두 비측으로 망막하액이 있었으며, 시신경유두 이측으로 망막층간분리가 확인되었다. 형광안저촬영에서 좌안황반부와 시신경유두주위에 다수의 잉크점 모양의 누출이 관찰되었고, 인도시아닌그린혈관조영에서 양안 맥락막혈관 과투과성이 관찰되어 시신경유두주위 망막층간분리를 동반한 만성 중심장액맥락망막병증으로 진단하고 누출점에 아르곤레이저광응고술을 시행하였다. 레이저 치료 8주 후 빛간섭단층촬영상 시신경유두 비측과 이측, 황반부 모두에서 망막층간분리 및 망막하액은 소실되었다. 결론: 중심장액맥락망막병증에 의한 시신경유두주위 망막층간분리는 누출점에 대한 아르곤레이저광응고술로 호전되었다. Purpose: To report a case of central serous chorioretinopathy with peripapillary retinoschisis. Case summary: A 64-year-old male presented with abnormal color vision of the left eye, which occurred 6 months prior to his visit. At the initial visit, a funduscopic examination revealed retinal elevation with suspected serous retinal detachment around the optic disc in the left eye. Spectral domain optical coherence tomography showed subretinal fluid on the nasal side of the optic disc and retinoschisis on the temporal side of the optic disc in the left eye. Fluorescein angiography revealed multiple leakages in the left eye. Indocyanine green angiography revealed choroidal vascular hyperpermeability in both eyes. Based on these results, the patient was diagnosed with chronic central serous chorioretinopathy and was treated with argon laser photocoagulation at the leakage points. After 8 weeks of laser therapy, optical coherence tomography indicated that there was no retinoschisis or subretinal fluid in the macula, nasal, or temporal sides of the optic disc. Conclusions: Peripapillary retinoschisis due to central serous chorioretinopathy improves with argon laser photocoagulation at leakage sites.

엑스염색체관련 연소망막층간분리 환자에서 외상 후 발생한 망막박리

곽지용,임형택,김민,이승규,변석호,김성수,이성철 한국망막학회 2019 Journal of Retina Vol.4 No.2

Purpose: To report the case of a 4-year-old male with X-linked juvenile retinoschisis (XLRS) who presented with total retinal detachment of the right eye and inner retinal detachment of the left eye after trauma. Case summary: A 4-year-old male patient presented to the emergency department with acute headache and was initially diagnosed with bilateral retinal detachment at a different hospital. Initial intraocular pressure (IOP) was high in the right eye. B-scan ultrasound and optical coherence tomography revealed total retinal detachment of the right eye and inner retinal detachment of the inferior half of the left eye. He was diagnosed with XLRS via genetic analysis, and treatment with acetazolamide stabilized the IOP and prevented further progression of retinoschisis. Conclusions: We describe a rare case of XLRS with severe bilateral retinal detachment after eye trauma. Retinal detachment in one eye eventually stabilized with the use of acetazolamide, whereas his fellow eye, which was more severely affected, progressed to phthisis. We hope to collect and analyze more evidence to understand the apparent susceptibility to eye trauma in patients with XLRS to protect their vision in the future.

엑스염색체관련 연소망막층간분리의 시력과 안저 소견

이종주,김정훈,정호경,허장원,김성준,유영석,Jong Joo Lee,Jeong Hun Kim,Ho-Kyung Choung,Jang Won Heo,Seong-Joon Kim,Young Suk Yu 대한안과학회 2007 대한안과학회지 Vol.48 No.7

Purpose: To evaluate long-term changes in visual acuity, fundus findings and complications in X-linked juvenile retinoschisis. Methods: A retrospective chart review was conducted on 48 patients diagnosed with X-linked juvenile retinoschisis and followed for a minimum of 12 months. Results: Forty-eight males (mean age 5.7 years) were followed for a mean of 6.3 years. The mean visual acuities were 0.14 at the initial and most recent examinations without significant change (p=0.67). Macular abnormalities were seen in all eyes. Macular lesions varied as follows: decreased foveal reflex (12.5%), typical foveal schisis (77.1%), atrophic change (5.2%), and macula-involving peripheral schisis (5.2%). When patients had different macular findings, the mean visual acuities were significantly different among groups (p≤0.005), except those between the atrophic change group and the macula-involving peripheral schisis group. Peripheral schisis was detected in 66% of patients. The fundus findings were stationary during the follow-up period except in complicated cases with vitreous hemorrhage (15.6%). Conclusions: X-linked juvenile retinoschisis causes bilateral visual acuity loss, affecting maculae. In uncomplicated cases, changes in visual acuity and fundus findings were not significant during the follow-up period.

Case Reports : Optic Disc Pit with Peripapillary Retinoschisis Presenting as a Localized Retinal Nerve Fiber Layer Defect

( In Seok Song ),( Joong Won Shin ),( Yong Woon Shin ),( Ki Bang Uhm ) 대한안과학회 2011 Korean Journal of Ophthalmology Vol.25 No.6

A 59-year-old woman was referred to our clinic for a glaucoma evaluation. The visual acuity and intraocular pressure were normal in both eyes. However, red-free fundus photography in the left eye showed a superotemporal wedge-shaped retinal nerve fiber layer defect, and visual field testing showed a corresponding partial arcuate scotoma. In an optical coherence tomography examination, the macula was flat, but an arcuate-shaped peripapillary retinoschisis was found. Further, the retinoschisis seemed to be connected with a superotemporal optic pit shown in a disc photograph. After 3 months of a topical prostaglandin analogue medication, the intraocular pressure in the retinoschisis eye was lowered from 14 to 10 mmHg and the peripapillary retinoschisis was almost resolved. We report a rare case of an optic disc pit with peripapillary retinoschisis presenting as a localized retinal nerve fiber layer defect.

Optic Disc Pit with Peripapillary Retinoschisis Presenting as a Localized Retinal Nerve Fiber Layer Defect

송인석,신중원,신용운,엄기방 대한안과학회 2011 Korean Journal of Ophthalmology Vol.25 No.6

A 59-year-old woman was referred to our clinic for a glaucoma evaluation. The visual acuity and intraocular pressure were normal in both eyes. However, red-free fundus photography in the left eye showed a superotemporal wedge-shaped retinal nerve fiber layer defect, and visual field testing showed a corresponding partial arcuate scotoma. In an optical coherence tomography examination, the macula was flat, but an arcuate-shaped peripapillary retinoschisis was found. Further, the retinoschisis seemed to be connected with a superotemporal optic pit shown in a disc photograph. After 3 months of a topical prostaglandin analogue medication, the intraocular pressure in the retinoschisis eye was lowered from 14 to 10 mmHg and the peripapillary retinoschisis was almost resolved. We report a rare case of an optic disc pit with peripapillary retinoschisis presenting as a localized retinal nerve fiber layer defect.