각막이식 후 발생한 수여 잔류막에 대한 야그레이저 치료 효과 = Clinical Outcomes of Nd-YAG Laser Membranotomy in Retained Host Corneal Membrane after Keratoplasty

국문 초록 (Abstract)

목적: 각막이식 후 전방에 의도하지 않게 발생된 수여 각막의 잔류막을 빛간섭단층촬영으로 분석하고, Nd-YAG 레이저로 치료 효과를 알아보고자 했다.
대상과 방법: 본원에서 2007년 1월부터 2013년 5월까지 전층각막이식 및 심층부분각막이식을 시행 받은 742명 중, 전방에 잔류막이 관찰되고, 교정시력이 저하되어, Nd-YAG 레이저 치료 후 1년 이상 추적관찰이 가능했던 10명의 환자의 의무기록을 후향적으로 분석하였다. 기저질환으로 수포성각막병증 2안, 홍채각막내피증후군 2안, 각막이상증 1안, 기타 원인에 의한 각막혼탁 5안을 대상으로 하였다. Nd-YAG 레이저를 이용한 잔류막 제거술은 이식 후 평균 4.9개월에 시행하여, 시행 전후 시력의 변화, 내피세포 수의 변화, 각막두께의 변화, 내피세포부터 전방 내 잔류막까지의 거리와 내피세포 감소와 상관 관계를 조사하였다.
결과: 대상자는 10명 10안, 남자 5명 5안, 여자 5명 5안이었으며, 평균 나이는 56.9세였다. Nd-YAG 레이저를 이용한 전방 잔류막 제거술 12개월 뒤에 측정한 교정시력은 통계학적으로 유의한 시력호전을 보였다(p=0.039). Nd-YAG 레이저 1달 후 측정한 공여각막 내피세포 수는 통계학적으로 유의하게 감소한 결과를 보였다(p=0.01). 공여각막 내피세포부터 전방 내 잔류막까지의 거리는 평균712.0 ± 217.5 μm였으며, 이 거리와 공여각막 내피세포 손실과의 통계적인 연관성은 없었다(R2=0.39, p=0.072).
결론: 각막이식 후 전방에 의도치 않게 발생된 잔류막은 공여각막 내피세포로부터 가까운 거리에서 형성됨을 빛간섭단층촬영으로 확인하였다. Nd-YAG 레이저를 이용한 제거술은 시력개선에 효과적이나, 내피세포로부터 가까이 형성됨에 따라 유의한 내피세포의 감소를 보였다.
<대한안과학회지 2015;56(5):664-671>

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the clinical efficacy and shortcomings of neodymium-doped yttrium aluminum garnet (Nd-YAG) laser membranotomy in inadvertently retained host membrane.
Methods: Among 742 patients who underwent penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) surgery at Seoul St. Mary's Hospital between January 2007 and May 2013 by a single surgeon, 10 patients had a thin, opaque membrane in the anterior chamber observed under slit lamp examination and both a subjective decrease in visual acuity and de-crease i best corrected visual acuity. A single surgeon performed membranotomy using the Nd-YAG laser at 4.9 months after graft surgery. In this study we compared the differences in visual acuity, endothelial cell count and correlations between distance from donor endothelium and retained host membrane and endothelial loss before and after the graft surgery.
Results: Patients who had Nd-YAG laser membranotomy performed on the retained host membrane showed significant im-provements in visual acuity (p = 0.039). Donor endothelial cell count was significantly reduced 1 month after Nd-YAG laser. The average distance between donor endothelium and retained host membrane was 712.0 ± 217.5 µm. The distance and the de-creased donor endothelial cell count were not statistically correlated (R2 = 0.39, p = 0.072). There were no significant complica-tions after the laser membranotomy.
Conclusions: Inadvertently retained host membrane forms close to the donor endothelium as identified on optical coherence to-mography (OCT) images. Nd-YAG laser membranotomy significantly affected clear vision but endothelial cell count loss was al-so observed.
J Korean Ophthalmol Soc 2015;56(5):664-671

목차 (Table of Contents)

• Abstract
• 대상과 방법
• 결과
• 고찰
• REFERENCES
• 국문초록

참고문헌 (Reference)

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