공막 석회화 절제 가위를 이용한 미용적 결막절제술 후의 공막석회화 제거 = Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy

다국어 초록 (Multilingual Abstract)

Purpose: To research the advantage of using calcium plaque scissors in conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. Methods: We analyzed 55 eyes that had undergone conjunctival flap surgery for calcified scleromalacia occurring after cosmetic conjunctivectomy. Surgical blade was used in 30 eyes (Group 1) and calcium plaque scissors in 25 eyes (Group 2). Time after conjunctivectomy, plaque size, operation time and visual acuity before and after the flap surgery were analyzed and compared. Additionally, necessity of additional scleral surgery was evaluated. Optical coherence tomography (OCT) of the sclera was performed both pre- and postoperatively and the results were compared.Results: An average of 3.9 ± 1.0 years elapsed until conjunctival flap surgery and follow-up time was 5.2 ± 3.8 months. Post conjunctivectomy time and plaque size were similar in both groups (<EM>p </EM>= 0.87 and 0.49, respectively). The surgery time in Group 2 was shorter than in Group 1 (17.5 ± 6.3 minutes and 21.9 ± 8.5 minutes, respectively, <EM>p</EM> = 0.20). Uncorrected visual acuity was similar in both groups before and after conjunctival flap surgery (<EM>p</EM> = 0.53 and <EM>p</EM> = 0.20, respectively). In Group 1, one sclera transplantation and three Ologena™ insertion surgeries were performed as an additional scleral surgery. Based on OCT, calcium plaque scissors were confirmed as a new surgical tool for calcium plaque removal with minimal scleral damage. Conclusions: Using calcium plaque scissors when performing conjunctival flap surgery for calcium plaque removal that occurred after cosmetic conjunctivectomy reduces the necessity of an additional scleral surgery and surgery time. J Korean Ophthalmol Soc 2014;55(11):1618-1624

참고문헌 (Reference)

1 오정환, "보존공막과 양막의 이식을 통한 공막연화증의 치료" 대한안과학회 42 (42): 810-816, 2001

2 Hsu WC, "Tissue bioengineering for surgical bleb defects: an animal study" 246 : 709-717, 2008

3 신혜영, "The Development of Scleromalacia after Regional Conjunctivectomy with the Postoperative Application of Mitomycin C as an Adjuvant Therapy" 대한안과학회 27 (27): 208-210, 2013

4 Sangwan VS, "Structural and functional outcome of scleral patch graft" 21 : 930-935, 2007

5 Moriarty AP, "Severe corneoscleral infection. A complication of beta irradiation scleral necrosis following pterygium excision" 111 : 947-951, 1993

6 Rubinfeld RS, "Serious complications of topical mitomycin-C after pterygium surgery" 99 : 1647-1654, 1992

7 Nguyen QD, "Scleral patch graft in the management of necrotizing scleritis" 39 : 109-131, 1999

8 Wan Norliza WM, "Scleral melting 16 years after pterygium excision with topical Mitomycin C adjuvant therapy" 29 : 165-167, 2006

9 Chen S, "Scleral dellen complicating primary pterygium excision" 14 : 100-101, 2000

10 Mitra S, "Scleral dellen complicating primary pterygium excision" 14 : 924-925, 2000

11 Hayasaka S, "Postoperative instillation of low-dose mitomycin C in the treatment of primary pterygium" 106 : 715-718, 1988

12 Leung TG, "Necrotizing scleritis as a complication of cosmetic eye whitening procedure" 3 : 39-, 2013

13 Chung DS, "Mitomycin C single soaking during surgery for primary pterygium" 37 : 927-933, 1996

14 Solomon A, "Long-term effects of mitomycin C in pterygium surgery on scleral thickness and the conjunctival epithelium" 111 : 1522-1527, 2004

15 Hayasaka S, "Late complications after pterygium excision with high dose mitomycin C instillation" 84 : 1081-1082, 2000

16 Dunn JP, "Development of scleral ulceration and calcification after pterygium excision and mitomycin therapy" 112 : 343-344, 1991

17 Kwon HJ, "Conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy" 32 : 821-825, 2013

18 Rhiu S, "Complications of cosmetic wide conjunctivectomy combined with postsurgical mitomycin C application" 31 : 245-252, 2012

19 Rosentreter A, "Capsule excision and Ologen implantation for revision after glaucoma drainage device surgery" 248 : 1319-1324, 2010

20 Tsai YY, "Acute scleral thinning after pterygium excision with intraoperative mitomycin C: a case report of scleral dellen after bare sclera technique and review of the literature" 21 : 227-229, 2002