다층 속말림 내경계막 절편술을 이용한 크기가 큰 황반원공의 치료

송동훈(Dong Hun Song),염명인(Myeong In Yeom),박정민(Jung Min Park) 대한안과학회 2018 대한안과학회지 Vol.59 No.5

Purpose: To describe a multi-layered inverted internal limiting membrane (ILM) flap technique and to evaluate the surgical outcomes of this surgery in patients with macular holes > 800 μm in base diameter. Methods: The medical records of patients who received a multi-layered ILM flap technique were retrospectively studied and patients with macular holes > 800 μm were included in the analyses. Best-corrected visual acuity (BCVA) before and after surgery, preoperative hole size, hole base size, vertical size, and hole closure after surgery were checked using spectral domain optical coherence tomography. Pars plana vitrectomy was performed and the ILM was stained using indocyanine green and peeled with the base attached at the hole margin. The ILM flap was inverted over the macular hole with 2~3 layers, and gas injection was performed. Results: The mean age of 12 patients was 65.2 ± 12.3 years. The mean BCVA (logMAR) was 1.27 ± 0.61. The mean hole size was 563.6 ± 221.9 μm, the mean vertical size was 418.8 ± 80.9 μm, and the mean hole base size was 1,182.8 ± 298.5 μm. The mean follow-up period was 174.4 ± 143.3 days. Nine macular holes were closed after surgery but three macular holes were not closed. The postoperative mean BCVA (logMAR) was 0.21 ± 0.51. Eight eyes showed visual improvement while three eyes did not show visual improvement after macular hole surgery. Conclusions: The macular hole was closed successfully and the visual acuity improved after the multi-layered, inverted ILM flap technique. The multi-layered, inverted ILM flap technique is therefore considered the treatment of choice for large macular holes. J Korean Ophthalmol Soc 2018;59(5):428-436

고도근시안에서 황반원공에 의해 발생한 망막박리에 대한 황반돌륭술

박도영,김재휘,하효신,강세웅,Do Young Park,Jae Hui Kim,Hyo Shin Ha,Se Woong Kang 대한안과학회 2012 대한안과학회지 Vol.53 No.7

Purpose: To evaluate the long-term anatomical and functional results of macular buckling for retinal detachment associated with a macular hole in high myopia. Methods: Eleven consecutive highly myopic eyes with retinal detachment and macular holes were retrospectively studied between January 2002 and September 2010. All cases developed after pars plana vitrectomy for internal limiting membrane removal, for the treatment of retinal detachment associated with a macular hole, or vitreomacular traction with a macular hole. Macular buckling with an episcleral sponge was performed for all cases. The mean follow-up period after macular buckling was 45.1 months (range from 12 to 102 months). Retinal reattachment and macular hole closure after the surgery and best-corrected visual acuity before and after the surgery were evaluated. Results: Nine out of 11 eyes were successfully treated with the macular buckling procedure. In the remaining 2 eyes, retinal re-detachment occurred with anterior proliferative vitreoretinopathy. In these eyes, successful retinal attachment occurred after reoperation with silicone oil tamponade. Optical coherence tomography (OCT) was performed after the surgery in 10 out of 11 eyes and the macular hole closure rate was 30%. The mean best corrected visual acuity went from counting fingers preoperatively to 0.06 postoperatively. Conclusions: The macular buckling procedure is effective for retinal detachment associated with a macular hole in high myopia, especially following an unsuccessful pars plana vitrectomy with removal of inner retinal traction. J Korean Ophthalmol Soc 2012;53(7):969-976

황반원공 내에 감돈된 작은 가스방울로 인한 황반원공폐쇄 실패 1예

김진현(Jin hyun Kim),이권휘(Gwon Hwi Lee),이승우(Seung Woo Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.5

Purpose: To report a case of failed sealing of full-thickness macular hole associated with an entrapped microbubble in the hole after vitrectomy, peeling of the internal limiting membrane and C3F8 (14%) gas injection. Case summary: A 69-year-old female visited our clinic for decreased visual acuity in her right eye. The best corrected visual acuity (BCVA) was 20/200 in the right eye. The fundoscopy and spectral domain optical coherence tomography (SD-OCT) showed a full-thickness macular hole. She had a history of spine surgery and, thus was unable to maintain a prone position after surgery. The patient underwent pars plana vitrectomy, peeling of the internal limiting membrane and C3F8 (14%) gas injection in a sitting position postoperatively. Three weeks postoperatively, fundoscopy showed an entrapped microbubble within the macular hole, which was not sealed as observed on SD-OCT. We thought the entrapped microbubble within the macular hole prevented closure of the hole and removed it during the repeated surgery. At 2 weeks after the microbubble removal, fundoscopy and SD-OCT in the right eye showed the closure of the macular hole and the BCVA was improved to 20/40. Conclusions: We experienced a failed sealing of full-thickness macular hole due to an entrapped microbubble within the hole after macular hole surgery and observed the closure of the macular hole after removal of the microbubble. Based on our results, early microbubble removal operation should be considered in the treatment of an entrapped microbubble within the hole. 목적: 전층 황반원공의 치료로 유리체절제술, 내경계막제거술 및 비팽창가스를 주입하였으나 수술 후 황반원공 내에 감돈된 작은 가스방울로 인해 원공폐쇄가 실패한 증례를 경험하여 이를 보고하는 바이다. 증례요약: 69세 여성이 우안 시력 저하를 주소로 내원하였다. 우안 최대교정시력은 20/200이었고, 안저검사 및 빛간섭단층촬영에서전층 황반원공이 관찰되었다. 과거력상 허리 수술로 인한 통증으로 수술 후 안면하 자세가 불가능하였다. 수술적 치료로 유리체절제술, 내경계막제거술 및 비팽창가스를 안구 내에 주입 후 앉아 있는 자세를 하였다. 수술 3주 후 안저검사에서 황반원공 내에 감돈된 작은 가스방울을 발견하였으며, 빛간섭단층촬영에서 원공의 폐쇄가 이루어지지 않은 것이 확인되었다. 감돈된 가스방울에 의한 황반원공 폐쇄의 실패로 생각하여 재수술을 통해 이를 제거하였다. 수술 2주 후 안저검사 및 빛간섭단층촬영상 황반원공이 완전히 폐쇄된 것을 확인할 수 있었으며, 우안 최대교정시력은 20/40으로 호전되었다. 결론: 저자들은 황반원공 수술 후 황반원공 내에 감돈된 작은 가스방울에 의해 원공폐쇄 실패를 경험하였고, 이를 수술적으로 제거한 후 황반원공의 폐쇄를 확인할 수 있어 빠른 수술적 처치가 필요함을 알 수 있었다.

Thickness of the Macula, Retinal Nerve Fiber Layer, and Ganglion Cell-inner Plexiform Layer in the Macular Hole: The Repeatability Study of Spectral-domain Optical Coherence Tomography

이우혁,조영준,김정열 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.6

Purpose: We measured the thicknesses of the ganglion cell and inner plexiform layer (GCIPL), the macula, and the retinal nerve fiber layer (RNFL) using spectral-domain optical coherence tomography in patients with idiopathic macula holes to analyze the repeatability of these measurements and compare them with those of the fellow eye. Methods: We evaluated 85 patients who visited our retinal clinic. The patients were divided into two groups according to their macular hole size: group A had a size of <400 µm, while group B had a size of ≥400 µm. Repeatability was determined by comparing the thicknesses of the GCIPL, macula, and RNFL with those of the normal fellow eye. Results: The average central macular thickness in patients with macular holes was significantly thicker than that in the normal fellow eye (343.8 ± 78.6 vs. 252.6 ± 62.3 µm, p < 0.001). The average thickness of the GCIPL in patients with macular holes was significantly thinner than that in the normal fellow eye (56.1 ± 23.4 vs. 77.1 ± 12.8 µm, p < 0.001). There was no significant difference in the average RNFL thickness between eyes with macular holes and fellow eyes (92.4 ± 10.0 vs. 95.5 ± 10.7 µm, p = 0.070). There were also no significant differences in the thicknesses of the GCIPL and RNFL among the two groups (p = 0.786 and p = 0.516). The intraclass correlation coefficients for the macula and RNFL were 0.994 and 0.974, respectively, in patients with macular holes, while that for the GCIPL was 0.700. Conclusions: Macular contour change with macular hole results in low repeatability and a tendency of thinner measurement regarding GCIPL thickness determined via spectral-domain optical coherence tomography. The impact of changes in the macular shape caused by macular holes should be taken into consideration when measuring the GCIPL thickness in patients with various eye diseases such as glaucoma and in those with neuro-ophthalmic disorders.

Thickness of the Macula, Retinal Nerve Fiber Layer, and Ganglion Cell-inner Plexiform Layer in the Macular Hole: The Repeatability Study of Spectral-domain Optical Coherence Tomography

Woo Hyuk Lee,Young Joon Jo,Jung Yeul Kim 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.6

Purpose: We measured the thicknesses of the ganglion cell and inner plexiform layer (GCIPL), the macula, and the retinal nerve fiber layer (RNFL) using spectral-domain optical coherence tomography in patients with idiopathic macula holes to analyze the repeatability of these measurements and compare them with those of the fellow eye. Methods: We evaluated 85 patients who visited our retinal clinic. The patients were divided into two groups according to their macular hole size: group A had a size of <400 μm, while group B had a size of ≥400 μm. Repeatability was determined by comparing the thicknesses of the GCIPL, macula, and RNFL with those of the normal fellow eye. Results: The average central macular thickness in patients with macular holes was significantly thicker than that in the normal fellow eye (343.8 ± 78.6 vs. 252.6 ± 62.3 μm, p < 0.001). The average thickness of the GCIPL in patients with macular holes was significantly thinner than that in the normal fellow eye (56.1 ± 23.4 vs. 77.1 ± 12.8 μm, p < 0.001). There was no significant difference in the average RNFL thickness between eyes with macular holes and fellow eyes (92.4 ± 10.0 vs. 95.5 ± 10.7 μm, p = 0.070). There were also no significant differences in the thicknesses of the GCIPL and RNFL among the two groups (p = 0.786 and p = 0.516). The intraclass correlation coefficients for the macula and RNFL were 0.994 and 0.974, respectively, in patients with macular holes, while that for the GCIPL was 0.700. Conclusions: Macular contour change with macular hole results in low repeatability and a tendency of thinner measurement regarding GCIPL thickness determined via spectral-domain optical coherence tomography. The impact of changes in the macular shape caused by macular holes should be taken into consideration when measuring the GCIPL thickness in patients with various eye diseases such as glaucoma and in those with neuro- ophthalmic disorders.

유리체 절제술을 시행한 안에서 백내장 수술 후 발생한 황반원공 1예

윤철민,양선모,김성우,오재령,허걸 대한안과학회 2012 대한안과학회지 Vol.53 No.4

Purpose: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. Case summary: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. Conclusions: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected. J Korean Ophthalmol Soc 2012;53(4):597-601

Macular Hole as a Risk Factor of Choroidal Detachment in Rhegmatogenous Retinal Detachment

( Jae Hoon Kang ),( Kyung Ah Park ),( Woo Jae Shin ),( Se Woong Kang ) 대한안과학회 2008 Korean Journal of Ophthalmology Vol.22 No.2

Purpose: Choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD) is a rare, but serious condition, which makes the prognosis worse. Previously reported risk factors for CD in RRD patients include high myopia, aphakia, pseudophakia, and advanced age. However, macular hole has not been discussed as an important factor in increasing the risk of CD in RRD patients. The purpose of this study was to evaluate macular hole as a risk factor for CD in eyes evidencing RRD. Methods: The medical records of 480 patients with primary RRD were reviewed. We compared the CD incidence among the RRD patients in accordance with the presence or absence of macular holes. The relationship between gender, age, presence of systemic disease, refractive errors, lens status, intraocular pressure and the development of CD were also analyzed. Results: The incidence (4/21 eyes, 19.0%) of CD in the RRD with macular hole was significantly higher than that (7/459 eyes, 1.5%) observed in the RRD without macular hole (p=0.010). The preoperative intraocular pressure (mean±SD; 2.5±1.3 mmHg) in the RRD with CD and macular hole was significantly lower than that (7.4±4.4 mmHg) observed in the cases of RRD with CD without macular hole (p=0.035). The eyes complicated by CD evidenced a higher prevalence of diabetes mellitus (p=0.024) than was observed in the eyes without CD. Conclusions: The retinal detachment combined with macular hole creates a predisposition toward the development of profound hypotony and CD.

특발성 황반원공 수술 중 안 내 공기충전술 후 3일간 독서자세만 취한 환자의 수술 결과

권영기(Young Ki Kwon),엄선정(Sun Jung Eum),신재필(Jae Pil Shin),김인택(In Taek Kim),박동호(Dong Ho Park) 대한안과학회 2015 대한안과학회지 Vol.56 No.11

목적: 특발성 황반원공 환자의 유리체절제술과 안내가스충전술 후 일주일간 안면하자세를 취한 군과 액체공기교환술 후 독서자세를 취한 군 간의 수술 후 원공폐쇄율과 평균시력을 비교하고자 한다. 대상과 방법: 특발성 황반원공 2, 3기로 진단 받은 환자 25안을 대상으로 하였다. 유리체절제술 중 액체공기교환술 후 14% C 3 F 8 가스 안내충전술 후 일주일간의 안면하체위를 시행한 군과 액체공기교환술 후 독서자세를 3일간 시행한 군의 수술 6개월 후 원공의 폐쇄율 과 최대교정시력을 각각 비교하였다. 결과: 평균 원공의 크기는 1군과 2군에서 456.2 ± 164.1 μm, 411.2 ± 105.7 μm로 두 군 간의 통계적 차이는 없었고( p =0.647) 원공의 폐쇄율은 수술 6개월째 1군에서 93%, 2군이 100%였다( p =0.616). 최대교정시력(logMAR)은 수술 전, 수술 6개월 후 1군의 경우 0.92 ± 0.35에서 0.82 ± 0.29였고 2군은 0.97 ± 0.33에서 0.71 ± 0.39로 두 군 모두 향상되었으나 두 군 간에 통계적 차이는 없었다 ( p =0.809, p =0.267). 결론: 특발성 황반원공 환자의 유리체절제술 중 액체공기교환술 후 3일간 독서자세만 취한 군의 6개월째 원공의 폐쇄율과 최대교정시 력의 개선 정도가 안내가스충전술 후 1주일간 안면하자세를 취한 군과 비교해서 큰 차이가 없었다. 이 수술 방법을 통해 황반원공의 수술 후 안면하자세로 인한 불편함을 경감시키는 데 도움이 될 수 있다고 생각한다. Purpose: In this study we compared the postoperative hole closure rate and average vision between a group who assumed a face-down position for a week using gas and a group who assumed a reading position after fluid air exchage (FAX), both after re-ceiving internal limiting membrane (ILM) peeling during vitrectomy in patients with idiopathic macular hole. Methods: This study included 25 eyes of patients diagnosed with idiopathic macular hole that underwent vitrectomy. Group I as-sumed a face-down position for a week after intraocular gas tamponade after FAX during vitrectomy and Group II assumed a reading position for 3 days after only FAX. The hole closure rate and the best-corrected visual acuity (BCVA) were compared be-tween the 2 groups 6 months postoperatively. Results: The preoperative mean macular hole size was 456.2 ± 164.1 µm in Group I and 411.2 ± 105.7 µm in Group II and the differences between the 2 groups were not statistically significant (p = 0.647). At 6 months after surgery, the macular hole clo-sure rate was 93% in Group I and 100% in Group II (p = 0.571) and the BCVA (log MAR) was 0.82 ± 0.29 preoperatively and 0.92 ± 0.35 postoperatively in Group I and 0.71 ± 0.39 and 0.97 ± 0.33 in Group II, respectively. The differences between the 2 groups (p = 0.09, p = 0.058) were not statistically significant (p = 0.809, p = 0.267). Conclusions: There was no significant differences in the macular hole closure rate and BCVA improvement after 6 months in pa-tients with idiopathic macular hole who had FAX during vitrectomy and maintained only a reading position for 3 days compared with those with gas tamponade and who maintained a face-down position for a week. This surgical method is considered helpful for easing discomfort caused by a face-down position after the macular hole surgery.

큰 황반원공에서 시행한 내경계막 자가이식술

김경호(Kyong Ho Kim),정재우(Jae Woo Jung),박성후(Sung Who Park),변익수(Ik Soo Byon),이지은(Ji Eun Lee) 대한안과학회 2015 대한안과학회지 Vol.56 No.12

목적: 크기가 큰 황반원공의 수술적 치료로서 내경계막 자가이식술을 시행한 환자 5명의 수술방법과 결과를 알아보고자 한다. 대상과 방법: 크기가 400 μm 이상인 큰 황반원공 환자를 대상으로 유리체절제술을 시행하고 0.025% Briliant blue G로 내경계막을 염색하였다. 원공 주변의 내경계막을 약 2.5 유두직경의 크기로 벗겨낸 뒤, 원공 속에 내경계막 절편을 이식하고, 추가적으로 약 1.5 유두직경 정도의 내경계막을 더 제거하였다. 액체공기교환을 하고 가스를 충전하였다. 수술 후 빛간섭단층영상으로 원공 폐쇄를 조사하였다. 결과: 5안의 평균 나이는 65.0 ± 11.8 (52-77)세였다. 평균 수술 전 교정시력(logMAR)은 0.80 ± 0.27이었고, 평균 구면대응 굴절값은 -2.0 ± 2.2디옵터였다. 원공 크기는 평균 수평직경 701.4 ± 129.4 μm, 수직 직경 630.2 ± 202.8 μm였다. 기저부는 1,043.4 ± 225.0 μm, 높이는 464.4 ± 218.9 μm였다. 4안은 수술 후 1일째, 1안은 수술 후 4-7일 사이에 원공이 완전히 폐쇄되었다. 경과관찰기간 동안 중심와의 해부학적 모양은 더욱 개선되었다. 2안에서는 시력호전이 되었으나, 3안은 술 전과 차이가 없었다. 결론: 내경계막 자가이식술을 통해 수술 후 빠른 기간에 성공적인 원공의 폐쇄를 얻을 수 있었다. 크기가 큰 황반원공에서 시행해 볼 만한 유용한 수술 술기라고 생각한다 Purpose: To evaluate the surgical outcome of autologous transplantation of internal limiting membrane (ILM) for the treatment of large macular hole. Methods: Twenty-five gauge pars plana vitrectomy was performed for the treatment of patients with full thickness macular hole larger than 400 μm. ILM was stained using 0.025% brilliant blue G. ILM around the hole was circumferentially peeled as large as 2.5 disc diameter (DD) in size and then transplanted inside the hole. ILM was peeled out additionally approximately 1.5 DD in size. Fluid-air exchange and gas injection were performed. After surgery, the hole was scanned using spectral domain optical coherence tomography. Results: A total of 5 eyes were included in the present study. The mean age was 65.0 ± 11.8 years (52-77) and mean best corrected visual acuity (log MAR) was 0.80 ± 0.27. The mean refractive error was -2.0 ± 2.2 diopter, mean horizontal size of hole was 701.4 ± 129.4 μm, mean vertical size was 630.2 ± 202.8 μm, mean hole base size was 1,043.4 ± 225.0 μm and hole height was 464.4 ± 218.9 μm. At the first day after surgery, transplanted ILM was detected inside the hole in all 5 eyes and complete closure of the hole occurred in 4 eyes. One hole was closed between postoperative days 4 and 7. Foveal contour improved gradually but photoreceptor integrity did not during the follow-up period. Two eyes showed visual improvement but 3 did not after surgery. Conclusions: Macular hole was closed successfully and quickly using the autologous ILM transplantation technique. Based on our results, the autologous ILM should be considered the treatment of choice for large macular holes.

황반원공 수술 후 발생한 중심외 황반원공 1예

황상조,박정일,이종현.Sang Jo Hwang. M.D.. Jung Il Park. M.D.. Jong Hyun Lee. M.D. 대한안과학회 2008 대한안과학회지 Vol.49 No.8

Purpose: To report a case of eccentric macular hole formation after surgery for a traumatic macular hole. Case summary: A 27-year-old man was admitted to our hospital because of baseball trauma to his left eye. A vitreous hemorrhage and Berlin’s edema were found in the macula. One month later, a full thickness macular hole was detected. Vitrectomy and internal limiting membrane (ILM) peeling and gas injection were performed. Two months postoperatively, the primary macular hole was closed, but an eccentric macular hole temporal to the fovea was observed. J Korean Ophthalmol Soc 49(8):1341-1344, 2008