외상섬모체해리에서 시행한 부분 공막편을 이용한 경공막 섬모체유착술 1예 = Transscleral Cyclopexy Using Partial-Thickness Scleral Flap for Repairing Cyclodialysis Cleft: a Case Report

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of a cyclodialysis cleft that was successfully managed with gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap.
Case summary: A 44-year-old man complaining of blurred vision in the left eye after blunt trauma was referred to our hospital. The intraocular pressure (IOP) was 4 mmHg and the visual acuity was counting finger. Gonioscopy examination revealed cyclodialysis cleft from 3 to 6 o’clock and fundus examination revealed macular folds. After the failure of conservative medical therapy and laser photocoagulation, gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap was performed. Four months later, the IOP was 18 mmHg, the visual acuity was 0.8, and fundus examination showed the disappearance of the macular folds.
Conclusions: Transscleral cyclopexy using partial-thickness scleral flap is a safe and effective method to treat hypotony maculopathy due to cyclodialysis and to minimize pupil distortion.

국문 초록 (Abstract)

목적: 보존적 약물 치료와 레이저광응고술에 반응하지 않았던 외상섬모체해리로 인하여 저안압 황반병증이 발생한 환자에서 부분 공막편을 이용하여 경공막섬모체유착술을 시행하여 성공적으로 치료된 1예를 보고하고자 한다.
증례요약: 44세 남자가 좌안에 둔상을 입은 후 발생한 시력저하를 주소로 내원하였다. 시력은 안전수지, 안압은 4 mmHg, 전방각경검사에서 3시에서 6시까지 이어지는 섬모체해리가 관찰되었고, 안저검사에서 맥락망막주름이 관찰되었다. 보존적 약물 치료와 레이저광응고술에 반응하지 않아 전방각경으로 확인하며 부분 공막편을 통한 경공막섬모체유착술을 시행하였다. 수술 4개월 후 시력은 0.8, 안압은 18 mmHg로 안정적으로 유지되었으며, 안저검사에서 맥락망막주름이 소실되고 동공의 모양은 잘 유지되었다.
결론: 부분 공막편을 통해 시행한 경공막섬모체유착술은 섬모체해리로 인한 저안압 황반병증의 치료에 안전하고 효과적이며 동공 변형을 최소화할 수 있는 방법이다.

참고문헌 (Reference)

1 안견, "모양체해리의 임상양상 및 수술(직접 모양체유착술) 예후에 관련된 요인분석" 대한안과학회 44 (44): 19-2335, 2003

2 Kim CS, "Treatment for persistent hypotony due to cyclodialysis" 39 : 1505-1515, 1998

3 Kim KH, "Surgical repair of traumatic cyclodialysis with persistent hypotony" 38 : 1294-1299, 1997

4 Ishida Y, "Pars plana vitrectomy for traumatic cyclodialysis with persistent hypotony" 18 : 952-954, 2004

5 Kato T, "Management of traumatic cyclodialysis cleft associated with ocular hypotony" 30 : 469-472, 1999

6 Ormerod LD, "Management of the hypotonous cyclodialysis cleft" 98 : 1384-1393, 1991

7 Helbig H, "Management of hypotonous cyclodialysis with pars plana vitrectomy, gas tamponade, and cryotherapy" 27 : 188-191, 1996

8 Chadha N, "Indirect cyclopexy for treatment of a chronic traumatic cyclodialysis cleft with hypotony" 8 : 591-594, 2014

9 Feiler DL, "Indirect cyclopexy for repair of cyclodialysis clefts" 2018

10 Rodrigues IA, "Gonioscopically guided nonpenetrating cyclodialysis cleft repair : a novel surgical technique" 11 : 31-34, 2017

11 Küchle M, "Direct cyclopexy for traumatic cyclodialysis with persisting hypotony. Report in 29 consecutive patients" 102 : 322-333, 1995

12 Ioannidis AS, "Cyclodialysis cleft : causes and repair" 21 : 150-154, 2010

13 González-Martín-Moro J, "Cyclodialysis : an update" 37 : 441-457, 2017

14 McCannel MA, "A retrievable suture idea for anterior uveal problems" 7 : 98-103, 1976