군날개와 결막이완증이 동반된 경우 결막소판술과 이완 결막을 이용한 결막 회전피판술의 비교 = Comparison of Miniflap and Rotational Conjunctival Flap Techniques of Pterygium Accompanied by Conjunctivochalasis

국문 초록 (Abstract)

목적: 군날개와 결막이완증이 동반된 환자에서 군날개 수술 시 군날개의 머리뿐 아니라 몸통 부분까지 절제한 후 공막 노출 부위에 결막소판술을 시행하는 경우와 이완결막을 이용한 회전피판술을 시행한 경우 군날개 재발률 및 미용적 측면에 대해 알아보았다.
대상과 방법: 군날개와 결막이완증이 동반된 환자 중 군날개 수술 시 결막소판술을 시행한 환자 27명과 이완된 결막을 이용한 회전피 판술을 시행한 21명을 대상으로 후향적으로 연구를 진행하였다. 수술 후 재발은 각막 윤부를 넘어선 경우로 정의하였고, 술 후 미용적인 평가로 수술 부위의 충혈 정도를 Image J 프로그램을 이용하여 빨간색, 녹색, 파란색을 분석한 후, 이 중에서 빨간색의 비율을 계산하여 평가하였다.
결과: 결막소판술 환자군의 평균 연령은 66세이며, 재발률은 5.1%이고 평균 경과관찰 기간은 12개월이었으며, 평균 술 후 5개월에 재발하였다. 회전피판술 환자군의 평균 연령은 62세이며, 재발률은 5.9%이고, 평균 경과관찰 기간은 20개월이었으며, 평균 술 후 5개 월에 재발하였다. 결막소판술 환자군에서는 술 전과 비교하여 술 후 빨간색의 비율이 평균 5.3% 감소하였으며, 회전피판술 환자군의 경우 술 후 빨간색의 비율이 평균 6.1% 감소하였다. 두 환자군 사이의 재발률과 수술 전후의 충혈 정도는 유의한 차이는 없었다.
결론: 군날개 환자 중 결막이완증이 병발한 경우 이완된 결막을 이용한 결막 회전피판술(rotational conjunctival flap)은 재발률 및미용적인 측면에서 유용한 수술 방법으로 생각된다.
<대한안과학회지 2018;59(9):810-818>

다국어 초록 (Multilingual Abstract)

Purpose: To investigate the differences between the recurrence and cosmesis of the miniflap technique and rotational conjunctival flap technique using redundant conjunctiva tissue in pterygium patients accompanied by conjunctivochalasis.
Methods: This retrospective clinical study included 48 patients diagnosed with pterygium and conjunctivochalsis: 27 pterygium patients who underwent surgery using the miniflap technique and 21 pterygium patients who underwent surgery using the rotational conjunctival flap technique with redundant conjunctiva tissue. The recurrence of each operation, defined as fibrovascular invasion of the cornea, was analyzed. Redness was compared using Image J software to resolve the red color ratios with respect to the red, green, and blue colors of the pterygium excision site. The difference in the red color ratio before and after surgery was analyzed with each surgery.
Results: For patients who underwent the miniflap technique, the mean age was 66 years, the recurrence rate was 5.1%, the mean follow-up period was 12 months, and the average recurrence was 5 months after surgery. For patients who underwent the rotational conjunctival flap technique using redundant conjunctiva tissue, the mean age was 62 years, the recurrence rate was 5.9%, the mean follow-up period was 20 months, and the average recurrence was 5 months after surgery. The ratio of the red color after surgery decreased 5.3% in the miniflap technique group and 6.1% in the rotational conjunctival flap technique group.
Between the two groups, there was no significant difference in the recurrence or redness after surgery.
Conclusions: The rotational conjunctival flap technique using redundant conjunctiva in patients with pterygium and conjunctivochalasis was useful for reducing recurrence and cosmesis.
J Korean Ophthalmol Soc 2018;59(9):810-818

목차 (Table of Contents)

• 대상과 방법
• 결 과
• 고 찰

참고문헌 (Reference)

1 조정우, "익상편수술시 결막소판술과 자가결막이식술의 재발률 비교" 대한안과학회 46 (46): 1471-1477, 2005

2 박선영, "익상편 수술에서 변형된 결막소판술 후 재발" 대한안과학회 53 (53): 1419-1424, 2012

3 Ward SK, "The role of oxidative stress and inflammation in conjunctivochalasis" 51 : 1994-2002, 2010

4 Wang Y, "The impact of nasal conjunctivochalasis on tear functions and ocular surface findings" 144 : 930-937, 2007

5 Hirst LW, "The Treatment of pterygium" 48 : 145-180, 2003

6 Janson BJ, "Surgical management of pterygium" 12 : 112-119, 2014

7 Yu XY, "Simultaneous treatment of pterygium complicated with conjunctivochalasis: analysis of pterygium excision and conjunctival autotransplantation combined with sclera fixation" 15 : 100-, 2015

8 Suzuki H, "Simultaneous treatment of pterygium and temporal conjunctivochalasis" 80 : 74-77, 2013

9 Solomon A, "Regulation of collagenase, stromelysin, and urokinase-type plasminogen activator in primary pterygium body fibroblasts by inflammatory cytokines" 41 : 2154-2163, 2000

10 Hirst LW, "Recurrent pterygium surgery using pterygium extended removal followed by extended conjunctival transplant: recurrence rate and cosmesis" 116 : 1278-1286, 2009

11 Cornelius CR, "Recurrence rate and complications of pterygium extended removal followed by extended conjunctival transplant" 36 : 101-103, 2017

12 Anbesse DH, "Prevalence and associated factors of pterygium among adults living in Gondar city, Northwest Ethiopia" 12 : e0174450-, 2017

13 Akura J, "Measures for preventing recurrence after pterygium surgery" 20 : 703-707, 2001

14 Gumus K, "Increasing prevalence and severity of conjunctivochalasis with aging detected by anterior segment optical coherence tomography" 155 : 238-242, 2013

15 Qiu W, "Evaluation of the effects of conjunctivochalasis excision on tear stability and contrast sensitivity" 6 : 37570-, 2016

16 Georgiadis NS, "Epiphora caused by conjunctivochalasis: treatment with transplantation of preserved human amniotic membrane" 20 : 619-621, 2001

17 Hirst LW, "Cosmesis after pterygium extended removalfollowed by extended conjunctival transplant as assessed by a new, web-based grading system" 118 : 1739-1746, 2011

18 Meller D, "Conjunctivochalasis: literature review and possible pathophysiology" 43 : 225-232, 1998

19 Liu D, "Conjunctivochalasis. A cause of tearing and its management" 2 : 25-28, 1986

20 Tong L, "Conjunctivochalasis is the precursor to pterygium" 81 : 927-930, 2013

21 Prabhasawat P, "Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision" 104 : 974-985, 1997

22 Kucukerdonmez C, "Comparison of conjunctival autograft with amniotic membrane transplantation for pterygium surgery: surgical and cosmetic outcome" 26 : 407-413, 2007

23 Alpay A, "Comparing techniques for pterygium surgery" 3 : 69-74, 2009

24 Zhang X, "Assessing the severity of conjunctivochalasis in a senile population: a community-based epidemiology study in Shanghai, China" 11 : 198-, 2011

25 Kheirkhah A, "Amniotic membrane transplantation with fibrin glue for conjunctivochalasis" 144 : 311-313, 2007

26 Fernandez-Hortelano A, "Amniotic membrane transplantation with fibrin glue as treatment of refractory conjunctivochalasis" 82 : 571-574, 2007

27 Meller D, "Amniotic membrane transplantation for symptomatic conjunctivochalasis refractory to medical treatments" 19 : 796-803, 2000

28 Arenas E, "A new surgical approach for the treatment of conjunctivochalasis: reduction of the conjunctival fold with bipolar electrocautery forceps" 2016 : 2016

29 Kim SH, "A Comparison of anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery" 32 : 1578-1581, 2013