특발성 망막앞막, 황반원공에서 유리체 절제술 후 주입한 가스 종류에 따른 백내장 진행 = Cataract Change after Vitrectomy and Gas Injection in Patients with Epiretinal Membrane and Macular Hole

국문 초록 (Abstract)

목적: 특발성 망막앞막과 황반원공 환자에서 유리체 절제술 후 주입한 가스의 종류에 따른 백내장의 진행 정도를 알아보고자 하였다.
대상과 방법: 유리체 절제술 후 액체/공기 교환술(Group 1), 20% SF6 주입술(Group 2)을 시행 받은 환자를 대상으로 수술 전과 수술 후 1, 2, 4, 6, 12개월째의 Lens Opacities Classification System (LOCS) III 분류를 이용한 핵경화도, 굴절력(구면대응치)을 측정하였다. PentacamⓇ 샤임플러그 이미지를 image J 프로그램을 이용하여 mean nuclear density와 maximal nuclear density를 측정하여 비교 분석하였다.
결과: 총 40명, 40안 중 액체/공기 교환술만 시행한 환자(Group 1)는 21안, 20% SF6 가스를 주입한 환자(Group 2)는 19안이었다. 두 군 모두 수술안이 비수술안에 비해 mean nuclear density와 maximal nuclear density, LOCS III를 이용한 백내장 진행의 분석에서 핵경화의 진행이 빨랐다. 가스의 종류에 따른 비교에서 mean nuclear density는 수술 후 4개월째 두 군의 유의한 차이를 보였으며, maximal nuclear density는 수술 후 2개월과 4개월째 두 군의 유의한 차이를 보였다. LOCS III는 수술 후 2개월과 4개월째, 구면대응치는 수술 후 1개월부터 6개월까지 두 군에서 통계적으로 유의한 차이를 보였다.
결론: 유리체절제술 전과 수술 후의 백내장 진행 정도는 주입한 가스와 관계없이 수술안이 비수술안에 비해 핵경화의 진행이 빨랐다. 20% SF6 주입술(Group 2)을 시행 받은 군에서 핵경화의 진행이 더 빨리 일어난 것을 확인하였으나 수술 후 12개월에는 가스의 종류에 상관없이 핵경화의 변화 정도는 비슷했다.
<대한안과학회지 2016;57(11):1745-1751>

다국어 초록 (Multilingual Abstract)

Purpose: To investigate the outcomes of quantitative lens nuclear opalescence change after pars plana vitrectomy and intravitreal gas injection in patients with idiopathic epiretinal membrane and macular hole.
Methods: All patients were divided into two group according to the kinds of injected gases, either Group 1 (fluid/air exchange) or Group 2 (20% SF6 gas injection). Lens nuclear opalescence according to the classification of Lens Opacities Classification System (LOCS) III, mean nuclear density and maximal nuclear density of Pentacam？？ scheimpflug image changed by image J, besides refractive errors were evaluated before surgery and 1, 2, 4, 6, and 12 months after surgery.
Results: Out of 40 eyes of 40 patients included in the analysis, 21 received only fluid/air exchange (Group 1) and 19 received 20% SF6 gas injection (Group 2). There were significant changes in lens nuclear opalescence between the study and control (unaffected) eyes. In both groups, the study eyes experienced significant progression of cataract compared with the control eyes, in terms of mean nuclear density, maximal nuclear density and LOCS III. In comparison according to the kinds of injected gases, there was a significant difference in mean nuclear density after 4 months, maximal nuclear density after 2 months and 4 months, LOCS after 2 months and 4 months, and refractive error after 1, 2, 4, and 6 months between both groups (p = 0.003).
Conclusions: After vitrectomy and intravitreal gas injection, changes in postoperative lens nuclear opalescence of the study eyes progressed more rapidly compared with the control eyes. This study identified that lens nuclear opalescence of Group 2 progressed rapidly, but after 12 months there was no significant difference of lens opacity between the kinds of injected gases.
J Korean Ophthalmol Soc 2016;57(11):1745-1751

목차 (Table of Contents)

• 대상과 방법
• 결 과
• 고 찰
• REFERENCES

참고문헌 (Reference)

1 Thompson JT, "The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes" 137 : 250-257, 2004

2 Chylack LT Jr., "The lens opacities classification system III. The longitudinal study of cataract study group" 111 : 831-836, 1993

3 Margherio RR., "Removal of epimacular membranes" 92 : 1075-1083, 1985

4 Ogura Y., "Quantitative analysis of lens changes after vitrectomy by fluorophotometry" 111 : 179-183, 1991

5 Briand S., "Prospective randomized trial : outcomes of SF₆ versus C₃F₈ in macular hole surgery" 50 : 95-100, 2015

6 Hsuan JD., "Posterior subcapsular and nuclear cataract after vitrectomy" 27 : 437-444, 2001

7 Petermeier K., "Pathophysiology of cataract formation after vitrectomy" 227 : 175-180, 2010

8 Kim SS., "Outcomes of sulfur hexafluoride(SF6)versus perfluoropropane(C3F8)gas tamponade for macular hole surgery" 28 : 1408-1415, 2008

9 Melberg NS., "Nuclear sclerotic cataract after vitrectomy in patients younger than 50 years of age" 102 : 1466-1471, 1995

10 Cherfan GM., "Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes causing macular pucker" 111 : 434-438, 1991

11 de Bustros S., "Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes" 105 : 160-164, 1988

12 Tranos PG., "Macular hole surgery without prone positioning" 21 : 802-806, 2007

13 Tan AC., "Lens Opacities Classification System III : cataract grading variability between junior and senior staff at a Singapore hospital" 34 : 1948-1952, 2008

14 Kirwan JF., "LOCS III examination at the slit lamp, do settings matter?" 10 : 259-266, 2003

15 Hall NF., "Grading nuclear cataract : reproducibility and validity of a new method" 83 : 1159-1163, 1999

16 Gupta D, "Face-down posturing after macular hole surgery : a review" 29 : 430-443, 2009

17 Hasegawa Y., "Equivalent tamponade by room air as compared with SF(6)after macular hole surgery" 247 : 1455-1459, 2009

18 Michael R., "Development and repair of cataract induced by ultraviolet radiation" 32 (32): ii-iii-1-44, 2000

19 Grewal DS., "Correlation of nuclear cataract lens density using Scheimpflug images with Lens Opacities Classification System III and visual function" 116 : 1436-1443, 2009

20 Magalhães FP., "Comparative analysis of the nuclear lens opalescence by the Lens Opacities Classification System III with nuclear density values provided by Oculus Pentacam : a cross-section study using Pentacam Nucleus Staging software" 74 : 110-113, 2011

21 "Age-Related Eye Disease Study Research Group. The age-related eye disease study (AREDS) system for classifying cataracts from photographs: AREDS report no. 4" 131 : 167-175, 2001