C단계 이상의 증식유리체망막병증이 합병된 열공망막박리의 고찰 = Clinical Characteristics of Rhegmatogenous Retinal Detachment Combined with Proliferative Vitreoretinopathy Grade C or Higher

다국어 초록 (Multilingual Abstract)

Purpose: To classify rhegmatogenous retinal detachment (RRD) combined with proliferative vitreoretinopathy (PVR) grade C or higher according to clinical difficulties and age and to investigate the outcomes and operation methods.
Methods: Eyes with RRD with PVR grade C or higher were reviewed retrospectively among 752 eyes of RRD over a period of 5 years. The cases with total retinal detachment combined with ocular hypotony, giant retinal tear, uveitis treated within 3 months, or atopic dermatitis were classified as the high risk group, and the others were the low risk group. Additionally, the low risk group was classified as the low risk group-older and low risk group-younger according to age 40. Operation methods and anatomical outcomes were analyzed according to group.
Results: Eighty-two eyes with RRD with PVR grade C or higher were enrolled, representing 10.9% of the total RRD eyes. Of these, 36 eyes were assigned to the high risk group, and 46 eyes were in the low risk group. In the low risk group, 14 eyes were classified in the low risk group-older, and 32 eyes were in low risk group-younger. The eyes in the high risk group were mainly treated with encircling combined with vitrectomy (89.0%), but the primary anatomical success rate was low (61.1%). Comparatively, scleral buckling was the main procedure performed in the low risk group-younger (94%), and a higher primary anatomical success rate was achieved (96.7%). The primary success rate of the low risk-older group was 71.4%.
Conclusions: The risk factors seem to be important when deciding the operation method and for predicting the prognosis of RRD with PVR grade C or higher. Scleral buckling could be considered as the first option for treating RRD with PVR grade C or higher in the absence of risk factors in patients aged less than 40.

국문 초록 (Abstract)

목적: C단계 이상의 증식유리체망막병증이 합병된 열공망막박리를 임상적 난이도와 나이에 따라 분류하고자 하였다.
대상과 방법: 5년간 열공망막박리로 수술받은 752안 중 C단계 이상의 증식유리체망막병증이 합병된 경우의 의무기록을 분석하였다.
전(total)망막박리와 저안압증이 동반된 경우, 거대 망막 열공이 동반된 경우, 3개월 이내 포도막염 치료력이 있거나, 아토피 피부염과 연관된 경우 고위험군으로, 나머지를 저위험군으로 분류하였다. 저위험군은 40세 이상을 저위험군-고령으로, 40세 미만을 저위험군-비고령으로 추가 분류하였다.
결과: 82안이 확인되어 C단계 이상의 증식유리체망막병증이 합병된 경우가 전체 열공망막박리의 10.9%였다. 고위험군은 36안(43.9%), 저위험군이 46안(56.1%)이었고, 저위험군 중 고령은 14안(17.1%), 비고령은 32안(39.0%)이었다. 고위험군은 저위험군에비해 공막돌륭(두르기)과 유리체절제 병합 수술 비중이 높았지만(32안, 89.0%), 일차 해부학적 성공률은 낮았다(61.1%). 저위험군-비고령에서는 공막돌륭술의 선택 비율이 높았고(30안, 94%), 높은 일차 해부학적 성공률을 보였다(96.7%).
결론: C단계 이상의 증식유리체망막병증이 동반된 열공망막박리의 치료 방법 선택과 예후 판단에 있어 고위험인자 및 나이가 중요하다고 생각된다. 고위험인자가 없는 젊은 환자에서 관찰되는 C단계 이상의 증식유리체망막병증이 동반된 열공망막박리는 공막돌륭술이 우선적으로 고려될 수 있다.