학술논문
감염성 각막염으로 인한 임박각막천공환자에서 보존된 공막조직을 이용한 치료적이식술의 효과에 관한 연구 / The Effect of Tectonic Graft Using Preserved Human Scleral Tissue for The Urgent Surgical Treatment of Corneal Perforation Due to The Infectious Keratitis
Document Type
Dissertation/ Thesis
Author
Source
Subject
Language
Korean
Abstract
각막천공이 임박하여 안약이나 안연고 등의 약물치료로 잘 낫지 않고 천공이 불가피하다고 판단 될 경우에 저자는 각막이식술에 사용하고 보관중인 주변부각막조직과 공막조직을 사용하여 치료적 응급이식술을 시술하여 그 임상 효과에 대해 알아보고자 하였다. 심한 각막궤양으로 기존의 약물치료로 잘 낳지 않고 각막실질조직의 괴사가 진행이 되고, 전방이 얕아지면서 2mm 크기 이상의 각막천공이 되었거나 임박한 경우의 각막염 환자 10안을 대상으로 하였다. 5안은 세균각막염이었고, 3안은 진균각막염, 2안은 헤페스각막염이었다. 천공부위 주위의 괴사된 각막조직을 절제하고 전방을 점탄물질이나 평형식염수로 유지를 한 후 보존적 이식술을 시술하였다. 알코올용액에 보관된 주변부각막조직과 공막조직을 적절한 크기로 절제하여 천공부위에 단속봉합하여 이식하였다. 술 후 주기적으로 각막의 상피재생, 이식편주변부 각막의 전방의 염증정도를 검사하고 부작용 및 합병증 유무를 조사 후, 각막염이 호전되고 창상치유가 완전한 경우 이차적으로 각막이식술을 시술하여 경과를 관찰하였다. 일차 수술 후 10안 중 8안에서 구조적인 성공을 나타내었다. 2안에서는 지속적인 각막상피결손으로 인하여 이식편의 괴사가 진행되어 재수술을 필요로 하였다. 7안에서 각막염이 호전되고 상피재생이 이루어진 후 전층각막이식술을 시행하여 이 중 6안에서 시력이 호전되었으며 1안에서는 동반된 이차녹내장으로 시력호전이 없었다. 전층각막이식술을 받지 않고 구조적이식술만 받은 3안에서는 시력회복이 어려울 것으로 예상이 되어 보존적 치료 후 경과관찰만 하였다. 심한 각막염으로 인한 임박각막천공의 경우, 보관중인 주변부각막조직과 공막조직을 사용하여 치료적 응급이식술을 시술하여 궤양조직을 대체하고 염증을 호전시켜 안구를 보존하였으며 그 이후 이차로 전층각막이식술을 시행하여 시력의 호전을 가져올 수 있었다.
The purpose of this study is to investigate the effect of tectonic graft using preserved human scleral tissue for the urgent treatment of corneal perforations caused by infectious corneal ulcer. 10 eyes with intractable infectious keratitis developed corneal perforationlarger than 2mm together with severely melted adjacent stroma. All the eyes were surgically treated with a urgent tectonic graft using preserved human scleral tissue for the preservation of the ocular structure. Melted corneal tissue together with fibrotic tissue were widely excised and human scleral tissue that were preserved in 70 % alcohol after the keratoplasty were grafted with 16 interrupted sutures. Human amniotic membrane was applied for the enhancement of epithelial wound healing. 7 eyes had received subsequent penetrating keratoplasty, and had a minimum follow-up period of 12 months. In our study, 5 eyes had bacterial keratitis, 3 eyes had fungal keratitis, and 2 eyes had herpes simplex keratitis. After the initial graft, anatomical success was achieved in 8 eyes. In two eyes a graft melting was developed secondary to delayed epithelial healing. Visual acuity was improved in all 7 eyes that received subsequent penetrating keratoplasty and no rejection was developed during the follow-up period of more than 12 months. This study showed that tectonic graft using preserved human scleral tissue for urgent purpose is useful method in acutely perforated corneal ulcer. To enhance the anatomical success of the graft, the healing of the overlying epithelium over the sclera is essential.
The purpose of this study is to investigate the effect of tectonic graft using preserved human scleral tissue for the urgent treatment of corneal perforations caused by infectious corneal ulcer. 10 eyes with intractable infectious keratitis developed corneal perforationlarger than 2mm together with severely melted adjacent stroma. All the eyes were surgically treated with a urgent tectonic graft using preserved human scleral tissue for the preservation of the ocular structure. Melted corneal tissue together with fibrotic tissue were widely excised and human scleral tissue that were preserved in 70 % alcohol after the keratoplasty were grafted with 16 interrupted sutures. Human amniotic membrane was applied for the enhancement of epithelial wound healing. 7 eyes had received subsequent penetrating keratoplasty, and had a minimum follow-up period of 12 months. In our study, 5 eyes had bacterial keratitis, 3 eyes had fungal keratitis, and 2 eyes had herpes simplex keratitis. After the initial graft, anatomical success was achieved in 8 eyes. In two eyes a graft melting was developed secondary to delayed epithelial healing. Visual acuity was improved in all 7 eyes that received subsequent penetrating keratoplasty and no rejection was developed during the follow-up period of more than 12 months. This study showed that tectonic graft using preserved human scleral tissue for urgent purpose is useful method in acutely perforated corneal ulcer. To enhance the anatomical success of the graft, the healing of the overlying epithelium over the sclera is essential.