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1 대한안과학회지 2015 년제 56 권제 6 호 J Korean Ophthalmol Soc 2015;56(6): ISSN (Print) ISSN (Online) Original Article 자가결막편이식술을이용한원발성군날개수술의임상성적 Surgical Outcome of Primary Pterygium Excision with Conjunctival Autograft 김동익 김미금 위원량 오주연 Dong Ik Kim, MD, Mee Kum Kim, MD, PhD, Won Ryang Wee, MD, PhD, Joo Youn Oh, MD, PhD 서울대학교의과대학서울대학교병원안과학교실 Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Purpose: To investigate the clinical outcomes of primary pterygium excision combined with free conjunctival autograft. Methods: The medical records of 112 patients (129 eyes) who underwent pterygium excision and free conjunctival autograft for primary pterygium were retrospectively reviewed for recurrence and postoperative complications and the outcomes compared with pterygium excision combined with amniotic membrane transplantation, conjunctival flap, or simple conjunctival closure. Additionally, the surgical outcomes were evaluated in relation to the intraoperative use of mitomycin C. Results: Postoperative recurrences were observed in 3 of 129 eyes (2.3%) that received pterygium excision and free conjunctival autograft, 2 of 10 eyes (20.0%) that received pterygium excision with amniotic membrane transplantation, 1 of 10 eyes (10.0%) that received pterygium excision with conjunctival flap and 1 of 12 eyes (8.3%) that received pterygium excision and simple conjunctival closure. Therefore, the recurrence rate was significantly lower in patients with conjunctival autograft than in those without (p = 0.024, Breslow-Wilcoxon test). Additionally, recurrence was observed in 1 of 10 eyes (10.0%) in patients that underwent pterygium surgery when mitomycin C was used intraoperatively and in 2 of 119 eyes (1.7%) without the use of mitomycin C. Conclusions: Pterygium excision combined with free conjunctival autograft is an effective and safe surgical procedure to treat primary pterygium. J Korean Ophthalmol Soc 2015;56(6): Key Words: Conjunctival autograft, Mitomycin C, Pterygium, Recurrence 군날개는결막의섬유혈관성조직이증식하여각막윤부, 각막을침범하는질환으로, 발생의정확한원인은알려져있지않으나자외선, 건조한기후, 퇴행성변화, 면역체계의변화등이병인중하나로생각되고있다. 1-5 최근보고에따 Received: Revised: Accepted: Address reprint requests to Joo Youn Oh, MD, PhD Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul , Korea Tel: , Fax: jooyounoh77@gmail.com * This study was presented as a poster at the 112th Annual Meeting of the Korean Ophthalmological Society 르면한국인에서군날개유병률은 40세이상성인에서 8.9%, 60세이상에서 16% 로군날개는비교적흔한안과적질환이다. 6 군날개의치료는그크기가작은경우표면윤활제를사용하며경과관찰할수있지만, 군날개가시축을침범하거나심한난시를유발하여시력저하를유발하는경우, 안구움직임의제한을초래하는경우, 주관적인불편감및미용적문제를심하게야기하는경우에는수술적절제가필요하다. 군날개의치료를위한가장오래된수술방법으로군날개절제술후노출된공막을그대로남겨주는공막노출법이있는데, 이는수술후재발률이 14-82% 로높고여러심 c2015 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 856

2 - 김동익외 : 자가결막편이식을이용한군날개수술 - 각한합병증이수술후에많이발생하기때문에현재는거의사용되지않는다. 7,8 따라서현재는군날개절제후노출된공막위를덮기위해주변부결막을당겨봉합하는단순결막봉합술, 주변부에서결막피판을만들어공막위를덮어주는결막피판술, 반대눈이나같은눈의정상부분에서만든자가결막편을군날개를제거한자리로이식후봉합하는자가결막편이식술, 동종양막을이용해공막위를덮어주는양막이식술등다양한방법이사용되고있다. 또한군날개의재발을억제하기위해수술중혹은수술후에마이토마이신 C와같이섬유아세포의증식및활성을억제하는항대사물질을사용하는경우도있다 본연구에서는원발성군날개의수술적치료를위해군날개절제술및자가결막편이식술을이용한경우의임상성적을알아보고자하였다. 대상과방법 환자군과자료수집서울대학교병원에내원하여원발성군날개진단하에한술자에의해군날개절제술을시행받은후최소 9개월이상추적관찰을한 140명, 161안의의무기록을후향적으로분석하였다. 환자의성별, 나이, 수술방법, 수술후재발, 수술중혹은수술후합병증 ( 감염, 공막괴사및얇아짐, 칼슘침착, 결막유착등 ) 에대해조사하였다. 수술전군날개의정도는 Tan et al 12 이제안한 Grade T1-T3 분류를사용하였다. Grade T1 (atrophic) 은세극등현미경으로보았을때군날개를통해상공막혈관을명확하게구분할수있는경우, Grade T2 (intermediate) 는군날개를통해상공막혈관이부분적으로가려지는경우, Grade T3 (fleshy) 는군날개를통해상공막혈관이완전히가려지는경우로정의하였다. 또한각막윤부로부터군날개선진부까지의길이를 mm 단위로기록하였다. 13,14 수술후재발의기준은증식된섬유혈관조직의각막윤부침범으로정의하였다. 수술과정및수술후처치수술은한술자 (JYO) 에의해서시행되었다. 0.5% proparacaine (Paracaine, Hanmi Pharmaceutical, Seoul, Korea) 으로점안마취후개검기로안구를노출시킨상태에서 2% lidocaine (Lidocaine hydrochloride 20 mg/ml, DAIHAN PHARM, Seoul, Korea) 에 epinephrine (Epinephrine HCl 1 mg/ml, DAIHAN PHARM) 을 1:100,000으로혼합한용액을군날개주변결막에국소주사한후눈에보이는병변밖 1 mm의각막상피를포함한각막쪽병변을 Beaver blade (Becton, Dickinson and company, Franklin Lakes, NJ, USA) 를이용하여각막에서분리시켜제거하고보우만층까지노출되도록다듬었다. 결막쪽군날개몸체조직은유구포셉과 Westcott 가위 (BAUSCH + LOMB Storz, St. Louis, MO, USA) 를사용하여결막및테논낭을포함하여제거하였다. 자가결막편이식술은군날개제거후노출된공막부위와동일한크기로같은눈의상이측정상결막에각막윤부인접하여마킹펜으로표시하였다. 표시부위결막하에 2% lidocaine에 epinephrine을 1:100,000으로혼합한용액을주입하여결막하공간을확장하고테논낭이포함되지않도록결막을얇게박리하여자가결막편을만들었다. 자가결막편은노출된공막부위에주위결막과 10-0 nylon (Ethilon, Ethicon, Norderstedt, Germany) 으로봉합하였다. 수술방법에대한자세한모식도는 Hirst 7 가 2003년에발표한종설의 Fig. 6과동일하다. 결막공여부위에는추가적인조작을시행하지않았다. 자가결막편이식술을시행한일부의환자에서군날개제거후제거된군날개주위의결막및테논낭아래에 0.02% 마이토마이신 C (Mitomycin-C 10 mg/1 vial, Kyowa Hakko Kirin Co. Ltd., Shizuoka, Japan) 를적신스펀지를 1분간둔후 10 ml의생리식염수로씻어내는과정을같이시행하였다. 양막이식술은냉동보존양막 (Amnisite-cornea Cryopreserved, Bioland, Ochang, Korea) 을사용하여시행하였다. 공막노출부위와동일한크기로양막을자른후상피쪽이위를향하게하여노출된공막부위를덮은후주위결막과 10-0 nylon으로봉합하였다. 결막피판술은군날개조직을제거한후바로인접한윗부위결막에서윤부를따라슬라이딩결막피판을만들어노출된공막위를덮은후 10-0 nylon으로봉합하여시행하였다. 수술방법에대한자세한모식도는 Hirst 7 가 2003년에발표한종설의 Fig. 4와동일하다. 단순결막봉합술은군날개절제후내측결막을당겨와노출된공막위를덮은후 10-0 nylon을사용하여일차봉합을시행하였다. 수술방법에대한자세한모식도는 Hirst 7 가 2003년에발표한종설의 Fig. 3과동일하다. 모든환자에서수술후치료용소프트콘택트렌즈 (Acuvue Oasys, Johnson & Johnson Vision Care Inc., New Brunswick, NJ, USA) 를 1주간착용하게하였고, 0.5% levofloxacin (Cravit, Santen, Osaka, Japan), 1% prednisolone acetate (Pred forte, Allergan, Irvine, CA, USA), 자가혈청안약을하루 4회씩 3주간점안하게하였다. 자가혈청안약은환자의사전동의후에 ml의혈액을채혈하여 2,500 rpm 에서 10분간원심분리후, 무균조작으로혈청만취하여생리식염수에 20% 농도로희석하여제조하였다. 봉합사는술 857

3 - 대한안과학회지 2015 년제 56 권제 6 호 - 후 1주째제거하였다. 통계분석 GraphPad Prism (GraphPad Software Inc., La Jolla, CA, USA) 을이용하여통계분석을시행하였다. Kaplan-Meier 법을이용하여군날개수술후부터재발까지의생존곡선을구하였고, Breslow-Wilcoxon 법을이용하여각군별중위수생존시간 (median survival time) 에유의한차이가있는지평가하였다. 각군별임상지표의유의성은 Pearson s chi square test 법을이용하여분석하였고, 군날개정도및크기차이의유의성은 Student s t-test 법을이용하여분석하였다. 통계적유의성은 p-value<0.05로정의하였다. 결과 자가결막편이식술을이용한군날개절제술은총 129안, 양막이식술을이용한군날개절제술은총 10안, 결막피판술을이용한군날개절제술은총 10안, 군날개절제술후단순결막봉합술은총 12안에서시행하였다. 각군환자의연령, 성별, 이환된눈의좌우등인구학적특성과군날개의크기및정도는 Table 1에정리하였고, 군간유의한차이를보이지않았다. 군날개수술후재발은자가결막편이식군 129안중 3안 (2.3%), 양막이식군 10안중 2안 (20.0%), 결막피판술군 10 안중 1안 (10.0%), 단순결막봉합술군 12안중 1안 (8.3%) 에서평균술후 11.2개월에관찰되었다 (Table 1). 자가결막편이식술을이용한군날개절제술을시행받은환자와그외수술방법을이용해군날개수술을시행받은환자사이에재발률을비교하였을때, 자가결막편이식군에서재발률은 2.3% 로, 자가결막편이식을이용하지않은군에서재발률 12.5% 에비해통계적으로유의하게군날개재발률이적었다 (p=0.024, Breslow-Wilcoxon 법 ) (Fig. 1A). 자가결막편이식군을각각의수술방법과비교하였을때, 자가결막편이식군에서양막이식군에비해유의하게재발률이적었다 (p=0.028, Breslow-Wilcoxon 법 ) (Fig. 1B). 하지만결막피판술군이나단순결막봉합술군과비교하였을때에는통계적으로유의한차이가없었는데, 이는자가결막편이식군에비해결막피판술군이나단순결막봉합술군에속한환자수가적었기때문으로생각된다 (Fig. 1C, D). 수술중마이토마이신 C 점적이군날개재발을막는효과가있는지알아보기위해군날개절제술및자가결막편이식술중마이토마이신 C 점적을동반하여시행한 10안과마이토마이신 C를사용하지않은 119안에서수술후군날개재발률을비교하여보았다 (Table 2). 두군간에인구학적특성이나군날개의정도및크기는유의한차이가없었다 (Table 2). 군날개수술후재발률은마이토마이신 C를 Table 1. Patient demographics and clinical characteristics Conjunctival autograft Amniotic membrane graft Conjunctival flap Simple closure Number of eyes Mean age at surgery (range) 59.2 (27-88) 55.2 (41-76) 50.3 (40-61) 58.8 (48-71) Laterality (right:left) 59:70 5:5 7:3 9:3 Sex (male:female) 61:68 3:7 3:7 3:9 Pterygium grade 2.15 ± ± ± ± 0.17 Pterygium size (mm) 2.60 ± ± ± ± 0.37 Mean follow-up (months) Recurrence (n, %) 3 (2.3) 2 (20.0) 1 (10.0) 1 (8.3) Months to recurrence 4, 6, 49 4, Values are presented as mean ± SD unless otherwise indicated. Table 2. Comparison between conjunctival autografts with and without intraoperative mitomycin C Conjunctival autograft Conjunctival autograft without mitomycin C with mitomycin C p-value Number of eyes Mean age at surgery (range) 59.4 (27-88) 56.3 (34-72) Laterality (right:left) 56:63 3:7 Sex (male:female) 52:67 9:1 Pterygium grade 2.14 ± ± Pterygium size (mm) 2.51 ± ± Recurrence (n, %) 2 (1.7) 1 (10.0) 0.10 Months to recurrence 4, 49 6 Values are presented as mean ± SD unless otherwise indicated. 858

4 - 김동익외 : 자가결막편이식을이용한군날개수술 - A B C D Figure 1. The Kaplan-Meier survival curves of pterygium recurrence after surgery. (A) Pterygium excision with conjunctival autograft vs. pterygium excision without conjunctival autograft. The recurrence rate of pterygium was significantly lower in conjunctival autograft group (p = 0.024, Breslow-Wilcoxon test). (B) Pterygium excision with conjunctival autograft vs. pterygium excision with amniotic membrane transplantation (AMT). The recurrence rate of pterygium was significantly lower in conjunctival autograft group, compared to amniotic membrane transplantation group (p = 0.028, Breslow-Wilcoxon test). (C) Pterygium excision with conjunctival autograft vs. pterygium excision with conjunctival flap. (D) Pterygium excision with conjunctival autograft vs. pterygium excision with simple conjunctival closure. There are no significant differences in the recurrence between conjunctival autograft group and conjunctival flap or simple closure group. 사용하지않은군에서는 2안 (1.7%) 에서재발하였고, 마이토마이신 C를사용한군에서는 1안 (10.0%) 에서재발하였는데두군간차이가통계적으로유의하지않았다 (Table 2, Fig. 2). 자가결막편이식술을이용한군날개절제술을받은후재발한환자 3안을살펴보았을때, 재발한이후에도군날개수술이전에비해군날개의정도가경미하고미용적으로더우수한것을알수있었다 (Fig. 3). 평균 2.9년의추적관찰기간중재발이외에감염, 공막괴사및얇아짐, 칼슘침착, 결막유착등임상적으로유의한합병증은관찰되지않았다. Figure 2. The Kaplan-Meier survival curve of pterygium recurrence after pterygium excision with conjunctival autograft according to the intraoperative use of mitomycin C. One eye recurred in 10 eyes (10.0%) with pterygium surgery using mitomycin C intraoperatively, while two of 119 eyes (1.7%) without the use of mitomycin C recurred. The difference is not statistically significant. MMC = mitomycin C. 고찰 기존문헌들에의하면자가결막이식술후군날개의재발률은 0-38% 로보고에따라다양하지만, 공막노출법후재발률이 14-82%, 단순결막봉합후재발률이 2-69%, 결막피판술후재발률이 % 로보고되는것을고려하면자 859

5 - 대한안과학회지 2015 년제 56 권제 6 호 - Before primary surgery After recurrence Figure 3. Anterior segment photographs of patients that developed recurrence after primary pterygium excision with conjunctival autograft. The preoperative and postoperative photographs of three eyes whose pterygium recurred after pterygium excision with conjunctival autograft showed that recurred pterygia were milder in size, vascularization, and fleshiness, compared to those before excision. Patient 1 had recurrence at the postoperative 6 months, patient 2 at the postoperative 49 months, and patient 3 at the postoperative 4 months. 가결막이식술이다른수술법에비해재발률이현저히적은수술방법임을알수있다 ,15 본연구에서원발성군날개의치료로군날개절제술및자가결막편이식술을이용한 129안중 2.3% 에서재발한반면, 자가결막편이식을같이시행하지않은 32안중 12.5% 에서재발하여자가결막편이식술을이용한군날개절제술의재발률이현저히적었다는점에서기존문헌들의보고 와일치하였다. 하지만자가결막편이식술을시행받은환자를결막피판술이나단순봉합술을받은환자들과각각비교하였을때재발률의차이는통계적으로유의하지않았다. 이는대상환자수가자가결막편이식군에서많고, 다른군에는적어통계적유의성을얻을수없었기때문으로, 수술방법을선택함에있어선택편향이작용한후향적연구의한계점으로생각된다. 860

6 - 김동익외 : 자가결막편이식을이용한군날개수술 - 원발성군날개의병인론으로가장대두되는것이자외선에의한각막윤부의손상이다. 각막윤부의손상에의해상피기저줄기세포의돌연변이가유발되고이때군날개세포들이만들어지는데, 이군날개세포들이각막중심부로이동하며기질금속단백분해효소를생성하여보우만층의파괴가일어나고상처치유과정에서섬유모세포들이과다증식하여결국군날개조직이형성된다는것이다 한연구에의하면, 군날개세포들은육안적으로관찰되는군날개조직의약간앞쪽에정상으로보이는각막쪽에위치한다. 16,17 또한다른연구에따르면부분각막윤부결핍시각막손상부위가정상적으로각막상피화되려면윤부로부터충분히떨어져서결막조직을제거하여각막이회복되는데충분한시간을주는것이필요하다고한다 이러한점들을고려하면, 군날개절제후재발률을낮추기위해서는군날개선진부에위치한군날개세포를같이제거하고, 비정상결막쪽조직도충분히제거하며, 군날개가있던부위에정상적인각막윤부를복원하여야할것으로생각할수있다. 자가결막편이식술은군날개주위의비정상결막으로부터각막윤부를보호하고정상윤부결막을이식하여정상환경을만들어준다는점에서군날개재발을적게할수있는방법으로생각된다. 본연구에서시행한수술방법은이원칙에입각하여, 군날개세포가위치하는군날개선진부를충분히제거하고, 정상적인윤부인접자가결막에서이식편을만들어제거한군날개부위에이식함으로써군날개가위치했던각막윤부로부터이전군날개주위의비정상결막부위를충분히떨어뜨려놓고정상적인각막윤부환경을만들어주었다. 수술중이나수술후에군날개의주요구성성분인섬유모세포의과다증식을억제하기위해마이토마이신 C를사용하는것이군날개수술후재발률을낮추는데도움이된다고기존여러연구들이보고하였다 하지만본연구에서는수술중마이토마이신 C 사용여부가군날개절제술과자가결막편이식술후군날개재발률에유의한영향을미치지는않았다. 다만본연구에서군날개의살집이크고혈관화가발달된증식성군날개의형태를보이는환자에서주로마이토마이신 C를사용하였기때문에수술방법을선택함에있어선택편향이작용한점이한계점으로생각된다. 하지만본연구의결과는각공막염및괴사, 각막내피세포손상등시력을위협하는심각한부작용을초래할수있는마이토마이신 C 를사용하지않더라도자가결막편이식을통해충분히높은군날개수술성공률을보일수있음을시사한다. 결론적으로, 자가결막편이식술을동반한군날개절제술은원발성군날개에서낮은재발률과적은합병증을보이 는유용한치료법이라고생각된다. REFERENCES 1) Taylor HR, West S, Muñoz B, et al. The long-term effects of visible light on the eye. Arch Ophthalmol 1992;110: ) Di Girolamo N, Chui J, Coroneo MT, Wakefield D. Pathogenesis of pterygia: role of cytokines, growth factors, and matrix metalloproteinases. Prog Retin Eye Res 2004;23: ) Reisman D, McFadden JW, Lu G. Loss of heterozygosity and p53 expression in pterygium. Cancer Lett 2004;206: ) Tan DT, Tang WY, Liu YP, et al. Apoptosis and apoptosis related gene expression in normal conjunctiva and pterygium. Br J Ophthalmol 2000;84: ) Solomon A, Li DQ, Lee SB, Tseng SC. Regulation of collagenase, stromelysin, and urokinase-type plasminogen activator in primary pterygium body fibroblasts by inflammatory cytokines. Invest Ophthalmol Vis Sci 2000;41: ) Yoon KC, Mun GH, Kim SD, et al. Prevalence of eye diseases in South Korea: data from the Korea national health and nutrition examination survey Korean J Ophthalmol 2011;25: ) Hirst LW. The treatment of pterygium. Surv Ophthalmol 2003;48: ) Kaufman SC, Jacobs DS, Lee WB, et al. Options and adjuvants in surgery for pterygium: a report by the American Academy of Ophthalmology. Ophthalmology 2013;120: ) Ang LP, Chua JL, Tan DT. Current concepts and techniques in pterygium treatment. Curr Opin Ophthalmol 2007;18: ) Young AL, Ho M, Jhanji V, Cheng LL. Ten-year results of a randomized controlled trial comparing 0.02% mitomycin C and limbal conjunctival autograft in pterygium surgery. Ophthalmology 2013;120: ) Kim CH, Lee JK, Park DJ. Recurrence rates of amniotic membrane transplantation, conjunctival autograft and conjunctivolimbal autograft in primary pterygium. J Korean Ophthalmol Soc 2009; 50: ) Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 1997;115: ) Gazzard G, Saw SM, Farook M, et al. Pterygium in Indonesia: prevalence, severity and risk factors. Br J Ophthalmol 2002;86: ) Durkin SR, Abhary S, Newland HS, et al. The prevalence, severity and risk factors for pterygium in central Myanmar: the Meiktila Eye Study. Br J Ophthalmol 2008;92: ) Zheng K, Cai J, Jhanji V, Chen H. Comparison of pterygium recurrence rates after limbal conjunctival autograft transplantation and other techniques: meta-analysis. Cornea 2012;31: ) Jaworski CJ, Aryankalayil-John M, Campos MM, et al. Expression analysis of human pterygium shows a predominance of conjunctival and limbal markers and genes associated with cell migration. Mol Vis 2009;15: ) Reid TW, Dushku N. What a study of pterygia teaches us about the cornea? Molecular mechanisms of formation. Eye Contact Lens 2010;36: ) Chui J, Coroneo MT, Tat LT, et al. Ophthalmic pterygium: a stem 861

7 - 대한안과학회지 2015 년제 56 권제 6 호 - cell disorder with premalignant features. Am J Pathol 2011; 178: ) Danjo S, Friend J, Thoft RA. Conjunctival epithelium in healing of corneal epithelial wounds. Invest Ophthalmol Vis Sci 1987;28: ) Dua HS. The conjunctiva in corneal epithelial wound healing. Br J Ophthalmol 1998;82: ) Kareem AA, Farhood QK, Alhammami HA. The use of antimetabolites as adjunctive therapy in the surgical treatment of pterygium. Clin Ophthalmol 2012;6: ) Shehadeh-Mashor R, Srinivasan S, Boimer C, et al. Management of recurrent pterygium with intraoperative mitomycin C and conjunctival autograft with fibrin glue. Am J Ophthalmol 2011;152: ) Bae SG, Kim JK, Lee JK, Park DJ. The effectiveness of mitomycin C on pterygium surgery with amniotic membrane transplantation. J Korean Ophthalmol Soc 2012;53: ) Kheirkhah A, Izadi A, Kiarudi MY, et al. Effects of mitomycin C on corneal endothelial cell counts in pterygium surgery: role of application location. Am J Ophthalmol 2011;151: ) Menghini M, Watson SL, Bosch MM. Corneal melting two weeks after pterygium excision with topical mitomycin C: successfully treated with lamellar keratoplasty and amnion membrane transplantation. Case Rep Ophthalmol 2012;3: ) Owoeye JF, Ayorinde OO. Surgically induced necrotising scleritis after pterygium excision. West Afr J Med 2012;31: = 국문초록 = 자가결막편이식술을이용한원발성군날개수술의임상성적 목적 : 자가결막편이식술을이용한원발성군날개수술의임상성적을알아보고자하였다. 대상과방법 : 군날개절제술및자가결막편이식술을시행받은원발성군날개환자 112 명, 129 안의의무기록을후향적으로조사하여군날개절제술및양막이식술, 결막피판술, 단순결막봉합술을시행받은환자 28 명, 32 안의수술성적과비교하였다. 또한자가결막편이식술을이용한군날개수술중마이토마이신 C 점적을동반한경우와동반하지않은경우의수술성적을비교하였다. 결과 : 군날개절제술및자가결막편이식술을시행받은원발성군날개 129 안중 3 안 (2.3%) 에서재발하였다. 반면군날개절제술및양막이식술을시행받은 10 안중 2 안 (20.0%), 군날개절제술및결막피판술을시행받은 10 안중 1 안 (10.0%), 군날개절제술및단순결막봉합술을시행받은 12 안중 1 안 (8.3%) 에서재발이관찰되어자가결막편이식을이용한수술에서자가결막편이식을이용하지않은경우보다유의하게군날개재발률이적었다 (p=0.024, Breslow Wilcoxon 법 ). 또한군날개절제술및자가결막편이식술도중마이토마이신 C 점적을사용한 10 안중 1 안 (10.0%) 에서군날개가재발하였고, 마이토마이신 C 를사용하지않은군날개절제술및자가결막편이식술을받은 119 안중 2 안 (1.7%) 에서군날개가재발하였다. 결론 : 원발성군날개의치료로자가결막편이식술을이용한군날개절제술은낮은재발률과적은합병증을보이는유용한치료법으로생각된다. < 대한안과학회지 2015;56(6): > 862

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar