= 증례보고 = 열공망막박리환자의수술후시야및망막신경섬유층변화비교 대한안과학회지 2012 년제 53 권제 9 호 J Korean Ophthalmol Soc 2012;53(9):1285-1290 pissn: 0378-6471 eissn: 2092-9374 http://dx.doi.org/10.3341/jkos.2012.53.9.1285 윤제환 남동흔 이대영 가천대학교길병원안과학교실 목적 : 열공망막박리로수술적치료를시행받은환자에서술후시야및망막신경섬유층변화를알아보고자하였다. 대상과방법 : 황반을포함한열공망막박리환자에서성공적으로망막이유착된 28 명을대상으로하였다. 수술후 3 개월에시야검사및망막신경섬유층두께측정을시행하여정상반대안과비교하였고또한공막돌륭술과유리체절제술의두군으로나누어각군간의차이를비교분석하였다. 결과 : 망막박리술후 PSD 와 MD 는정상안에비하여높았고 (p=0.002, p<0.001) 망막신경섬유층두께는낮았다 (p<0.001). 이중공막돌륭술군과유리체절제술군에서교정시력은통계적인차이가없었으나시야검사상반대안과의 PSD 와 MD 차이는각각 4.0 ± 4.0, 0.7 ± 1.5 (p=0.006) 와 6.5 ± 4.6, 1.9 ± 1.9 (p=0.001) 로유리체절제술군에서높았으며반대안과의망막신경섬유층의두께차이또한 8.2 ± 10.3 μm, 1.8 ± 2.7 μm (p=0.015) 로유의하게유리체절제술군에서높았다. 결론 : 열공망막박리환자수술후시야손상및망막신경섬유층의두께감소가있었으며공막돌륭술에비해유리체절제술에서더심하였다. < 대한안과학회지 2012;53(9):1285-1290> 열공망막박리는망막의열공이있고, 신경상피와망막색소상피간의유착을일으키는생리적인힘의균형이깨어짐으로신경상피아래에액체가저류하고그결과로각상피의사이가분리되는질환이다. 열공망막박리와이로인한합병증은유리체망막수술의가장중요한적응증이며전체유리체망막수술의약절반을차지한다. 1 유리체망막수술들중 1951년에 Schepens가도입한공막돌륭술이수십년간망막박리의기본적수술방법으로높은해부학적성공률을보여주었으며이후개발된유리체절제술또한해부학적성적및최대교정시력에서공막돌륭술과유사하였다. 2 그러나공막돌륭술과유리체절제술에서해부학적성공은있었으나시기능, 특히시야의감소가발생한사례가보고되고있으며유리체절제술의경우망막및시신경유두의손상이그원인이될수있고공막돌륭술의경우에는직접적인망막이나시시경유두의손상은드물지만맥락망막의순환장애가원인이될수있다. 3,4 공막돌륭술및유리체절제술의술 접수일 : 2011년 12월 27일 게재허가일 : 2012년 8월 5일 심사통과일 : 2012 년 3 월 1 일 책임저자 : 이대영인천광역시남동구남동대로 774 번길 21 가천대학교길병원안과 Tel: 032-460-3364, Fax: 032-460-3358 E-mail: dylee@gilhospital.com * 이논문의요지는 2011 년대한안과학회제 106 회학술대회에서포스터로발표되었음. 후결과의비교에대한많은보고가있었으나이러한시야손상및망막신경섬유층손상정도의비교는아직보고된바없어이에대한두수술간의우월성은가늠할수없다. 2,5 이에본저자들은임상적으로공막돌륭술이나유리체절제술이모두적응가능하다고판단되는단순열공망막박리환자에서각각의단독치료를시행하고술후시야검사및망막신경섬유층검사를시행하여각수술에서나타나는시야및망막신경섬유층의변화를비교하고자하였다. 대상과방법 2009년 1월부터 2011년 10월까지본원에서황반부를포함하여적도부를 3시간이상, 6시간이하로침범한단순열공망막박리로진단받은환자들을대상으로하여 learning curve를벗어난 2명의술자가수술대상환자의순서에따라유리체절제술과공막돌륭술을번갈아차례대로시행하여성공적으로망막이유착된 28명 28안을대상으로하였으며반대안의안과질환력이있는경우는제외하였다. 단순열공망막박리는이전의수술이나외상등의이차적인합병증으로발생하지않았고, 열공에의한박리가확실하며열공이상측에위치하여일차적인유리체절제술이나단순한공막돌륭술만으로유착이가능하다고판단되는박리로정의하였다. 2 이러한망막박리환자들을대상으로술전나이나성별, www.ophthalmology.org 1285
- 대한안과학회지 2012 년제 53 권제 9 호 - 수정체의상태, 최대교정시력, 굴절률, 안축장길이, 안압, 증상발현에서수술까지의기간및술후 3개월의최대교정시력, 안압을측정하였고술후 3개월에험프리자동시야검사 (Carl Zeiss Meditec, Dublin, CA, USA), 빛간섭단층촬영검사 (Stratus OCT III, Carl Zeiss Meditec) 를시행하였다. 험프리자동시야검사계는 central 24-2, SITA standard strategy로검사하여 pattern standard deviation (PSD) 과 mean deviation (MD) 을구하였으며빛간섭단층촬영검사는환자를산동시킨후 fast retinal nerve fiber layer (RNFL) scan으로검사하여망막신경섬유층두께를구하였다. 이러한결과를우선수술안과정상반대안사이에서비교하였으며또한각각의정상인반대안과의차이를구하여 (ΔPSD, ΔMD, ΔRFNL) 공막돌륭술을시행한군과유리체절제술을시행한군에서이를비교하였다. 또한, 망막신경섬유층두께를상측, 비측, 하측, 이측으로나누어분석하고이에해당하는시야영역에해당하는험프리자동시야검사상의각검사점의 Total deviation (TD) 을평균하여 알아보았다 (Fig. 1). 6,7 검사는숙련된한검사자에의하여시행되었다. 통계적분석방법은 SPSS 12.0 에서 Mann-witney U-test, Wilcoxon signed-rank test를이용하였고, p 값이 0.05 미만인경우를통계적으로유의하다고판정하였다. 결과 28명 28안중유리체절제술군과공막돌륭술군은각각 15안과 13안이었으며평균연령은유리체절제술군은 46.07 ± 12.2세, 공막돌륭술군은 37.69 ± 17.9세로차이가없었고, 증상발생에서수술까지의기간이나술후시야검사및망막신경섬유층두께검사를시행하기까지의기간, 술전굴절률, 안축장길이도두군간의유의한차이는없었다 (Table 1). 수술안과비수술안을비교해보면, 술후안압은양군의차이가없었으나 (p=0.083) 술후최대교정시력은 0.10 ± A B Figure 1. (A) Distribution of superior, nasal, inferior, temporal sectors in RNFL scan. (B) Distribution of VF zones and associated HVF central 24-2 test points. Superior RNFL thickness associated 3, 4, 5, 6, 7, 8 VF test points. Temporal RNFL thickness associated 9, 10, 12, 13 VF test points (yellow box). Inferior RNFL thickness associated 14, 15, 16, 17, 18, 19, 20 VF test points. Nasal RNFL thickness associated 1, 21 VF test points (blue box). N = nasal; T = temporal. Table 1. Characteristics of patients with rhagmatogenous retinal detachment Vitrectomy (n = 15) Scleral buckling (n = 13) p-value * Age (yr) 46.07 ± 12.2 37.69 ± 17.9 0.156 Sex (M:F) 5:10 8:5 Symptom duration (mon) 5.5 ± 4.7 7.7 ± 9.6 0.964 Preoperative BCVA (log MAR) 0.57 ± 0.34 0.66 ± 0.57 0.981 Preoperative IOP (mm Hg) 10.6 ± 2.7 10.1 ± 2.5 0.618 Preoperative spherical equivalent -3.2 ± 3.3-2.8 ± 3.5 0.275 Axial length (mm) 24.1 ± 1.8 24.5 ± 3.1 0.341 Values are presented as mean ± SD or number. SD = standard deviation; BCVA = best corrected visual acuity. * Mann-Whitney U-test. 1286 www.ophthalmology.org
- 윤제환외 : 망막박리수술후시야변화의비교 - Table 2. Comparison of operated eyes and fellow eyes 3 month after operation (n = 28) Operated eye Fellow eye p-value * Postoperative BCVA 0.10 ± 0.10 0.06 ± 0.11 0.045 Postoperative IOP (mm Hg) 11.6 ± 3.4 12.3 ± 3.0 0.083 Preoperative spherical equivalent (mm) -3.0 ± 3.5-3.3 ± 2.7 0.712 Axial length 24.3 ± 2.2 23.8 ± 3.1 0.623 PSD 5.2 ± 3.8 2.9 ± 2.0 0.002 MD 8.6 ± 6.1 4.3 ± 4.1 <0.001 Superior (14, 15, 16, 17, 18, 19, 20 test points) 5.6 ± 5.6 4.1 ± 1.9 0.049 Temporal (1, 21 test points) 5.3 ± 5.4 4.6 ± 3.4 0.132 Inferior (3, 4, 5, 6, 7, 8 test points) 13.9 ± 5.6 5.0 ± 2.1 0.001 Nasal (9, 10, 12, 13 test points) 9.6 ± 5.2 3.5 ± 2.1 0.015 RNFL (μm) 89.3 ± 13.0 94.5 ± 10.3 <0.001 Superior (μm) 112.4 ± 16.4 120.3 ± 8.2 0.001 Temporal (μm) 67.2 ± 20.6 71.7 ± 10.6 0.049 Inferior (μm) 121.3 ± 11.4 125.4 ± 15.1 0.087 Nasal (μm) 56.3 ± 21.6 60.6 ± 18.6 0.054 Values are presented as mean ± SD. BCVA = best corrected visual acuity; SD = standard deviation; PSD = pattern standard deviation; MD = mean deviation; RNFL = retinal nerve fiber layer. * Wilcoxon signed-rank test. Table 3. Comparison of vitrectomized eyes and scleral buckling eyes 3 months after operation Vitrectomy (n = 15) Scleral buckling (n = 13) p-value * Phakic:Pseudophakic 7:8 0:0 Significant cataract 0 0 Significant PCO 0 - Postoperative BCVA 0.10 ± 0.11 0.10 ± 0.10 0.821 Postoperative IOP (mm Hg) 11.9 ± 3.8 11.3 ± 2.9 0.786 PSD 7.2 ± 3.9 2.9 ± 2.2 0.002 ΔPSD 4.0 ± 4.0 0.7 ± 1.5 0.006 MD 11.4 ± 6.8 5.4 ± 2.8 0.005 ΔMD 6.5 ± 4.6 1.9 ± 1.9 0.001 ΔRFNL (μm) 8.2 ± 10.3 1.8 ± 2.7 0.015 Values are presented as mean ± SD or number. PCO = posterior capsule opacity; ΔPSD = difference between PSD of the eye with operation and the fellow eye; ΔMD = difference between MD of the eye with operation and fellow eye; Δ RNFL = difference between retinal nerve fiber layer of the eye with operation and the fellow eye. * Mann-Whitney U-test. 0.10, 0.06 ± 0.11 (p=0.045) 로비수술안에서높았으며시야손상은 PSD와 MD가각각 5.2 ± 3.8, 2.9 ± 2.0 (p=0.002) 과 8.6 ± 6.1, 4.3 ± 4.1 (p<0.001) 로수술안에서유의하게컸고영역별로나누어보면 Total deviation 의평균은상측, 비측, 하측에서유의한차이가있었다. 또한, 망막신경섬유층두께는 89.3 ± 13.0 μm, 94.5 ± 10.3 μm (p<0.001) 로수술안에서얇았고영역별로나누어보면망막신경섬유층두께는상측, 이측에서유의한차이가있었다 (Table 2). 유리체절제술군과공막돌륭술군모두시력에영향을줄수있는백내장이나수정체낭혼탁은없었으며술후최대교정시력과안압에도차이가없었으나 (p=0.821, p=0.786) 시야손상및망막신경섬유층두께는유의한차이를보였다. 시야손상은 PSD와 ΔPSD가각각 7.2 ± 3.9, 2.9 ± 2.2 (p=0.002) 와 4.0 ± 4.0, 0.7 ± 1.5 (p=0.006) 로유리체절제술군이공막돌륭술군에비해높았으며 MD와 ΔMD또한각각 11.4 ± 6.8, 5.4 ± 2.8 (p=0.005) 과 6.5 ± 4.6, 1.9 ± 1.9 (p=0.001) 로유리체절제술군이유의하게높았다. 망막신경섬유층두께는 ΔRFNL이각각 8.2 ± 10.3 μm, 1.8 ± 2.7 μm (p=0.015) 로유리체절제술군에서공막돌륭술군보다더높은차이를보였다 (Table 3). 고찰 열공망막박리의수술적치료의방법은술전환자의상태, 가능한수술기구, 술자의경험및능력등에따라매우 www.ophthalmology.org 1287
- 대한안과학회지 2012 년제 53 권제 9 호 - 개별적으로결정된다. 그러나최근열공망막박리에대한수술적치료법의흐름은저명하게유리체절제술로흘러가고있다. 이러한변화의원인은첫째로유리체절제술이복잡한열공망막박리를성공적으로치료한많은보고가있으며또한공막돌륭술보다자세히열공을찾을수있고, 망막박리의중요기전인유리체견인을제거할수있으며망막박리의큰합병증인유리체망막병증의원인이되는유리체를제거할수있다는장점이있기때문으로생각한다. 그러나아직유리체절제술과공막돌륭술의수술성공률에는이견이있다. 8 시야는안구의기능적변화를확인할수있는중요한지표이나자동시야검사상의시야손상이최대교정시력과직접적인연관관계를가지는것은아니다. 9 유리체절제술과공막돌륭술사이의수술결과에대한대부분의보고들은최대교정시력및합병증의빈도를결과의분석에이용하였으며시야의변화에대하여는간과하였다. 2,8,10,11 본연구에서는시야변화를중점적으로분석하였으며술후양군의최대교정시력과안압의유의한차이는없었으나시야변화에서는유리체절제술에서공막돌륭술보다통계적으로유의한시야의손상을나타냄을알수있었다. 망막박리환자의수술후시야손상의이유로박리된망막에의한손상과그외의원인으로인한손상을생각해볼수있는데우선박리된망막은박리후광수용체세포들로의영양공급이차단되어 24시간이내에변성이발생하며박리기간이길어질수록변성은심해지고이의재유착이후부분적인회복만이이루어져망막신경섬유층의감소와함께박리되었던망막에시야손상이발생할수있다. 12 본연구에서도황반을포함한상측부에망막박리가있었으므로이에해당하는상측및이측부의망막신경섬유층과이에대응하는하측및비측부의시야가비수술안에비해유의하게감소되어있어이를알수있었다. 그러나침범된망막의영역이황반부를포함하여적도부를 3시간이상, 6시간이하로침범한단순열공망막박리환자를대상으로하여이러한박리의양으로인해발생하는차이를최소화하였으며또한양군의술후증상에서수술까지의기간이통계적으로유의한차이가없어망막박리의양과박리기간으로인한시야손상의차이는작음에도불구하고하측부및비측부이외에상측부에도수술안에비하여유의한시야손상이있으며평균값또한유리체절제술군과공막돌륭술군의시야손상에차이가있어이의원인으로박리된망막이외의것을생각해볼수있고기타원인에대한보고는이전에도있어왔다. 유리체절제술에서시야손상의이유로현재까지제시된것은첫째술중의안압상승과안압의심한유동성, 둘째, 구후마취로인한안와내압력상승으로인한시신경손상, 셋째, 인공적인후유리체박리시시신경유 두에대한직접적인손상, 넷째, 시신경주변에서시행하는강한흡입으로인한손상, 다섯째, 술중가스주입으로인한망막손상, 여섯째, 공기액체교환술시발생하는망막손상등이있다. 3,13-16 또한공막돌륭술에의한시야손상또한보고된바있는데이의원인으로공막돌륭술로인해압박된맥락막이맥락막순환을감소시키고감소된맥락막순환으로인해시신경유두로의혈류를감소시키고또한공막돌륭으로인한장력이시신경유두에작용하여이로인한정상안압녹내장으로인해시야손상이발생할수있다고하였다. 4 그러나이러한의견에반하여공막돌륭으로인한맥락막순환은공막돌륭부위에만영향이있으며그이상의영역에는큰영향을미치지않는다는연구결과도있다. 17 따라서본연구에서나타난유리체절제술군과공막돌륭술군간의시야손상의차이는이러한박리된망막으로인한손상이외의원인으로인할가능성이있다. 저자들은시야변화뿐만아니라망막신경섬유층의두께를함께조사하였고망막신경섬유층은수술안과비수술안사이에서수술안에서유의하게감소되어있었으며특히망막박리가있었던상측부에서두드러진감소가보였고이는유리체절제술과공막돌륭술모두에서나타났다. 망막박리후재유착과정에서발생하는내경계막부위로의뮬러세포의이동으로인한망막덧막등의발생으로인해앞서언급한망막박리시발생하는광수용체의손상과관련된신경절세포의축삭변성으로인한망막신경섬유층의얇아짐이가려진다는보고도있으나본연구에선비수술안과비교하여통계적으로유의한차이가있었다. 18 또한앞서시야손상과마찬가지로망막박리가있었던상측부및이측부이외의영역에도비수술안과비교하여산술적인감소가있었고평균값또한비수술안과의차이가유리체절제술에서공막돌륭술보다유의하게큰것으로보아망막신경섬유층의변화에단순히박리된망막으로인한변성뿐만아니라수술과정에중에발생하는요인들이작용할가능성이있으며이러한요인들로앞서언급한바있는유리체절제술및공막돌륭술에서발생하는시야변화의원인들을생각해볼수있다. 특히유리체절제술은안내수술로써술중지속적으로유지되는안내고안압과후유리체박리및안내내용물흡입시발생하는시신경유두에대한물리적인충격으로인해시신경유두의손상이일어나고이로인해시신경유두로들어오는망막신경섬유층이손상될가능성이있으며공막돌륭술에서는시신경으로전달되는맥락막혈류의이상으로인한시신경유두손상가능성이제기된바있으나또다른연구에서맥락막혈류의변화는공막돌륭술부위이외에는큰영향을미치지않는다고하여아직까지공막돌륭이시신경유두및망막신경층에미치는영향은명확하게밝혀진 1288 www.ophthalmology.org
- 윤제환외 : 망막박리수술후시야변화의비교 - 바없다. 3,4,13-17 본연구에서는박리된망막이외의영역에서도망막신경섬유층두께의감소및시야손상이관찰되었고박리된망막의양, 박리의기간이유사함에도불구하고유리체절제술후망막신경섬유층의두께가더크게감소함을알수있었으며시야손상또한유리체절제술후더큰것으로보아망막박리의수술적치료중발생하는망막신경섬유층의손상이시야손상과관련이있을가능성을생각해볼수있었다. 본연구는망막박리수술후시야손상과망막신경섬유층두께변화의측면에서유리체절제술과공막돌륭술을비교하였다는점에서의미가있으나환자대상군이적다는제한점이있으며환자들의증상이발생한시점만으로는망막박리가발생한시점을정확히알기어려워망막박리발생후수술적치료까지의기간을명확히하기어렵고이로인해박리된망막의광수용체세포층변성으로인한망막신경섬유층두께변화의차이가능성을완전히배제할수없었다. 결론적으로소규모연구였지만시야및시신경손상의측면에서망막박리수술을비교한최초의연구였으며이를통해유리체절제술이공막돌륭술에비해시야및망막신경섬유층을더많이손상시킴을알수있어향후단순망막박리환자의수술적치료법결정시고려해야할것으로생각하고특히작은시신경손상으로큰시야장애를나타낼가능성이있는녹내장환자의단순망막박리수술시는공막돌륭술이더안전할것으로판단된다. 또한이러한시야손상및망막신경섬유층의손상의원리와기전에관하여더많은대상을바탕으로더장기간관찰하는연구가시행되어야할것이다. 참고문헌 1) Ah-Fat FG, Sharma MC, Majid MA, et al. Trends in vitreoretinal surgery at a tertiary referral centre: 1987 to 1996. Br J Ophthalmol 1999;83:396-8. 2) Koh TH, Choi MJ, Cho SW, et al. Scleral buckling and primary vitrectomy in simple rhegmatogenous retinal detachment. J Korean Ophthalmol Soc 2010;51:366-71. 3) Yan H, Dhurjon L, Chow DR, et al. Visual field defect after pars plana vitrectomy. Ophthalmology 1998;105:1612-6. 4) Sato EA, Shinoda K, Inoue M, et al. Reduced choroidal blood flow can induce visual field defect in open angle glaucoma patients without intraocular pressure elevation following encircling scleral buckling. Retina 2008;28:493-7. 5) Sasoh M, Ito Y, Wakitani Y, et al. 10-year follow-up of visual functions in patients who underwent scleral buckling. Retina 2005;25: 965-71. 6) Arantes TE, Garcia CR, Tavares IM, et al. Relationship between retinal nerve fiber layer and visual field function in human immunodeficiency virus-infected patients without retinitis. Retina 2012;32:152-9. 7) Weber J, Ulrich H. A perimetric nerve fiber bundle map. Int Ophthalmol 1991;15:193-200. 8) Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 2007;114:2142-54. 9) Garweg JG, Bergstein D, Windisch B, et al. Recovery of visual field and acuity after removal of epiretinal and inner limiting membranes. Br J Ophthalmol 2008;92:220-4. 10) Chong DY, Fuller DG. The declining use of scleral buckling with vitrectomy for primary retinal detachments. Arch Ophthalmol 2010;128:1206-7. 11) Kim YK, Woo SJ, Park KH, et al. Comparison of persistent submacular fluid in vitrectomy and scleral buckle surgery for macula-involving retinal detachment. Am J Ophthalmol 2010;149: 623-9. 12) Fisher SK, Lewis GP. Müller cell and neuronal remodeling in retinal detachment and reattachment and their potential consequences for visual recovery: a review and reconsideration of recent data. Vision Res 2003;43:887-97. 13) Kerrison JB, Haller JA, Elman M, Miller NR. Visual field loss following vitreous surgery. Arch Ophthalmol 1996;114:564-9. 14) Hirata A, Yonemura N, Hasumura T, et al. Effect of infusion air pressure on visual field defects after macular hole surgery. Am J Ophthalmol 2000;130:611-6. 15) Yang SS, McDonald HR, Everett AI, et al. Retinal damage caused by air-fluid exchange during pars plana vitrectomy. Retina 2006; 26:334-8. 16) Ezra E, Arden GB, Riordan-Eva P, et al. Visual field loss following vitrectomy for stage 2 and 3 macular holes. Br J Ophthalmol 1996; 80:519-25. 17) Nagahara M, Tamaki Y, Araie M, Eguchi S. Effects of scleral buckling and encircling procedures on human optic nerve head and retinochoroidal circulation. Br J Ophthalmol 2000;84:31-6. 18) Ozdek S, Lonneville Y, Onol M, et al. Assessment of retinal nerve fiber layer thickness with NFA-GDx following successful scleral buckling surgery. Eur J Ophthalmol 2003;13:697-701. www.ophthalmology.org 1289
- 대한안과학회지 2012 년제 53 권제 9 호 - =ABSTRACT= Comparison of Postoperative Visual Field and Nerve Fiber Layer Change in Rhegmatogenous Retinal Detachment Je Hwan Yoon, MD, Dong Heun Nam, MD, PhD, Dae Young Lee, MD Department of Ophthalmology, Gachon University Gil Medical Center, Gachon University, Incheon, Korea Purpose: To compare the visual field and retinal nerve fiber layer of scleral buckling (SB) and primary pars plana vitrectomy (PPV) for treatment of simple rhegmatogenous retinal detachment (RRD). Methods: We studied 20 eyes with RRD that were underwent successful surgical reattachment. Visual field test and retinal nerve fiber layer (RNFL) thickness measurements were performed in patients, and outcomes were compared not only between the operated eye and fellow eye, but also between SB and PPV 3 months postoperatively. Results: After the operation, PSD and MD were higher in the operated eye than in the fellow eye (p = 0.002, p < 0.001, respectively). RNFL thickness was lower in the operated eye than in the fellow eye (p < 0.001). No significant differences in BCVA were detected between SB and PPV. However, the respective differences between the operated eye and fellow eye regarding pattern standard deviation (4.0 ± 4.0, 0.7 ± 1.5), mean deviation (6.5 ± 4.6, 1.9 ± 1.9), and RNFL (8.2 ± 10.3 μm, 1.8 ± 2.7 μm) were significantly higher in PPV than in SB. Conclusions: Both visual field defect and retinal nerve fiber damage are significantly larger in PPV than in SB. J Korean Ophthalmol Soc 2012;53(9):1285-1290 Key Words: Pars plana vitrectomy, Retinal nerve fiber layer, Rhegmatogenous retinal detachment, Scleral buckling, Visual field Address reprint requests to Dae Young Lee, MD Department of Ophthalmology, Gachon University Gil Medical Center #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: dylee@gilhospital.com 1290 www.ophthalmology.org