수정체팽대녹내장 수술 후 발생한 만성폐쇄각녹내장 치료를 위한 주변홍채앞유착해리술 1예
Goniosynechialysis for Chronic Angle-closure Glaucoma after Extracapsular Cataract Extraction: A Case Report
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목적: 수정체팽대녹내장으로 백내장낭외적출술을 시행한 후 진행된 주변홍채앞유착과 안약으로 조절되지 않는 만성폐쇄각녹내장을 전방각유착해리술로 치료한 경험을 소개하고자 한다. 증례요약: 59세 여자가 3일 전부터 시작된 우안 통증 및 시력저하를 주소로 방문하였다. 안압은 46 mmHg, 좁은 중심전방과 주변부 홍채각막접촉이 확인되어 수정체팽대녹내장으로 진단하고 백내장낭외적출술을 시행하였지만 충분히 주변홍채앞유착을 박리하지 못하였다. 이후 점안 안약제 1개로 시력, 안압, 시야가 잘 유지되었지만, 점차 망막시신경섬유층 두께는 감소하고 최대한의 녹내장점안약으로도 수술 후 22개월부터 안압이 조절되지 않아 수술 후 24개월에 전방각유착해리술을 시행하였다. 안압은 25 mmHg에서 시술 후 13 mmHg로 잘 조절되었고, 전방출혈, 모양체해리, 섬유소형성 등의 합병증은 관찰되지 않았다. 결론: 주변홍채앞유착이 장기간 지속되어 안압이 상승한 만성폐쇄각녹내장의 경우에도 안전하고 합병증이 적은 전방각유착해리술을 시행하는 것이 도움이 된다.
Abstract
Purpose: We present a case of goniosynechiolysis in the treatment of chronic angle-closure glaucoma with persistent peripheral anterior synechia (PAS) after extracapsular cataract extraction (ECCE) for phacomorphic glaucoma that remained uncontrolled using topical glaucoma medications. Case summary: A 59-year-old woman presented with right eye pain and visual loss that started 3 days ago. Examination revealed an intraocular pressure (IOP) of 46 mmHg, a narrow central anterior chamber, and peripheral iridocorneal touch, indicative of phacomorphic glaucoma. Although ECCE was performed, PAS was not adequately resolved. Initially, visual acuity, IOP, and visual field were controlled with a single topical glaucoma medication. However, progressive retinal nerve fiber layer thinning and uncontrolled IOP, despite maximal medical therapy. Therefore, goniosynechiolysis was performed at 24 months after ECCE. The procedure reduced IOP from 25 mmHg to 13 mmHg without complications, such as hyphema, cyclodialysis, and fibrin formation. Conclusions: Goniosynechiolysis can be a safe and effective intervention for chronic angle-closure glaucoma with persistent PAS and elevated IOP.
참고문헌 (15)
- Steinert RF, "Cataract surgery", pp.333~341 (2010), Saunders
- Figueiredo CG, "Brazilian technique for prevention of the Argentinean flag sign in white cataract", J Cataract Refract Surg, 38, pp.1531~1536 (2012)
- Campbell DG, "Modern goniosynechialysis for the treatment of synechial angle-closure glaucoma", Ophthalmology, 91, pp.1052~1060 (1984)
- Teekhasaenee C, "Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma", Ophthalmology, 106, pp.669~674 (1999)
- Shao T, "Anterior chamber angle assessment by anterior-segment optical coherence tomography after phacoemulsification with or without goniosynechialysis in patients with primary angle closure glaucoma", J Glaucoma, 24, pp.647~655 (2015)
- Rodrigues IA, "Aqueous outflow facility after phacoemulsification with or without goniosynechialysis in primary angle closure : a randomised controlled study", Br J Ophthalmol, 101, pp.879~885 (2017)
- Tun TA, "Swept-source optical coherence tomography assessment of iris-trabecular contact after phacoemulsification with or without goniosynechialysis in eyes with primary angle closure glaucoma", Br J Ophthalmol, 99, pp.927~931 (2015)
- Lee CK, "Effect of goniosynechialysis during phacoemulsification on IOP in patients with medically wellcontrolled chronic angle-closure glaucoma", J Glaucoma, 24, pp.405~409 (2015)
- Husain R, "Efficacy of phacoemulsification alone vs phacoemulsification with goniosynechialysis in patients with primary angle-closure disease : a randomized clinical trial", JAMA Ophthalmol, 137, pp.1107~1113 (2019)
- Angmo D, "Comparative evaluation of phacoemulsification alone versus phacoemulsification with goniosynechialysis in primary angle-closure glaucoma : a randomized controlled trial", Ophthalmol Glaucoma, 2, pp.346~356 (2019)
- Yun YM, "Clinical factors that influence intraocular pressure change after cataract surgery in primary open-angle glaucoma and angle-closure glaucoma", J Korean Ophthalmol Soc, 47, pp.85~96 (2006)
- Cho SH, "Combined phacoemulsification, synechiolysis without gonioprism lens and intracameral tissue plasminogen activator injection for angle-closure glaucoma", J Korean Ophthalmol Soc, 56, pp.931~937 (2015)
- Harasymowycz PJ, "Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure", J Glaucoma, 14, pp.186~189 (2005)
- Hayashi K, "Effect of cataract surgery on intraocular pressure control in glaucoma patients", J Cataract Refract Surg, 27, pp.1779~1786 (2001)
- Hamanaka T, "Histopathology of the trabecular meshwork and Schlemm's canal in primary angle-closure glaucoma", Invest Ophthalmol Vis Sci, 52, pp.8849~8861 (2011)