아메드밸브삽입술 후 고안압기에 동시에 시행한 주사침 여과포 복원술과 안구 지압의 효과
Needle Revision and Digital Ocular Massage for Treatment of Ocular Hypertension Phase after Ahmed Valve Implantation
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목적: 아메드밸브삽입술 후 고안압기가 발생한 환자에게 주사침 여과포 복원술, 5-fluorouracil (5-FU) 결막하 주사, 그리고 안구 지압을 동시에 시행하였을 경우 안압 하강 효과와 안정성에 대해서 알아보고자 하였다. 대상과 방법: 아메드밸브삽입술 후 발생한 고안압기에 주사침 여과포 복원술, 5-FU 결막하 주사, 그리고 안구 지압을 동시에 시행받은 환자를 대상으로 의무기록을 후향적으로 분석하였다. 시술 전과 후의 시력, 안압, 그리고 녹내장 안약의 개수의 변화를 비교하고 시술의 누적 성공률을 Kaplan–Meier 생존 분석을 이용하여 분석하였다. 시술의 완전 성공은 녹내장 안약을 사용하지 않고 안압이 6 mmHg 이상, 21 mmHg 이하인 경우, 부분 성공은 1개 이상의 녹내장 안약을 사용하고 안압이 6 mmHg 이상, 21 mmHg 이하인 경우로 정의하였다. 결과: 총 53명(53안)의 환자가 본 연구에 포함되었다. 아메드밸브삽입술 후 첫 번째 시술까지의 기간은 평균 25일이었고 환자당 2.1 ± 0.8회의 시술을 받았다. 시술 전과 시술 후 48주째 평균 안압은 각각 24.4 ± 2.9 mmHg, 16.9 ± 3.5 mmHg였고 시술 후 경과관찰 기간 중 평균 안압은 시술 전과 비교하여 통계적으로 유의하게 낮았다. 시술 후 48주째 완전 성공률은 22.6%였고 부분 성공률은 81.1%였다. 결론: 아메드밸브삽입술 후 고안압기가 발생하였을 때 주사침 여과포 복원술, 5-FU 결막하 주사, 그리고 안구 지압을 동시에 시행하는 것이 효율적인 안압 하강에 도움이 될 것으로 생각된다.
Abstract
Purpose: To evaluate the effects and safety of needle revision with 5-fluorouracil (5-FU) subconjunctival injection and digital ocular massage for the treatment of ocular hypertension phase following Ahmed valve implantation (AVI). Methods: We retrospectively analyzed the medical records of patients who underwent needle revision with 5-FU subconjunctival injection and digital ocular massage for treatment of ocular hypertension phase. Changes in visual acuity, intraocular pressure (IOP), and the number of anti-glaucoma medications before and after the procedure were compared. The cumulative success rate of the procedure was analyzed using Kaplan–Meier survival analysis. Success was categorized as complete when the IOP was 6-21 mmHg without medication and qualified when it was 6-21 mmHg with medication. Results: In total, 53 eyes of 53 patients were included in this study. The average time interval between AVI and the first procedure was 25 days, and 2.1 ± 0.8 procedures were performed per patient. The mean IOP before and at 48 weeks after the procedure was 24.4 ± 2.9 and 16.9 ± 3.5 mmHg, respectively. At each follow-up visit, the IOP was significantly lower than that before the procedure. At 48 weeks after the procedure, the complete and qualified success rates were 22.6%, and 81.1%, respectively. Conclusions: Needle revision with 5-FU subconjunctival injection and digital ocular massage are effective and safe for the treatment of ocular hypertension phase following AVI.
참고문헌 (22)
- Taglia DP, "Comparison of the Ahmed Glaucoma Valve, the Krupin Eye Valve with Disk, and the double-plate Molteno implant", J Glaucoma, 11, pp.347~353 (2002)
- Minckler DS, "Aqueous shunts for glaucoma", Cochrane Database Syst Rev, (2), pp.CD004918~ (2006)
- Lim KS, "Glaucoma drainage devices;past, present, and future", Br J Ophthalmol, 82, pp.1083~1089 (1998)
- Hong CH, "Glaucoma drainage devices : a systematic literature review and current controversies", Surv Ophthalmol, 50, pp.48~60 (2005)
- Sahiner N, "Creation of a drug-coated glaucoma drainage device using polymer technology : in vitro and in vivo studies", Arch Ophthalmol, 127, pp.448~453 (2009)
- Eibschitz-Tsimhoni M, "Incidence and management of encapsulated cysts following Ahmed glaucoma valve insertion", J Glaucoma, 14, pp.276~279 (2005)
- Ayyala RS, "Anatomic and histopathologic findings following a failed ahmed glaucoma valve device", Ophthalmic Surg Lasers, 32, pp.248~249 (2001)
- Välimäki J, "Capsule excision after failed Molteno surgery", Ophthalmic Surg Lasers, 28, pp.382~386 (1997)
- Classen L, "Histopathologic and immunohistochemical analysis of the filtration bleb after unsuccessful glaucoma seton implantation", Am J Ophthalmol, 122, pp.205~212 (1996)
- Shah AA, "Shunt revision versus additional tube shunt implantation after failed tube shunt surgery in refractory glaucoma", Am J Ophthalmol, 129, pp.455~460 (2000)
- Schwartz KS, "Glaucoma drainage implants : a critical comparison of types", Curr Opin Ophthalmol, 17, pp.181~189 (2006)
- Feldman RM, "Needle revision of filtering blebs", J Glaucoma, 17, pp.594~600 (2008)
- Quaranta L, "Needle revision with 5-fluorouracil for the treatment of Ahmed glaucoma valve filtering blebs : 5-fluoruracil needling revision can be a useful and safe tool in the management of failing Ahmed glaucoma valve filtering blebs", J Glaucoma, 25, pp.e367~e371 (2016)
- Erdem B, "Needling with 5-fluorouracil for encapsulated blebs after Ahmed glaucoma valve implantation", Cutan Ocul Toxicol, 38, pp.395~400 (2019)
- Yadgari M, "The role of primary needle revision after Ahmed glaucoma valve(AGV)implantation", Int Ophthalmol, 41, pp.99~105 (2021)
- Buys YM, "Glaucoma surgery", pp.139~144 (2005), Taylor and Francis
- Wieland M, "Use of digital compression following glaucoma surgery", Ophthalmic Surg, 19, pp.350~352 (1988)
- Smith M, "Digital ocular massage for hypertensive phase after Ahmed valve surgery", J Glaucoma, 19, pp.11~14 (2010)
- Nouri-Mahdavi K, "Evaluation of the hypertensive phase after insertion of the Ahmed Glaucoma Valve", Am J Ophthalmol, 136, pp.1001~1008 (2003)
- Wu SC, "Clinical experience with the Ahmed glaucoma valve implant in complicated glaucoma", Chang Gung Med J, 26, pp.904~910 (2003)
- Nam KY, "Effects of digital ocular massage in patients in a hypertensive phase after Ahmed glaucoma valve implantation", J Korean Ophthalmol Soc, 52, pp.315~324 (2011)
- McIlraith I, "Ocular massage for intraocular pressure control after Ahmed valve insertion", Can J Ophthalmol, 43, pp.48~52 (2008)