한국인 개방각녹내장 환자에서 결막절개에 따른 XEN® 스텐트삽입술의 단기 효과와 안정성
Short-term Efficacy and Safety of XEN Stent Implantation with or without a Conjunctival Incision
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목적: 결막절개 여부에 따른 젠 스텐트삽입술의 단기 안압하강 효과 및 안전성을 알아보고자 하였다. 대상과 방법: 2021년 1월부터 5월까지 외부경유(ab externo) 젠 스텐트 단독 삽입술을 시행받은 개방각녹내장 환자들을 결막절개 유무에 따라 절개군, 비절개군으로 분류하고 6개월 이상 경과 관찰을 시행한 의무기록을 후향적으로 분석하였다. 술 후 6개월째 안압이술 전 안압과 비교하여 감소한 경우를 기준으로 녹내장 약물의 사용 없이 안압이 하강한 경우는 완전 성공으로, 약물을 사용하여목표 안압을 달성한 경우를 포함하여 부분 성공으로 정의하였다. 결과: 총 43안 중 비절개군 20안, 절개군 23안이었고, 수술 6개월 후 안압은 유의하게 감소하였다. 필요한 안압하강제 개수 또한 감소하였다. 수술 후 안압은 비절개군의 감소폭이 더 컸다. 6개월 후 부분 성공률은 비절개군 55%, 절개군 52.2%였고 완전 성공률은 비절개군 40%, 절개군 8.7%로 비절개군이 유의하게 높았다. 연구 기간 동안 주사침을 이용한 여과포 복원술(bleb needling revision)을1회 이상 받은 환자는 58.1%였고 수술 실패로 재수술을 시행한 환자는 20.9%였으며 두 군 간의 차이는 없었다. 결론: XEN® 스텐트삽입술은 결막절개와 관계없이 6개월 관찰 시 심각한 합병증 없이 안압을 낮추고 안압하강제 사용을 줄이는데도움이 되나 술 후 안압 유지를 위하여 상당수에서 결막 시술을 필요로 한다.
Abstract
Purpose: Comparison of the 6-month outcomes of ab externo XEN 45 gel stent implantation with conjunctival resection in Korean glaucoma patients. Methods: From January to May 2021, 43 open-angle glaucoma patients who underwent ab externo XEN stent insertion alone and were followed for more than 6 months were classified into incision (n = 23) and non-incision (n = 20) groups according to the presence or absence of a conjunctival incision and analyzed retrospectively. Qualified or complete success was defined as achieving the personal target intraocular pressure (IOP) with or without medication, respectively. Results: The IOP measured 6 months after surgery decreased significantly in both groups. The number of IOP-lowering drugs required was also reduced. The decrease in IOP after surgery was greater in the non-incision group. Six months after surgery, the qualified success rate was 55% in the non-incision group and 52.2% in the incision group, while the complete success rate was 40% and 8.7%, respectively. During follow-up, 58.1% of the patients underwent bleb needling more than once, and 20.9% underwent additional IOP-lowering surgery, but there was no difference between the two groups. Conclusions: XEN stent insertion helped to reduce IOP and the number of IOP-lowering agents after 6 months regardless of a conjunctival incision. However, to maintain the target IOP, bleb manipulation was required in many cases.
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