선택적 레이저 섬유주성형술의 녹내장수술로의 진행 예방에 대한 성공인자 분석
Factors Predicting Successful Selective Laser Trabeculoplasty to Prevent Glaucoma Progression to Surgery
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목적: 약물 치료로는 안압이 조절되지 않는 녹내장 환자에서 선택적 레이저 섬유주성형술(selective laser trabeculoplasty, SLT)을통해 녹내장수술로의 진행을 예방할 수 있는 성공인자를 분석하고자 하였다. 대상과 방법: 2018년부터 2020년까지 SLT를 시행받고 추적 관찰을 시행한 92명의 102안을 대상으로 의무기록을 후향적으로 분석하였다. 1년 이상 안압이 21 mmHg 이하로 조절되어 녹내장수술을 시행하지 않고 경과 관찰 중인 환자를 SLT 성공군, 1년 이내에 녹내장수술을 시행한 경우를 SLT 실패군으로 정의하였다. Kaplan-Meier 생존 분석 및 Cox proportional hazard model을 이용하여 성공률을 산출하고 성공예측인자를 분석하였다. 결과: 시술 전 안압이 낮을수록, 교정시력이 좋을수록, 시야결손이 적을수록 SLT 시술의 성공률이 더 높았다. 반대안이 녹내장수술을받은 경우나 SLT 시술이 실패한 경우 SLT 시술의 성공률은 더 낮았다. 특히 시술 전 측정한 안압이 1 mmHg 증가할수록, 반대안SLT 시술이 실패하였을 경우 SLT 시술이 실패할 확률이 각 1.376배, 19.577배 증가하였으며, 시야결손의 mean deviation값이 1 dB 증가할수록 SLT 시술이 실패할 확률이 0.928배 감소하였다(p<0.05). 결론: 약물 치료로 안압이 조절되지 않는 환자 중 안압이 25 mmHg 이하이고 시력저하나 시야결손이 비교적 덜 진행된 초기 녹내장일때 SLT 시술을 시행하는 것이 녹내장수술로의 진행을 예방하는 데 유리하다.
Abstract
Purpose: To investigate the factors predicting successful selective laser trabeculoplasty (SLT) to prevent glaucoma progression to surgery in patients whose intraocular pressure (IOP) is not controlled with medications. Methods: This retrospective chart review included 102 eyes of 92 glaucoma patients who underwent SLT between 2018 and 2020. Success was defined as the prevention of glaucoma surgery for at least 1 year with an IOP less than 21 mmHg or no progression of retinal nerve fiber layer thinning. Kaplan-Meier survival analysis and the Cox proportional hazard model were used for the analysis. Results: A low pretreatment IOP, good visual acuity, and a smaller visual field defect were significantly correlated with success. When the other eye underwent glaucoma surgery or its SLT treatment failed, the success rate of SLT was lower. As the pretreatment IOP increased by 1 mmHg, the SLT failure rate increased by 1,376 times and when the SLT for the other eye failed, it increased by 19,577 times. When the mean deviation of the visual field increased by 1 decibel (dB), the SLT failure rate decreased by 0.928 times (p < 0.05). Conclusions: SLT is more effective in early glaucoma patients with an IOP lower than 25 mmHg, smaller visual field defect, and good visual acuity to prevent glaucoma progression to surgery.
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