말기 녹내장 환자에서 백내장수술 후 임상 경과
Effect of Phacoemulsification Cataract Surgery on the Clinical Outcomes of Advanced Glaucoma Patients
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목적: 말기 녹내장 환자에서 백내장수술 후 임상 경과에 대해 알아보고자 하였다. 대상과 방법: 개방각 녹내장 환자에서 백내장수술을 시행받고 1년 이상 경과 관찰한 환자를 후향적 분석을 하였다. Advanced group 은 술 전 시야검사상 mean deviation (MD) 값 -12 dB 미만으로 정의하였고, mild to moderate군(MD≥-12 dB)을 대조군으로 설정하였다. 술 후 2년간의 안압 변화를 정량적으로 확인하였고, 술 후 시력, 시야 지표(MD, pattern standard deviation) 녹내장 안약 개수를함께 분석하였다. 결과: Advanced group 87명, mild to moderate group 109명이 분석에 포함되었다. 술 1주 후부터 24개월까지 두 군 모두 술 전대비 감소된 안압을 보였다(all p<0.05). 술 후 1일째 급격한 안압상승의 빈도는 두 군에서 비슷하였고, 술 후 2년 동안 두 군 간 평균안압은 유의한 차이를 보이지 않았다. 술 후 1년 시점에서 두 군 모두 술 전 대비 유의한 시력 상승을 보였으며, 시야검사 지표는각각 술 전 대비 차이를 보이지 않았다. 녹내장 안약 수도 감소하였으나, advanced군에서만 유의성을 보였다. 결론: 본 연구를 통하여 말기 녹내장군은 초기 및 중기 녹내장과 백내장수술 후 유사한 안압 및 시야 변화, 시력 향상 및 안압약 개수감소가 확인되었다. 이는 말기 녹내장에서의 백내장수술이 다른 녹내장군과 비슷한 임상 효과 및 경과를 보여줌을 시사한다.
Abstract
Purpose: To identify the clinical outcomes of cataract surgery in patients with advanced glaucoma. Methods: A retrospective chart review of open-angle glaucoma patients who underwent cataract surgery and were followed-up for 1 year was conducted. Advanced glaucoma was defined as a mean deviation (MD) < -12 dB on the preoperative visual field test. A group with mild-to-moderate glaucoma (MD ≥ -12 dB) served as the control group. Changes in intraocular pressure (IOP) at 1, 3, 6, and 12 months, and in the postoperative visual acuity (VA) as well as in the visual field indices (MD and the pattern standard deviation), and the number of antiglaucoma medications were compared. Results: Eighty-seven eyes (87 patients) of the advanced group and 109 eyes (109 patients) of the mild-to-moderate group were finally included. From 1 week to 24 months postoperatively, both groups evidenced IOP decreases compared to the preoperative values (both p < 0.05). The IOP spike prevalence was similar in the two groups (11% vs. 13%, p = 0.199). The mean IOP difference between the two groups was not significant at months 1, 3, 6, 12, or 24 postoperatively (all p > 0.05). Both groups evidenced VA improvements at 1 year postoperatively and the visual field (VF) indices did not differ from those before surgery. The numbers of antiglaucoma medications used decreased after surgery, but the decrease was significant only in the advanced glaucoma group (p = 0.030). Conclusions: The advanced and mild-to-moderate glaucoma groups evidenced similar IOP and VF changes after cataract surgery. The VA improved and the number of antiglaucoma medications decreased. Our findings suggest that cataract surgery for patients with advanced glaucoma may afford similar clinical outcomes compared to other less severe glaucoma groups.
참고문헌 (27)
- Weinreb RN, "The pathophysiology and treatment of glaucoma : a review", JAMA, 311, pp.1901~1911 (2014)
- Musch DC, "The collaborative initial glaucoma treatment study : study design, methods, and baseline characteristics of enrolled patients", Ophthalmology, 106, pp.653~662 (1999)
- Friedman DS, "Surgical strategies for coexisting glaucoma and cataract : an evidence-based update", Ophthalmology, 109, pp.1902~1913 (2002)
- Mansberger SL, "Reduction in intraocular pressure after cataract extraction", Ophthalmology, 119, pp.1826~1831 (2012)
- Samuelson TW, "Randomized evaluation of the trabecular mico-bypass stent with phacoemulsification in patients with glaucoma and cataract", Ophthalmology, 118, pp.459~467 (2011)
- Liu CJ, "Determinants of long-term intraocular pressure after phacoemulsification in primary angle-closure glaucoma", J Glaucoma, 20, pp.566~570 (2011)
- Lam DS, "Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure", Ophthalmology, 115, pp.1134~1140 (2008)
- Nonaka A, "Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure", Ophthalmology, 113, pp.437~441 (2006)
- Jacobi PC, "Primary phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma Historical image", Ophthalmology, 109, pp.1597~1603 (2002)
- Chen PP, "The effect of phacoemulsification on intraocular pressure in glaucoma patients : a report by the American Academy of Ophthalmology", Ophthalmology, 122, pp.1294~1307 (2015)
- Meyer MA, "The effect of phacoemulsification on aqueous outflow facility", Ophthalmology, 104, pp.1221~1227 (1997)
- Greve EL, "Surgical management of coexisting glaucoma and cataract", pp.51~57 (1987), Kugler publications
- 김예니, "정상안압녹내장 환자의 망막신경섬유층 두께와 시야검사의 상관관계", 대한안과학회지, 46(9), pp.1532~1539 (2005), 대한안과학회
- Bleckmann H, "Posterior chamber lenses and glaucoma", Klin Monatsbl Augenheilkd, 187, pp.173~177 (1985)
- Greve EL, "Surgical management of coexisting glaucoma and cataract", pp.59~64 (1987), Kugler publications
- Zamani M, "Early changes in intraocular pressure following phacoemulsification", J Ophthalmic Vis Res, 8, pp.25~31 (2013)
- Altmeyer M, "Cataract surgery in patients with end-stage glaucoma", Klin Monatsbl Augenheilkd, 223, pp.297~302 (2006)
- Hayashi K, "Influence of cataract surgery on automated perimetry in patients with glaucoma", Am J Ophthalmol, 132, pp.41~46 (2001)
- Lam BL, "Effect of cataract on automated perimetry", Ophthalmology, 98, pp.1066~1070 (1991)
- Smith SD, "Effect of cataract extraction on the results of automated perimetry in glaucoma", Arch Ophthalmol, 115, pp.1515~1519 (1997)
- Carrillo MM, "Effect of cataract extraction on the visual fields of patients with glaucoma", Arch Ophthalmol, 123, pp.929~932 (2005)
- Stewart WC, "Effect of cataract extraction on automated fields in chronic open-angle glaucoma", Arch Ophthalmol, 113, pp.875~879 (1995)
- Chen PP, "The effects of cataract extraction on the visual field of eyes with chronic open-angle glaucoma", Am J Ophthalmol, 125, pp.325~333 (1998)
- Handa J, "Extracapsular cataract extraction with posterior chamber lens implantation in patients with glaucoma", Arch Ophthalmol, 105, pp.765~769 (1987)
- Yasutani H, "Intraocular pressure rise after phacoemulsification surgery in glaucoma patients", J Cataract Refract Surg, 30, pp.1219~1224 (2004)
- Slabaugh MA, "Risk factors for acute postoperative intraocular pressure elevation after phacoemulsification in glaucoma patients", J Cataract Refract Surg, 40, pp.538~544 (2014)
- Selvan H, "Changes in intraocular pressure and angle status after phacoemulsification in primary angle closure hypertension", J Glaucoma, 28, pp.105~110 (2019)