야그레이저를 이용한 홍채낭종 절개술의 임상 효과
Clinical Efficacy of Iris Cystostomy Using a Yttrium Aluminum Garnet Laser
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목적: Neodymium-doped yttrium aluminium garnet (Nd:YAG) 레이저 단독으로 홍채낭종 절개술을 시행하였을 때의 치료 효과 및각막내피세포에 미치는 영향에 관해 알아보고자 한다. 대상과 방법: 세극등현미경 검사에서 홍채낭종으로 각막내피세포의 감소나 시축을 가려 시력 저하가 있던 3안을 대상으로 하였다. 초음파생체현미경 검사로 확진하였고, Nd:YAG 레이저 단독으로 홍채낭종 병변에 절개술을 시행하고, 첫 방문과 마지막 외래 내원시점에서 logMAR 시력, 안압과 각막내피층의 형태 변화를 관찰하였다. 결과: 평균 나이는 54.0 ± 5.3세이었고, 평균 경과 관찰 기간은 11.7 ± 2.1개월이었다. 치료 전 시력은 logMAR 0.23 ± 0.25, 치료후 시력은 logMAR 0.16 ± 0.15로 치료 후 시력이 호전되었으나, 통계적 유의성은 없었다(p=0.317). 평균 안압은 치료 전 14.7 ± 2.3 mmHg, 치료 후 13.7 ± 0.6 mmHg로 치료 전후에 통계적으로 유의한 차이는 없었다(p=0.276). 치료 전후의 각막내피세포 밀도, 육각형세포 비율, 세포면적 변이계수 변화량을 반대안과 비교하였을 때 역시 유의한 차이는 없었다(p=0.109, p>0.999, p=0.285). 시술후 심각한 합병증이나 홍채낭종이 재발한 경우는 없었다. 결론: Nd:YAG 레이저 단독 홍채낭중 절개술 후 각막내피세포의 밀도와 형태의 변화가 적어, 홍채낭종으로 각막내피세포의 감소가있거나, 시축을 침범하여 시력이 저하되는 경우의 효과적인 치료 방법으로 고려된다.
Abstract
Purpose: To report the clinical efficacy of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser iris cystotomy in iris cysts. Methods: We examined three eyes with primary iris cysts diagnosed by ultrasound biomicroscopy that had fewer cornea endothelial cells or reduced visual acuity due to an occluded visual axis. Nd:YAG laser cystotomy was done. The logarithm of the minimum angle of resolution (logMAR) visual acuity, intraocular pressure (IOP), and specular microscopy test at baseline and last follow-up were reviewed. Results: The average patient age was 54.0 ± 5.3 years; the mean follow-up was 11.7 ± 2.1 months. The baseline and final logMAR visual acuity were 0.23 ± 0.25 and 0.16 ± 0.15, respectively. Visual acuity improved, although not significantly (p = 0.317). The baseline and final IOP were 14.7 ± 2.3 and 13.7 ± 0.6 mmHg, respectively (p = 0.276). The corneal endothelial cell density (p = 0.109), hexagonality (p > 0.999), and coefficient of variation (p = 0.285) were not significantly different after treatment. There were no serious complications or recurrence. Conclusions: After Nd:YAG laser cystotomy, the cell density and morphology of corneal endothelial cells changed little. It can be considered an effective treatment when there is a decrease in corneal endothelial cells or occlusion of the visual axis.
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