경공막 섬모체광응고술 후 아메드밸브삽입술의 수술 결과
Surgical Outcomes of the Ahmed Valve Implantation Following Trans-scleral Cyclophotocoagulation
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목적: 섬모체광응고술을 시행한 환자에서 아메드밸브삽입술의 안압하강 효과 및 안정성을 확인하고자 한다. 대상과 방법: 본 연구는 후향적 관찰 연구이며, 섬모체광응고술 후 아메드밸브삽입술을 시행한 환자를 1군으로, 아메드밸브삽입술 후 섬모체광응고술을 시행한 환자를 2군으로, 섬모체광응고술을 재시행한 환자를 3군으로 연구에 포함시켰다. 수술 전과 수술 후 1주, 1개월, 3개월, 6개월, 12개월째의 안압, 녹내장 점안제의 개수, 최대교정시력 및 수술 후 합병증을 분석하였다. 결과: 1군에 8명, 2군에 10명, 3군에 7명이 포함되었다. 수술 전 안압은 세 군에서 각각 45.6 ± 15.5, 29.3 ± 5.6, 43.4 ± 14.4 mmHg였으며, 녹내장 점안제의 개수는 세 군에서 각각 3.8 ± 0.7, 3.9 ± 0.3, 3.7 ± 1.0개였다. 수술 후 12개월째 세 군 모두에서 수술 전에 비해 안압이 유의하게 감소하였으며(p<0.05), 녹내장 점안제의 개수도 유의하게 감소하였다(p<0.05). 수술 전 시력이 0.02 decimal 이상이었던 2군의 8명 중 2명과 3군의 4명 중 1명에서 수술 후 시력이 저하되었다(p=0.380). 1군의 1명과 3군의 2명에서 저안압이 발생하였고(p=0.383), 이들 중 1군의 1명과 3군의 1명이 안구로로 진행하였다(p=0.940). 결론: 섬모체광응고술 후에도 안압이 조절되지 않는 환자에서 아메드밸브삽입술은 비교적 안전하면서도 효과적으로 안압을 떨어뜨릴 수 있는 치료 방법으로 사용될 수 있을 것으로 기대된다.
Abstract
Purpose: To determine the intraocular pressure (IOP) lowering effect and complications of Ahmed valve implantation (AGV) in patients who underwent cyclophotocoagulation (CPC). Methods: Patients who underwent AGV after CPC in group 1, those who underwent CPC after AGV in group 2, and patients who underwent repeated CPC in group 3 were included in this retrospective observational study. Changes in IOP, number of glaucoma eye drops, and best corrected visual acuity (BCVA) were analyzed before and 1 week, 1 month, 3 months, 6 months, and 12 months after surgery, and postoperative complications were analyzed. Results: Eight patients in group 1, 10 patients in group 2, and seven patients in group 3 were included in the analysis. Preoperative IOP was 45.6 ± 15.5, 29.3 ± 5.6, and 43.4 ± 14.4 mmHg in the three groups, respectively, and the number of glaucoma eye drops was 3.8 ± 0.7, 3.9 ± 0.3, and 3.7 ± 1.0 in the three groups, respectively. At 12 months postoperatively, IOP decreased significantly in all three groups compared to preoperatively (all p < 0.05), and the number of glaucoma eye drops was also significantly reduced (all p < 0.05). Among patients with preoperative BCVA of 0.02 decimal or higher, postoperative BCVA decreased in two patients in group 2 and one in group 3 (p = 0.380). Hypotony occurred in one patient in group 1 and two patients in group 3 (p = 0.383), and among them, one patient in group 1 and one patient in group 3 progressed to the phthisis (p = 0.940). Conclusions: In patients whose IOP cannot be controlled after CPC, AGV is expected to be used as a relatively safe and effective treatment method for lowering IOP.
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