거짓비늘녹내장에서 수정체안과 인공수정체안에 대한 섬유주절제술의 장기 성적 비교
The Long-term Outcomes of Mitomycin C Trabeculectomy of Phakic versus Pseudophakic Eyes of Patients with Exfoliative Glaucoma
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목적: 거짓비늘녹내장에서 이전에 시행된 백내장수술이 섬유주절제술의 예후에 미치는 영향을 알아보고자 하였다. 대상과 방법: 거짓비늘녹내장에서 섬유주절제술을 시행 받은 수정체안 51안과 인공수정체안 40안에 대한 수술 성적을 후향적으로조사하였다. 수술 성공은 안압하강률 ≥ 20%이면서 수술 후 안압 < 18 mmHg인 경우로 정의하였고, 안압하강제 사용 없이 달성한경우를 완전 성공이라 하였다. Kaplan-Meier 생존분석으로 누적 성공률을 비교하였다. 수술 실패의 위험 요인을 Cox 비례위험모형을이용하여 분석하였다. 결과: 전체 평균 관찰 기간은 44.7 ± 28.0개월이었다. 마지막 경과 관찰 시 최종 안압은 수정체안에서 4.5 mmHg, 인공수정체안에서11.1 mmHg 감소하였다(p=0.005). 완전 성공률은 수정체안보다 인공수정체안에서 더 높았으나(1년: 78.4 vs. 85.0%; 5년: 15.0 vs. 31.5%) 통계적 유의성은 없었다(p=0.068). 섬유주절제술 실패의 위험 요인은 수술 후 초기 저안압(hazard ratio=2.81, p=0.016)과수술 시 수정체안 상태였다(hazard ratio=1.97, p=0.040). 결론: 거짓비늘녹내장에서 섬유주절제술 후 장기 누적 성공률은 수정체안과 인공수정체안 사이에 유의한 차이는 없었으나, 수정체안상태는 수술 실패의 위험 요인이었다. 따라서 본 연구는 백내장이 동반된 거짓비늘녹내장 환자에서 섬유주절제술이 필요한 경우 백내장수술을 먼저 시행하고 섬유주절제술을 나중에 시행하는 것이 더 나은 선택이 될 수 있음을 보여준다.
Abstract
Purpose: To determine whether previous cataract surgery affected the surgical prognosis of primary trabeculectomy with mitomycin- C (MMC) to treat exfoliative glaucoma (XFG). Methods: This retrospective, consecutive study included 51 phakic eyes and 40 pseudophakic eyes of XFG patients that had previously undergone phacoemulsification via a temporal, clear corneal incision. All patients underwent primary trabeculectomy with MMC. Complete success was defined by an intraocular pressure (IOP) <18 mmHg and an IOP reduction ≥ 20% without any glaucoma medication. The cumulative probabilities of success were compared using Kaplan-Meier survival analysis, and risk factors for surgical failure were analyzed using the Cox’s proportional hazards model. Results: The mean follow-up period was 44.7 ± 28.0 months. The IOP had decreased by 4.5 mmHg in phakic eyes and 11.1 mmHg in pseudophakic eyes at the last visits after surgery (p = 0.005). The cumulative complete success rates were 78.4% at 1 year and 15.0% at 5 years for phakic eyes, and 85.0% and 31.5% for pseudophakic eyes. The complete success rates thus tended to be lower for phakic than pseudophakic eyes (p = 0.068). The risk factors associated with surgical failure were early postoperative hypotony (hazard ratio = 2.81, p = 0.016, complete success) and phakic status (hazard ratio = 1.97, p = 0.040, complete success). Conclusions: The long-term outcomes of XFG patients whose pseudophakic eyes had undergone phacoemulsification prior to primary trabeculectomy with MMC were comparable to or better than those of patients with phakic eyes. Therefore, performing phacoemulsification first, followed by trabeculectomy, may be the better option if trabeculectomy is required by XFG patients with cataracts.
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