유리체가 전방을 채운 난치성 녹내장 환자에서 유리체절제술 후 시행한 섬유주절제술의 임상경과
Trabeculectomy Following Vitrectomy in Refractory Glaucoma with Vitreous Filling of the Anterior Chamber: a Case Series
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목적: 유리체가 전방을 채우고 있는 난치성 녹내장 환자에서 25게이지 무봉합 경결막 유리체절제술 후 시행한 섬유주절제술의 1년 임상경과를 알아보고자 하였다. 대상과 방법: 전방 내 유리체가 존재하고 최대약물치료에도 안압이 조절되지 않는 위수정체와 무수정체 녹내장 환자들을 대상으로 유리체절제술을 시행하고 순차적으로 마이토마이신C를 이용한 섬유주절제술을 시행하였다. 섬유주절제술 후 최소 12개월 이상 경과 관찰한 환자들의 의무기록을 후향적으로 분석하였다. 완전 수술 성공은 안압하강제 사용 없이 안압이 18 mmHg 이하이고, 수술 전에 비해 20% 이상 하강한 경우이며, 제한적 수술 성공은 안압하강제 사용과 관계없이 안압이 18 mmHg 이하이고 수술 전에 비해 20% 이상 하강한 경우로 정의하였다. 결과: 총 7명 8안(위수정체군 4명 4안, 무수정체 3명 4안)이 본 연구에 포함되었다. 섬유주절제술 후 12개월에 제한적 수술 성공률은 87.5%, 완전 수술 성공률은 62.5%였다. 섬유주절제술 전 평균 안압은 28.1 ± 3.5 mmHg에서 수술 후 마지막 방문 시 15.0 ± 3.7 mmHg로 유의하게 감소하였다(p=0.012). 섬유주절제술 전 사용한 평균 안압하강제 수는 4 ± 0개에서 수술 후 마지막 방문 시 1.5 ± 2.1개로 유의하게 감소하였다(p=0.010). 모든 증례에서 망막박리, 유리체출혈, 낭성황반부종, 유리체 감돈은 발생하지 않았다. 결론: 유리체가 전방을 채우고 있는 난치성 녹내장 환자에서 경결막 무봉합 유리체절제술 후 시행한 섬유주절제술은 효과적이고 안압감소 방법임을 알 수 있었다.
Abstract
Purpose: To evaluate the 1-year clinical outcome of subsequent trabeculectomy following 25-gauge transconjunctival sutureless vitrectomy in refractory glaucoma with vitreous filling of the anterior chamber. Methods: This study was a retrospective and consecutive case series study. We reviewed the medical records of pseudophakic and aphakic glaucoma patients with vitreous filling of the anterior chamber who underwent subsequent trabeculectomy with mitomycin C (MMC), following 25-gauge transconjunctival sutureless vitrectomy. All patients had been followed up for more than 12 months. Complete surgical success was defined as an intraocular pressure (IOP) ≤18 mmHg and IOP reduction ≥20% without glaucoma medication. Qualified surgical success was defined as IOP ≤18 mmHg and an IOP reduction ≥20% with or without glaucoma medication. Results: Eight eyes of seven patients (four eyes of four patients with pseudophakic glaucoma and four eyes of three patients with aphakic glaucoma) were included in this study. The cumulative probability of qualified success was 87.5%, and the cumulative probability of complete success was 62.5% at 12 months after trabeculectomy. The mean IOP decreased from 28.1 ± 3.5 mmHg preoperatively to 15.0 ± 3.7 mmHg at the final visit (p = 0.012). The mean number of glaucoma medications decreased from 4 ± 0 to 1.5 ± 2.1 at the final visit (p = 0.010). Complications including retinal detachment, vitreous hemorrhage, cystoid macular edema, and vitreous incarceration into the fistula were not observed. Conclusions: Transconjunctival sutureless vitrectomy and subsequent trabeculectomy with MMC is an effective method for controlling IOP in pseudophakic and aphakic glaucoma with vitreous filling of the anterior chamber.
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