섬유주절제술 후 안압하강이 빛간섭단층혈관촬영을 이용한 혈관밀도 변화에 미치는 영향
Effect of Reducing Intraocular Pressure on Vessel Density after Trabeculectomy Using Optical Coherence Tomography Angiography
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목적: 섬유주절제술 후 빛간섭단층혈관촬영을 이용한 시신경유두주위 및 황반부 혈관밀도 변화를 평가하고자 한다. 대상과 방법: 녹내장 환자 중 섬유주절제술을 시행한 20안을 대상으로 후향적 연구를 실시하였다. 수술 전후의 안압, 빛간섭단층촬영및 빛간섭단층혈관촬영으로 측정한 시신경유두주위 망막신경섬유층두께, 황반부 신경절-내망상층두께, 시신경유두주위 및 황반부 혈관밀도를 Wilcoxon 검정으로 분석하였으며, 혈관밀도 변화에 영향을 주는 인자를 회귀분석으로 확인하였다. 결과: 평균 안압은 술 전 31.0 ± 11.80 mmHg에서, 술 후 1개월 및 6개월에 각각 11.47 ± 4.52 mmHg (p<0.001), 11.52 ± 3.34 mmHg로 유의한 감소를 보였다(p<0.001). 술 전에 비해 술 후 6개월에 시신경유두주위 망막신경섬유층두께(p=0.002)는 유의미한 증가를 보였다. 수술 후 시신경유두주위 혈관밀도는 유의미하게 증가하였으며(p=0.007), 시신경유두주위 혈관밀도의 변화량은 안압감소량이 클수록(p<0.001), 술 전 시신경유두주위 혈관밀도가 낮을수록(p=0.003) 증가하였다. 시신경유두주위 망막신경섬유층두께는 수술 전후 안압하강이 클수록 더 많이 증가하는 양상을 보였다(p=0.011). 결론: 빛간섭단층혈관촬영을 이용한 시신경유두주위 혈관밀도 측정이 섬유주절제술 시행 후 안압하강에 의한 시신경 손상의 가역적 변화를 확인하는 데 유용할 것으로 사료된다.
Abstract
Purpose: To evaluate peripapillary and macular vessel density changes in glaucoma patients after lowering intraocular pressure (IOP) by trabeculectomy, using optical coherence tomography (OCT) angiography. Methods: A retrospective study was conducted on 20 glaucomatous eyes that underwent trabeculectomy. Preoperative and postoperative IOP, peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell-inner plexiform layer thickness, peripapillary and macular vessel density measured by OCT, and OCT angiography were analyzed by the Wilcoxon signed-rank test. A regression analysis was performed to identify the factors influencing the change in vessel density. Results: The mean IOP was 31.0 ± 11.80 mmHg prior to surgery, 11.47 ± 4.52 mmHg at 1 month (p < 0.001), and 11.52 ± 3.34 mmHg at 6 months (p < 0.001). Peripapillary RNFL thickness (p = 0.002) increased significantly 6 months postoperatively. Peripapillary vessel density increased significantly 6 months after surgery (p = 0.007) and the magnitude of the reversal of peripapillary vessel density was significantly associated with a greater reduction in IOP (p < 0.001), and the lower preoperative peripapillary vessel density value (p = 0.003) and change in peripapillary vessel density increased significantly. The improvement in peripapillary RNFL thickness was associated with a greater reduction in the IOP (p = 0.011). Conclusions: Measuring peripapillary vessel density using OCT angiography was useful to identify the reversible changes in optic nerve damage caused by reducing IOP after trabeculectomy.
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