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개방각녹내장 환자에서 수정체유화술 시 안압하강에 영향을 미치는 인자 분석

The Effect of Intraoperative Factors on Intraocular Pressure Reduction after Phacoemulsification in Open-angle Glaucoma

조경진|문정일|박율리
대한안과학회 (The Korean Ophthalmological Society)|2018.10|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제59권 제10호|pp. 930-937

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키워드

Intraocular pressureCataractPhacoemulsificationOpen-angle glaucoma
주제분류안과학

초록

목적: 원발개방각녹내장 환자에서 수정체 초음파유화술 시 안압하강에 영향을 미치는 인자에 대해 알아보고자 하였다. 대상과 방법: 원발개방각녹내장 환자 중 초음파유화술 시행 후 3년 이상 경과한 145안을 대상으로 후향적 의무기록 분석을 시행하였다. 나이, 안압, 안축장, 전방 깊이, 수정체 위치, 굴절력, 초음파유화술 시간, 누적소비에너지, 평형염액 사용량 등을 술 후 6, 12, 24, 36개월째 비교 분석하였다. 단변량 및 다변량 회귀분석을 이용하여 위 인자들과 술 후 안압의 관계를 분석하였다. 결과: 술 후 6, 12, 24, 36개월에 각각 평균 -1.9 ± 2.9, -1.6 ± 2.8, -1.4 ± 3.1, 그리고 -1.2 ± 2.7 mmHg의 통계적으로 유의한 안압하강을 보였다(p<0.01). 단변량 회귀분석상 술 전 안압이 높을수록(p<0.001), 술 전 수정체가 앞쪽으로 위치하였을수록(p<0.001), 초음파유화술 시간이 길수록(p<0.05), 누적소비에너지가 클수록(p<0.05) 술 후 안압하강이 더 컸다. 다변량 회귀분석상 술 전 안압(p<0.01), 수정체 위치(p=0.04), 그리고 초음파유화술 시간(p=0.04)이 술 후 3년까지 안압하강과 연관이 있었다. 결론: 원발개방각녹내장 환자에서 높은 술 전 안압은 초음파유화술 후 더 큰 안압하강 효과를 보였고, 술 전 안압과 나이를 보정하였을 때 초음파유화술 시간과 앞쪽으로의 수정체 위치가 안압하강과 연관성을 보였다. 이는 개방각녹내장 환자에서 수정체 초음파유화술과 녹내장 수술의 동시 수술 여부의 결정에 있어 도움이 될 것으로 생각된다.

Abstract

Purpose: To identify independent predictors of long-term postoperative intraocular pressure (IOP) reduction after phacoemulsification in patients with primary open-angle glaucoma (POAG). Methods: This was a retrospective review of 145 eyes with open-angle glaucoma (OAG) who were followed up for more than 3 years after uncomplicated phacoemulsification cataract surgeries. Demographic, clinical, biometric, and intraoperative variables such as IOP, refractive errors, anterior chamber depth, axial length, relative lens position (RLP), and phacoemulsification parameters such as phaco time, cumulative dissipated energy (CDE), and balanced salt solution volume were evaluated at 6, 12, 24, and 36 months after surgery. Univariate and multivariate linear regression were used to analyze the relationship between these variables and the postoperative IOP. Results: There was a statistically significant average postoperative IOP reduction at 6, 12, 24, and 36 months of -1.9 ± 2.9, -1.6 ± 2.8, -1.4 ± 3.1, and -1.2 ± 2.7 mmHg, respectively (p < 0.01). Higher preoperative IOP (p < 0.001), a more relative anterior lens position (p < 0.001), shorter phaco time (p < 0.05), and higher CDE (p < 0.05) were significantly associated with a greater postoperative decrease in IOP using univariate analyses. Using multivariate analyses, preoperative IOP (p < 0.01), lens position (p = 0.04), and phaco time (p = 0.04) were associated with greater postoperative IOP reduction at 3 years. Conclusions: Higher preoperative IOP was associated with a greater IOP-lowering effect after phacoemulsification in OAG patients. Phaco time and anterior RLP were independently associated with IOP reduction after adjusting for age and preoperative IOP. These findings have important implications when considering combined cataract extraction and filtration surgery for POAG patients.

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