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콜라겐 기질을 삽입한 섬유주절제술과 전통적인 섬유주절제술의 효과와 합병증의 비교

Comparison of Effects and Complications between Conventional Trabeculectomy and Trabeculectomy with a Collagen Matrix Insertion

김경남|김창식|김정열|이성복|박기섭
대한안과학회 (The Korean Ophthalmological Society)|2018.01|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제59권 제1호|pp. 50-59

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키워드

GlaucomaTrabeculectomyCollagen matrix
주제분류안과학

초록

목적: 콜라겐 기질(OlogenⓇ)을 삽입한 섬유주절제술과 콜라겐 기질을 삽입하지 않은 섬유주절제술의 수술결과를 비교하고자 하였다. 대상과 방법: 콜라겐 기질을 삽입한 실험군과 콜라겐 기질을 삽입하지 않은 대조군에서 수술 후 1주, 2주, 1개월, 2개월, 4개월, 6개월, 12개월째에 안압검사와 세극등현미경검사를 포함한 안과검사를 시행하였으며, 수술성공률과 합병증을 포함한 임상양상을 비교 분석하였다. 결과: 실험군 21안과 대조군 42안에서 수술 후 12개월째 수술성공률은 각각 76% (16안), 69% (29안)로 유의한 차이가 없었다(p=0.554). Needling 및 5-fluorouracil 결막하 주사나 레이저공막편 봉합사 절제가 필요했던 경우는 실험군에서 3안(14.3%), 대조군에서 18안(42.9%)으로 대조군에서 유의하게 높은 빈도를 보였다(p=0.023). 합병증은 전체 발생률에는 차이가 없었으나(실험군 23.8% vs. 대조군 19.0%, p=0.745) 서로 다른 양상을 보여, 실험군에서는 테논낭포가 3안(14.3%)으로 가장 많았지만 대조군에서는 무혈관성여과포가 3안(7.1%)으로 가장 많았다. 결론: 콜라겐 기질을 삽입한 섬유주절제술은 콜라겐 기질을 삽입하지 않은 섬유주절제술에 비해 대등한 수술성공률을 보였다. 하지만 술 후 요구되는 처치의 빈도는 유의하게 낮았으며, 발생하는 합병증도 다른 양상을 보여 수술방법의 선택과 경과관찰 시 이를 고려해야 할 것으로 보인다.

Abstract

Purpose: To compare the surgical outcomes between trabeculectomy with a collagen matrix (Ologen®) insertion and conventional trabeculectomy. Methods: An ophthalmic examination, including tonometry and a slit lamp examination, was performed 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, and 12 months postoperatively in glaucoma patients who underwent a trabeculectomy using Ologen® (experimental group) or a conventional trabeculectomy (control group). Clinical features including success rate and complications were compared between the two groups. Results: In 21 eyes of the experimental group and 42 eyes of the control group, the success rates were 76% and 69%, respectively (p = 0.554). Needling with subconjunctival 5-fluorouracil injection or laser suture lysis of the scleral flap was required in three eyes (14.3%) in the experimental group and 18 eyes (42.9%) in the control group (p = 0.023). The types of complications differed, although the total number of complications did not differ between the two groups (23.8% vs. 19.0%, respectively; p = 0.745). The most common complication in the experimental group was an encapsulated bleb, which occurred in three eyes (14.3%), whereas an avascular bleb occurred in three eyes (7.1%) in the control group. Conclusions: The success rate of trabeculectomy with Ologen® was comparable to that of conventional trabeculectomy. However, postoperative interventions were less commonly required after trabeculectomy with Ologen®, and the complications differed between the groups. When choosing the surgical method and examining the postoperative condition, these differences should be considered.

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