원발급성폐쇄각발작 환자 반대편안의 예방적레이저홍채절개술과 수정체적출술 후 장기적 안압 변화
Long-Term Intraocular Pressure Outcome in Fellow Eyes with Angle-Closure Glaucoma after Laser Iridotomy and Phacoemulsification
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목적: 원발급성폐쇄각발작 환자의 반대편안에서 예방적레이저홍채절개술만 시행한 환자군과 예방적레이저홍채절개술에 이은 수정체적출술을 시행한 환자군에 대해 장기간의 안압 변화를 알아보고자 한다. 대상과 방법: 원발급성폐쇄각발작으로 내원하여 반대편안에 예방적레이저홍채절개술만을 시행한 환자군(A군) 35명과 예방적레이저홍채절개술에 이은 1달 이내 수정체 적출술을 시행한 환자군(B군) 27명, 총 62명을 대상으로 조사하였다. 내원한 초진 시, 예방적레이저홍채절개술 시술 후 1시간, 1일, 1주일, 3개월, 6개월, 12개월에서 A, B군에 대해 발작 반대편안에 대한 안압 변화, 시력, 레이저홍채절개술과 수정체 적출 및 인공수정체 삽입술 후 합병증 등을 조사하였다. 결과: A군의 경우 반대편안에 레이저홍채절개술 시행 후 1개월부터는 레이저홍채절개술 시행 이전으로 안압이 상승되었으나(내원 시 15.9 ± 5.0 mmHg, 12개월 15.9 ± 2.6 mmHg) B군의 경우 레이저홍채절개술 및 수정체 적출술 후 안압의 상승 없이(내원 시 17.0 ± 3.3 mmHg, 12개월 13.3 ± 2.8 mmHg) 장기간 유지되는 결과를 보였다. 반대편안에 안압의 상승으로 약물치료가 추가로 필요했던환자는 1년간 장기 관찰 중 A군 13명(37.14%), B군 4명(14.8%)으로 B군에서 유의하게 적었다(p=0.032). 반대편안의 평균 최대교정시력은 내원 시 A군 0.78 ± 0.21, B군 0.71 ± 0.22 최종 관찰 시 A군에서 0.73 ± 0.31, B군에서 0.93 ± 0.27로 B군에서 시력개선 효과가 의미 있게 높았다(p=0.003). 결론: 원발급성폐쇄각발작 시 반대편안에 대해서 레이저홍채절개술에 이은 조기 수정체 적출 시행 후 1년간의 관찰 결과 모두 성공적으로 안압 조절이 가능하였으며 레이저홍채절개술만 시행한 군에 비해 안정적인 결과를 보였다. 본 연구를 통해 원발급성폐쇄각발작시 반대편안에 대해서 예방적레이저홍채절개술에 이은 조기에 수정체 적출 및 인공수정체 삽입술을 시행함으로써 장기적인 안압 하강과 시력 호전을 가져 올 수 있음을 확인할 수 있었다.
Abstract
Purpose: To evaluate long-term change in intraocular pressure (IOP) in the fellow eyes after laser iridotomy and early phacoemusification with laser iridotomy in patients with acute angle-closure glaucoma. Methods: We performed a retrospective, comparative chart review of 62 patients with acute angle-closure glaucoma; 35 patients (Group A) who underwent only prophylactic laser iridotomy on fellow eyes and 27 patients (Group B) who underwent prophylactic laser iridotomy and early phacoemusification on fellow eyes. Patients were followed up at 1 day, 1 week and 1, 3, 6 and 12 months. IOP change was analyzed after laser iridotomy 1 hour and at every follow-up. In addition, visual acuity and complications of laser iridotomy and phacoemusification were determined. Results: In Group A, the mean IOP increase in fellow eyes occurred within 1 month after laser iridotomy (initial, 15.9 ± 5.0 mm Hg; final, 15.9 ± 2.6 mm Hg), However, in Group B, the mean IOP of fellow eyes was maintained up to 12 months without an increase in IOP (initial, 17.0 ± 3.3 mm Hg; final, 13.3 ± 2.8 mm Hg) Among the fellow eyes, 13 patients in Group A (37.14%) and 4 patients in Group B (14.81%, p = 0.032) underwent further medical therapy. The initial visual acuity of fellow eyes in Group A was 0.78 ± 0.21 and 0.71 ± 0.22 in Group B, and at the final visit, 0.73 ± 0.31 in Group A and 0.93 ± 0.27 in Group B (p = 0.003). Conclusions: We found that most fellow eyes treated with laser iridotomy and phacoemulsification maintained satisfactory IOP and good vision. These results support that laser iridotomy and phacoemulsification in the fellow eye with acute angle-closure glaucoma is a reasonable prophylactic treatment.
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