Ahmed 밸브 삽입술 후 발생한 관미란의 수술적 치료
Surgical Treatment for Tube Erosion after Ahmed Valve Implantation
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목적: Ahmed 밸브 삽입술 후 관미란이 발생하여 수술이 필요하였던 증례들을 보고하고자 한다. 대상과 방법: Ahmed 밸브 삽입술을 받은 121명 125안을 대상으로 후향적 추적관찰 연구를 진행하여 이 중 관미란이 발생한 7안의 수술 후 경과를 관찰하였다. 관미란은 Ahmed 밸브 삽입술 후 평균 60.5 ± 67.5개월(2-196개월)에 발생하였다. 관미란의 재발을 막기 위해 4안에서 관을 재위치시켰으며 노출된 관을 덮기 위해 모든 경우에 동종공막이식을 하였고 부분공막편, collagen matrix implant, bovine pericardium 등을 필요에 따라 사용하였다. 관미란 부위 주변 결막의 결손부위가 크거나 유착이 심한 경우에는 회전결막편, 자가결막이식, 양막이식을 사용하여 안구표면을 덮어주었다. 결과: 관미란이 발생했던 7안 중 1회의 수술로 성공적으로 회복된 경우가 3안(42.9%), 2회 수술이 필요했던 경우가 3안이었고 1안에서는 4회 수술로 재건에 성공하였다. 치료실패로 Ahmed 밸브를 제거한 경우는 없었다. 관의 위치를 조정한 4안 중 1안에서, 부분공막편을 사용한 5안 중 3안에서 관미란이 재발하였으며 짧은 간격으로 반복적인 관미란이 발생한 1안은 collagen matrix implant와 양막이식을 시행하여 재발 없이 치료되었다. 결론: Ahmed 밸브 삽입술 후 관미란이 발생한 경우 관의 위치를 조정하거나 동종공막이식을 동반한 부분공막편, pericardial graft, collagen matrix implant, 양막이식술 등의 다양한 방법으로 치료할 수 있었다.
Abstract
Purpose: To report serial cases of patients who received surgical treatment for tube erosion after Ahmed valve implantation. Methods: In this retrospective and longitudinal study, surgical outcomes of reconstruction for tube erosion after Ahmed valve implantation were evaluated. Tube erosion occurred in 7 of 125 eyes (121 patients) at 60.5 ± 67.5 months (2 to 196 months). To prevent recurrence of tube erosion, the tube was repositioned backward in 4 eyes. Scleral allograft was used in all cases. Partial thickness scleral flap, collagen matrix implant, or bovine pericardium was used to cover the exposed tube in selected cases. In eyes with large conjunctival defects or severe adhesions between surrounding conjunctiva and episclera, rotational conjunctival flap, conjunctival autograft, or amniotic membrane graft was used to reconstruct the ocular surface. Results: Three of 7 eyes (42.9%) with tube erosion were successfully repaired by the first surgical treatment. No recurrence of tube erosion was found after the second and the fourth surgical procedure in 3 and 1 eyes, respectively. There was no case of explantation of the Ahmed valve in our series. Tube erosion recurred in 1 of the 4 eyes in which tube-repositioning was required and in 3 of the 5 eyes in which a partial thickness scleral flap was made to cover a tube. One eye experienced recurrent tube erosion in a relatively short-term interval and was repaired successfully using both collagen matrix implantation and amniotic membrane transplantation. Conclusions: Tube erosion after Ahmed valve implantation was successfully treated by various methods including tube repositioning, partial thickness scleral flap combined with scleral allograft, biodegradable collagen implant, pericardial graft, and/or amniotic membrane transplantation.
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