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공막경유 다이오드레이저 섬모체광응고술이 시력에 미치는 영향

Change in Visual Acuity Following Trans-Scleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma

김경남|김창식|이한민
대한안과학회 (The Korean Ophthalmological Society)|2015.11|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제56권 제11호|pp. 1759-1766

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키워드

ComplicationVisual acuityRefractory glaucomaTransscleral diode laser cyclophotocoagulation
주제분류안과학

초록

목적: 난치성 녹내장 환자에 시행한 공막경유 다이오드레이저 섬모체광응고술이 시력에 미치는 영향을 알아보고자 하였다. 대상과 방법: 공막경유 다이오드레이저 섬모체광응고술을 시행하고 6개월 이상 추적관찰이 가능했던 148명 148안의 의무기록을 후향적으로 분석하였으며, 시술 전 시력이 ‘광각 있음’ 이상인 49명(1군)과 ‘광각 없음’이었던 99명(2군)으로 분류하여 섬모체광응고술 후시력 변화를 포함한 임상결과를 분석하였다. 결과: 평균 추적관찰 기간은 1군은 19.1 ± 13.5개월, 2군은 16.7 ± 12.7개월이었다. 1군과 2군에서 안압(p＜0.001), 안압하강제의수(p＜0.001)는 유의하게 감소하였다. 전체 환자에서 시술 전 최대교정시력은 2.4 ± 0.9 logMAR에서 시술 후 2.5 ± 0.8 logMAR로유의한 변화는 없었지만(p=0.612), 1군에서는 1.4 ± 1.0 logMAR에서 1.9 ± 1.1 logMAR로 통계적으로 유의하게 감소하였다(p＜0.001). 1군의 31안(63.3%)에서는 시술 후 0.2 logMAR 이상의 시력저하가 관찰되었고, 이들 중 15안(30.6%)에서는 광각소실이 발생하였다. 전체 환자에서 합병증으로는 각막부종이 5안(3.4%)에서 관찰되었고, 안구로, 만성 저안압이 각각 3안(2.0%), 포도막염이 2안(1.4%)에서 발생하였다. 결론: 난치성 녹내장 환자에서 공막경유 다이오드레이저 섬모체광응고술은 안압하강 목적으로 유용하게 사용될 수 있지만 시력이있는 환자에서는 유의한 시력저하를 유발할 수 있다는 점을 염두에 두어야 하겠다.

Abstract

Purpose: To evaluate the effects of trans-scleral diode laser cyclophotocoagulation (TSDLC) on best corrected visual acuity (BCVA) in patients with refractory glaucoma. Methods: The medical records of 148 eyes of 148 patients with refractory glaucoma who were followed-up for over 6 months after TSDLC were analyzed retrospectively. Among them, 49 eyes of 49 subjects who had BCVA greater than no light perception (NLP) before TSDLC were classified as Group 1 and the other 99 eyes of 99 patients who had NLP vision were classified as Group 2. The outcomes of TSDLC including change in BCVA following surgery were analyzed for all patients and 49 subjects. Results: The mean follow-up period in Group 1 was 19.1 ± 13.5 months and 16.7 ± 12.7 months in Group 2. The intraocular pressure (IOP) and the number of IOP lowering medications decreased in both groups (both p < 0.001). In all subjects, there was no significant difference between BCVA before surgery and at the last follow-up (2.4 ± 0.9 log MAR and 2.5 ± 0.8 log MAR, respectively, p = 0.612). However, in Group 1, BCVA was decreased from 1.4 ± 1.0 to 1.9 ± 1.1 log MAR after the TSDLC (p < 0.001). In those patients, visual loss ≥ 0.2 log MAR was found in 31 eyes (63.3%) and light perception was lost in 15 eyes (30.6%). After treatment, corneal edema developed in 5 eyes (3.4%), phthisis bulbi and chronic hypotony occurred in 3 eyes each (2%) and iridocydlitis occurred in 2 eyes (1.4%). Conclusions: TSDLC in patients with refractory glaucoma showed an efficient reduction in IOP and the number of IOP-lowering medications. However, there was a significant loss in BCVA in many patients and therefore, careful monitoring regarding potential visual loss is necessary when considering TSDLC in glaucoma patients with useful vision.

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