포도막염에 의한 녹내장과 원발개방각녹내장 환자에서 섬유주절제술의 성적 비교
Comparative Results of Trabeculectomy with Mitomycin C in Uveitic Glaucoma versus Primary Open-Angle Glaucoma
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목적: 포도막염녹내장에서 마이토마이신 C를 이용한 섬유주절제술의 장기 수술 성적을 원발개방각녹내장과 비교하여 조사하고 수술실패의 위험인자를 알아보고자 하였다. 대상과 방법: 영남대학교병원에서 2000년부터 2012년까지 마이토마이신 C를 이용한 섬유주절제술 시행 후 최소 1년 이상 경과관찰이가능하였던 포도막염녹내장 60안과 원발개방각녹내장 402안을 대상으로 안압, 안압하강제의 개수, 수술 후 합병증 등을 의무기록을통하여 후향적으로 조사하였다. 백내장수술을 포함하여 안과적 수술 기왕력이 있는 경우는 제외하였다. 수술 성공은 안압하강제의사용 여부와 관계없이 수술 후 안압이 15 mmHg (기준 A) 또는 18 mmHg 이하(기준 B)로 유지되는 경우로 정의하였다. 누적수술 성공률과 수술 실패의 위험인자는 Kaplan-Meier 생존분석과 Cox’s Regression Model을 이용하여 분석하였다. 결과: 포도막염녹내장군의 5년 수술 성공률은 원발개방각녹내장군에 비해 낮았지만(65.8% vs. 76.4%, 기준 B) 유의한 차이가 없었다. 하지만 생존분석에 의한 누적수술 성공률은 기준 A, B 모두에서 포도막염녹내장이 원발개방각녹내장보다 낮았다(p=0.049, 0.044). 섬유주절제술 후 저안압과 저안압황반병증의 발생은 포도막염녹내장에서 유의하게 높았다(p=0.044, 0.044). 수술 후 얕은 전방은포도막염녹내장군에서 기준 A와 B 모두에서 수술 실패의 의미 있는 위험인자로 나타났다. 결론: 포도막염녹내장에서 마이토마이신 C를 이용한 섬유주절제술의 누적수술 성공률은 원발개방각녹내장과 근소한 차이를 보여 마이토마이신 C를 이용한 섬유주절제술은 포도막염녹내장의 안압 조절을 위한 일차적 수술적 치료로 선택해 볼 수 있겠다.
Abstract
Purpose: In this study we evaluated the long-term outcomes and prognostic factors of trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG) compared with primary open-angle glaucoma (POAG). Methods: We performed a retrospective chart review of 60 eyes with UG and 402 eyes with POAG that were followed up for at least 1 year after trabeculectomy with MMC between June 2000 and December 2012. The review included intraocular pressure (IOP), number of anti-glaucoma medications, and postoperative complications. Surgical success was analyzed using the Kaplan-Meier life-table method based on 2 definitions of successful IOP control with topical anti-glaucoma medications: Definition A (IOP ≤ 15 mm Hg) and Definition B (IOP ≤ 18 mm Hg). Risk factors for surgical failure of trabeculectomy were analyzed using the Cox proportional hazards model. Results: Success rate at 5 years after trabeculectomy was lower in UG than in POAG (65.8% vs. 76.4%, Definition B), but without significant difference. However, UG had a significantly lower cumulative probability of success than POAG based on Kaplan-Meier survival curves (p = 0.049 and 0.044, respectively). Postoperative hypotony and hypotony maculopathy was more frequent in UG (p = 0.044 and 0.044, respectively). In UG, the Cox proportional hazards model showed postoperative shallow anterior chamber was associated with surgical failure in both Definition A and B. Conclusions: Long-term results of trabeculectomy with MMC in eyes with UG showed successful IOP control similar to POAG. Trabeculectomy with MMC is a reasonable surgical option for the management of UG.
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