백내장 수술 여부에 따른 선택적 레이저 섬유주 성형술의 안압 하강 효과 비교
Effect of Prior Cataract Surgery on the Clinical Outcome of Selective Laser Trabeculoplasty
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목적: 원발 개방각 녹내장에서 백내장 수술력이 선택적 레이저 섬유주 성형술(selective laser trabeculoplasty, SLT)의 안압하강 효과에 미치는 영향을 알아보고자 하였다. 대상과 방법: 원발 개방각 녹내장으로 진단 후 360˚ SLT를 시행한 환자들 중 유수정체안 55안 및 위수정체안 24안을 대상으로 후향적조사를 진행하였다. SLT 시행 전 및 후 1주, 1, 3, 6, 9, 12, 18, 24개월에 각각 골드만 압평 안압계로 측정한 안압 및 안압 하강률, 치료 성공률을 비교하였다. 치료 성공은 술전에 비해 20% 이상 안압이 감소하였으며 추가적인 항녹내장 약물이나 레이저, 수술 등을받지 않은 상태인 것으로 정의하였다. 결과: 술 후 안압의 평균 하강률은 1주, 1, 3, 6, 12, 18, 24개월에 각각 유수정체안에서는 18.8%, 23.9%, 24.6%, 23.3%, 24.0%, 22.1%, 20.8%, 17.9%였으며, 위수정체안에서는 15.7%, 22.3%, 23.7%, 25.3%, 25.6%, 25.2%, 21.9%, 19.3%였다. 치료 성공률은 유수정체안에서 57.6 ± 11.9%, 위수정체안에서 61.3 ± 10.4%를 나타냈다. SLT 시행 후 모든 시점에서 안압의 변화 및 안압 하강률, 치료 성공률은두 군 간 유의한 차이를 보이지 않았다(p＞0.05). 결론: 원발 개방각 녹내장에서 360˚ SLT는 유수정체안 및 위수정체안 모두에서 유의한 차이 없이 효과적인 안압 하강 효과를 나타냈으며, 치료 효과의 평가는 술 후 1달 이후에 하는 것이 바람직할 것으로 사료된다.
Abstract
Purpose: To compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes in primary open-angle glaucoma. Methods: Charts of 55 phakic eyes and 24 pseudophakic eyes that underwent 360-degree SLT were retrospectively reviewed. Intraocular pressure (IOP) was measured before SLT and 1 week, 1, 3, 6, 9, 12, 18 and 24 months after SLT. Treatment success was defined as IOP reduction ≥ 20% without additional medications, laser or glaucoma surgery. Mean IOP change, mean percentage of IOP reduction and success rates of phakic and pseudophakic eyes were compared. Results: Mean percentage of IOP reduction after SLT at 1 week and 1, 3, 6, 9, 12, 18, and 24 months were 18.8%, 23.9%, 24.6%, 23.3%, 24.0%, 22.1%, 20.8%, and 17.9%, respectively, in the phakic group and 15.7%, 22.3%, 23.7%, 25.3%, 25.6%, 25.2%, 21.9%, and 19.3%, respectively, in the pseudophakic group. Success rates were 57.6 ± 11.9% in the phakic group and 61.3 ± 10.4% in the pseudophakic group. No statistically significant differences in IOP change, percentage of IOP reduction, and success rates were observed between the groups at each time point after SLT (p > 0.05). Conclusions: Application of 360-degree SLT appears an efficient treatment option for the management of phakic and pseudophakic open-angle glaucoma. Evaluating the success of SLT 1 month postoperatively may be premature.
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