신생혈관녹내장 환자에서 섬유주절제술 전 유리체강내베바시주맙 주입술의 효과
The Effect of Intravitreal Bevacizumab Injection before Trabeculectomy in Patients with Neovascular Glaucoma
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목적: 신생혈관녹내장 환자에서 섬유주절제술 전 시행한 유리체강내 베바시주맙 주입술의 효과와 수술 성공에 영향을 미치는 인자에대해 알아보았다. 대상과 방법: 2003년부터 2013년까지 신생혈관녹내장으로 섬유주절제술을 시행한 환자는 총 58명(58안)이었다. 2003년부터 2006년까지는 마이토마이신 C를 이용한 섬유주절제술만 시행하였고 2007년부터 2013년까지는 위의 술식에 술 전 유리체강내 베바시주맙을추가하였다. 의무기록을 후향적으로 조사하여 술 전 유리체강내 베바시주맙 주입술의 효과를 알기 위하여 시행한 군과 하지 않은군으로 나누어 섬유주절제술 전부터 수술 후 12개월까지의 최대교정시력과 안압을 조사하여 비교하였다. 섬유주절제술 후 수술 성공률과 관련된 인자들을 알기 위해 연령, 수정체 상태, 유리체강내 베바시주맙 주입술 여부 및 섬유주절제술과의 기간, 이전 유리체절제술 여부와 술 후 발생한 합병증으로 구분하였다. 결과: 마이토마이신 C를 이용한 섬유주절제술만 시행한 안은 26안이며 술 전 유리체강내 베바시주맙 주입술을 시행한 안은 32안이었다. 수술 후 성공률은 6개월에서 유리체강내 베바시주맙 주입술을 시행한 경우 81.3%로 섬유주절제술만 시행한 경우인 57.7%보다높았으며(p=0.012) 1년의 경과관찰에서도 각각 78.1%와 50.0%로 관찰되었다(p=0.021). 또한 유리체강내 베바시주맙 주입술을 시행한경우에서 유의한 안압 하강을 관찰할 수 있었으며(p=0.048) 1년 후 안압 유지를 위해 사용해야 하는 점안 안압하강제의 개수가 0.4개로 섬유주절제술만 시행한 경우인 0.8개에 비해 유의하게 적었다(p=0.040). 수술 실패의 위험인자로 단변량 연구에서는 술 후 전방출혈(hazard ratio [HR]=2.872, p=0.044)과 술 전 유리체강내 베바시주맙 주입술(HR=0.280, p=0.030)이었지만 다변량 회귀분석에서는 유일하게 술 전 유리체강내 베바시주맙 주입술만이 유의한 인자였다(p=0.046). 결론: 신생혈관녹내장 환자에서 섬유주절제술 전 유리체강내 베바시주맙주입술은 수술 성공을 높이는 인자이며 술 후 1년에서 섬유주절제술만 시행한 경우에 비해 유의한 안압 하강과 수술 후 사용해야 하는 점안 안압하강제의 개수가 적음을 보여주었다.
Abstract
Purpose: To evaluate the efficacy of preoperative intravitreal bevacizumab injection (IVBI) and prognostic factors of surgical success in neovascular glaucoma patients, who underwent trabeculectomy. Methods: A total of 58 patients (58 eyes) diagnosed with neovascular glaucoma who underwent trabeculectomy between 2003 and 2013 were enrolled in this retrospective study. Trabeculectomy with mitomycin C was performed between 2003 and 2006 and additional preoperative IVBI with the above mentioned technique was performed between 2007 and 2013. To evaluate the efficacy of preoperative IVBI, the patients were divided into the preoperative IVBI group and control group. Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured from preoperative to postoperative 12 months. To evaluate the prognostic factors related to surgical success, the following was investigated: age, lens status, preoperative IVBI, time interval between preoperative IVBI and trabeculectomy, previous vitrectomy and, postoperative complications. Results: Trabeculectomy with mitomycin C only was performed in 26 eyes and additional preoperative IVBI was performed in 32 eyes. Surgical success was 81.3% in the IVBI group and 57.7% in the control group at postoperative 6 months (p = 0.012), and 78.1% in the IVBI group and 50.0% in the control group at postoperative 12 months (p = 0.021). Statistically significant IOP reduction effect was observed in the IVBI group (p = 0.048), and reduced anti-glaucoma eye drop usage was observed in the IVBI group (0.4) compared with 0.8 in the control group (p = 0.040). Postoperative hyphema (hazard ratio [HR] = 2.872, p = 0.044) and preoperative IVBI (HR = 0.280, p = 0.030) were considered risk factors for surgical failure in univariate analysis, however, only preoperative IVBI was statistically significant in multivariate analysis (p = 0.046). Conclusions: In neovascular glaucoma patients, preoperative IVBI before trabeculectomy is a good prognostic factor of surgical success and shows benefit in lowering the IOP and reducing anti-glaucoma eye drop usage at postoperative 1 year.
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