폐쇄각녹내장에서 초음파유화술 및 유착해리술과 조직 플라스미노겐 활성체 전방내 주입 효과
Combined Phacoemulsification, Synechiolysis without Gonioprism Lens and Intracameral Tissue Plasminogen Activator Injection for Angle-Closure Glaucoma
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목적: 폐쇄각녹내장 안에 초음파유화술 시 전방각경을 사용하지 않고 시행한 주변홍채앞유착해리술과 전방 내 조직 플라스미노겐활성체(tissue plasminogen activator, tPA) 주입 후 안압 하강 결과 및 합병증을 알아보고자 하였다. 대상과 방법: 백내장이 동반되어 있는 폐쇄각녹내장 환자 20안에 대해 초음파유화술 및 전방각경 없이 주변홍채앞유착해리술을 360o 시행한 후, 염증완화를 위해 tPA를 전방 내 주입하였다. 수술 전후 안압 및 녹내장약 개수를 비교하였으며, 합병증 유무에 대해 조사하였다. 결과: 20안을 대상으로 조사한 결과, 평균 나이는 71.4 ± 5.4세였고, 수술 후 평균 경과관찰 기간은 31.3 ± 24.3개월이었다. 수술전 평균안압은 21.70 ± 9.50 mmHg였고, 수술 후 평균안압은 12.40 ± 2.30 mmHg로 평균 9.30 ± 8.99 mmHg의 안압 하강이 있었다(p＜0.0001). 수술 전 사용한 평균 녹내장약의 수는 2.40 ± 0.82개였으며, 수술 후 0.30 ± 0.57개로 통계적으로 유의하게 감소하였다(p＜0.0001). 20안 모두 수술 후 안압이 16 mmHg 이하로 조절되었으나 5안은 녹내장약을 다시 점안하였다. 20안 모두 수술중과 수술 후에 섬유소형성반응, 심한 전방출혈 같은 특별한 합병증은 없었다. 결론: 전방각경 없이 주변홍채앞유착해리술을 시행하고 전방 내 tPA를 주입하는 방법은 폐쇄각녹내장 환자의 백내장 수술 시 간편히시행할 수 있으며, 특별한 합병증 없이 좋은 안압 하강 결과를 나타냈다.
Abstract
Purpose: In this study we evaluated the safety and efficacy of combined phacoemulsification and synechiolysis without aid of gonioprism lens and intraoperative intracameral tissue plasminogen activator (tPA) injection for angle-closure glaucoma. Methods: The method used in this study was synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection following cataract surgery. Results: A total of 20 patients with a mean age of 71.4 ± 5.4 years were treated. Mean follow-up time was 31.3 ± 24.3 months. Mean preoperative and last visit intraocular pressures (IOPs) were 21.70 ± 9.50 mm Hg and 12.40 ± 2.30 mm Hg, respectively (p < 0.0001). The mean number of glaucoma medications decreased from 2.40 to 0.30 (p < 0.0001). IOP was maintained below 16 mm Hg in all cases. No significant intraoperative and postoperative complications, hyphema, or fibrin reaction occurred. Conclusions: Combined phacoemulsification and peripheral anterior synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection is an effective and safe surgical procedure.
참고문헌 (34)
- Ritch R., "The Glaucomas" (1996), Mosby
- Lowe RF., "Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma", Br J Ophthalmol, 54, pp.161~169 (1970)
- Lowe RF., "Anterior lens curvature. Comparisons between normal eyes and those with primary angle-closure glaucoma", Br J Ophthalmol, 56, pp.409~413 (1972)
- Campbell DG., "Modern goniosynechialysis for the treatment of synechial angle-closure glaucoma", Ophthalmology, 91, pp.1052~1060 (1984)
- Shingleton BJ., "Surgical goniosynechialysis for angle-closure glaucoma", Ophthalmology, 97, pp.551~556 (1990)
- Tanihara H., "Argon-laser gonioplasty following goniosynechialysis", Graefes Arch Clin Exp Ophthalmol, 229, pp.505~507 (1991)
- Tanihara H., "Surgical results and complications of goniosynechialysis", Graefes Arch Clin Exp Ophthalmol, 230, pp.309~313 (1992)
- Fang AW., "Endoscopically controlled goniosynechialysis in managing synechial angle-closure glaucoma", J Glaucoma, 19, pp.19~23 (2010)
- Fakhraie G., "Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure", Eur J Ophthalmol, 22, pp.714~718 (2012)
- Teekhasaenee C., "Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma", Ophthalmology, 106, pp.669~675 (1999)
- Imaizumi M., "Phacoemulsification and intraocular lens implantation for acute angle closure not treated or previously treated by laser iridotomy", J Cataract Refract Surg, 32, pp.85~90 (2006)
- Ming Zhi Z., "A pilot study of lens extraction in the management of acute primary angle-closure glaucoma", Am J Ophthalmol, 135, pp.534~536 (2003)
- Jacobi PC., "Primary phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma", Ophthalmology, 109, pp.1597~1603 (2002)
- Hayashi K., "Effect of cataract surgery on intraocular pressure control in glaucoma patients", J Cataract Refract Surg, 27, pp.1779~1786 (2001)
- Maeda M., "Goniosynechialysis using an ophthalmic endoscope and cataract surgery for primary angle-closure glaucoma", J Glaucoma, 23, pp.174~178 (2014)
- Lai JS., "The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma(PACG)and co-existing cataract : a prospective case series", J Glaucoma, 15, pp.47~52 (2006)
- White AJ., "Outcomes of combined lens extraction and goniosynechialysis in angle closure", Clin Experiment Ophthalmol, 41, pp.746~752 (2013)
- 윤여민, "원발개방각 및 원발폐쇄각녹내장에서 백내장 수술 후 안압 변화에 영향을 미치는 인자", 대한안과학회지, 47(1), pp.85~96 (2006), 대한안과학회
- Liu CJ., "Factors predicting intraocular pressure control after phacoemulsification in angle-closure glaucoma", Arch Ophthalmol, 124, pp.1390~1394 (2006)
- Wishart PK., "Extracapsular cataract extraction and posterior chamber lens implantation in patients with primary chronic angle-closure glaucoma: effect on intraocular pressure control", Eye (Lond), 3(Pt 6), pp.706~712 (1989)
- Harasymowycz PJ., "Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure", J Glaucoma, 14, pp.186~189 (2005)
- Liu CJ., "Determinants of long-term intraocular pressure after phacoemulsification in primary angle-closure glaucoma", J Glaucoma, 20, pp.566~570 (2011)
- Hamanaka T., "Histopathology of the trabecular meshwork and Schlemm’s canal in primary angle-closure glaucoma", Invest Ophthalmol Vis Sci, 52, pp.8849~8861 (2011)
- Sihota R., "The trabecular meshwork in acute and chronic angle closure glaucoma", Indian J Ophthalmol, 49, pp.255~259 (2001)
- Wedrich A., "The use of recombinant tissue plasminogen activator for intracameral fibrinolysis following cataract surgery", Int Ophthalmol, 18, pp.277~280 (1995)
- Moon J., "Treatment of postcataract fibrinous membranes with tissue plasminogen activator", Ophthalmology, 99, pp.1256~1259 (1992)
- Heiligenhaus A., "Recombinant tissue plasminogen activator in cases with fibrin formation after cataract surgery : a prospective randomised multicentre study", Br J Ophthalmol, 82, pp.810~815 (1998)
- Tripathi RC., "Intracameral tissue plasminogen activator for resolution of fibrin clots after glaucoma filtering procedures", Am J Ophthalmol, 111, pp.247~248 (1991)
- Laatikainen L., "The use of tissue plasminogen activator in post-traumatic total hyphaema", Graefes Arch Clin Exp Ophthalmol, 234, pp.67~68 (1996)
- Bennett SR., "Factors prognostic of visual outcome in patients with subretinal hemorrhage", Am J Ophthalmol, 109, pp.33~37 (1990)
- Sanders D., "The toxicity of intravitreal whole blood and hemoglobin", Albrecht Von Graefes Arch Klin Exp Ophthalmol, 197, pp.255~267 (1975)
- Toth CA., "Fibrin directs early retinal damage after experimental subretinal hemorrhage", Arch Ophthalmol, 109, pp.723~729 (1991)
- Razeghinejad MR., "Combined phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle closure glaucoma", Int Ophthalmol, 30, pp.353~359 (2010)
- Varma D., "Viscogonioplasty in patients with chronic narrow angle glaucoma", Br J Ophthalmol, 90, pp.648~649 (2006)