아메드밸브 삽입술 후 전방 내 실리콘관 첨단의 위치와 각막내피세포 변화
Location of the Tube Tip in the Anterior Chamber and Change in Corneal Endothelium after Ahmed Valve Implantation
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목적: 아메드밸브 삽입술 후 실리콘관 첨단의 위치가 각막내피세포에 미치는 영향을 확인하고자 한다. 대상과 방법: 단일 술자에 의해 아메드밸브 삽입술을 받은 21명 24눈에서 전안부 빛간섭단층촬영(OCT)을 이용하여 실리콘관 첨단과각막 사이의 거리를 측정하였다. 수술 전후 경면현미경으로 중심 및 상, 상이, 상비측 각막내피세포를 검사하였다. 결과: 아메드밸브 삽입술 후 평균 19.2 ± 11.8개월에 전안부 OCT와 경면현미경으로 각각 실리콘관 첨단과 각막 사이의 거리와 중심부및 상, 상이, 상비측 각막내피세포를 검사하였다. 수술 전후 중심 각막내피세포는 2278 ± 565/mm2에서 2177 ± 529/mm2로 통계적으로 유의하게 감소하였지만(p=0.043), 감소 정도는 앞서 측정한 거리와 유의한 상관관계가 없었다. 그러나 실리콘관이 위치하는 상이측에서는 상측, 상비측과 비교하여 중심 각막보다 각막내피세포가 통계적으로 더 많이 감소하였고(p=0.006), 감소 정도는 그 거리와음의 상관관계를 보였다(시간 보정 부분상관계수 -0.558, p=0.031). 결론: 아메드밸브 삽입술 후 각막내피세포의 감소를 최소화하기 위해서 수술 시 실리콘관의 첨단과 각막 사이에 충분한 거리를 확보하는 것이 중요하다.
Abstract
Purpose: To evaluate the impact of location of a silicone tube tip in the anterior chamber on corneal endothelium after Ahmed glaucoma valve implantation. Methods: We measured the distance from the tip of a silicone tube in the anterior chamber to the posterior surface of the cornea by anterior segment optical coherence tomography (OCT) in 24 eyes of 21 patients who underwent Ahmed glaucoma valve implantation. All surgeries were performed by a single surgeon. The corneal endothelial cells of central, superior,superotemporal, and superonasal area of the cornea were examined by specular microscope before and after surgery. Results: The distance from the tip of the silicone tube in the anterior chamber to the posterior surface of the cornea and the corneal endothelium were measured at 19.2 ± 11.8 months (2.8-41.2 months) after surgery. At the central corneal area, a statistically significant decrease in the number of corneal endothelial cells (2278 ± 565/mm2 vs. 2177 ± 529/mm2, p = 0.043)after surgery was observed, but no relationship was found between the amount of decrease and distance from the tip to the posterior surface of the cornea. At the superotemporal corneal area where the tip of the silicone tube was located in the anterior chamber, there was more significant loss of corneal endothelial cells than in the other areas after surgery (p = 0.006). Moreover, the amount of endothelial cell loss at the superotemporal area was negatively correlated to the distance from the tip to the posterior surface of the cornea (partial correlation coefficient by time -0.558, p = 0.031). Conclusions: To minimize the loss of corneal endothelial cells after Ahmed glaucoma valve implantation, ensuring a sufficient distance from the tip of the silicone tube to the posterior surface of the cornea is important.
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