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원발녹내장에서 백내장초음파유화섬유주절제술과 섬유주절제술의 여과포와 안압의 경과비교

Comparison of Filtering-Bleb Survival and Intraocular Pressure between Combined Phacotrabeculectomy and Trabeculectomy in Primary Glaucomas

김창식|허동원
대한안과학회 (The Korean Ophthalmological Society)|2012.12|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제53권 제12호|pp. 1835-1845

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참고문헌

키워드

Intraocular pressureTrabeculectomyPhacotrabeculectomyFiltering bleb
주제분류안과학

초록

목적: 초음파유화술-섬유주절제술 병용수술과 섬유주절제술 후 안압의 경과와 여과포생존율을 비교하였다. 대상과 방법: 원발개방각녹내장 42안과 원발폐쇄각녹내장 60안에 실시한 병용수술 52예와 섬유주절제술 50예의 3년간 안압, 녹내장약제 수, 여과포생존율을 비교하였다. 결과: 섬유주절제술군이 병용수술군보다 수술 후 12개월까지 더 낮은 안압을 나타내었고(p˂0.05, t-test), 이후 차이가 없었다. 전체적여과포생존율은 3년간 섬유주절제술군에서 유의하게 높았다. 개방각녹내장에서는 섬유주절제술의 여과포생존율이 더 높았으나(p=0.016, log-rank test), 폐쇄각녹내장에서는 두 군간 차이가 없었다. 개방각녹내장에서 술 후 1년까지 섬유주절제술군이 더 낮은안압을 보이고 이후 차이가 없었다. 폐쇄각녹내장에서는 술 후 1, 3, 6개월에 섬유주절제술군에서 더 낮은 안압을 나타내었지만, 18개월, 36개월에는 병용수술군이 더 낮은 안압을 나타냈다. 결론: 개방각녹내장에서는 섬유주절제술이 안압과 여과포의 유지에 유리했다. 그러나 폐쇄각녹내장에서는 여과포유지는 차이가 없었고, 안압조절은 1년 이전에는 섬유주절제술이, 1년 이후에는 병용수술이 더 양호했다.

Abstract

Purpose: To evaluate clinical results of combined phacotrabeculectomy (PHACO-TRAB) and trabeculectomy (TRAB) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods: Forty-two eyes of 42 patients with POAG and 60 eyes of 60 patients with PACG were studied retrospectively. Fifty-two patients underwent PHACO-TRAB and 50 patients underwent TRAB. The IOP, number of anti-glaucoma medications, and duration of filtering bleb survival for 3 years after surgery were compared. Results: For 12 months after surgery, the TRAB group maintained significantly lower IOP than the PHACO-TRAB group (p < 0.05,t-test), and there was no significant difference thereafter. The filtering bleb survival rate was significantly higher in the TRAB group during the study period. In patients with POAG, the TRAB group showed higher filtering bleb survival rate for 3 years (p = 0.016,log-rank test). However, in patients with PACG, there was no significant difference in filtering bleb survival between the 2 groups. In patients with POAG, the TRAB group maintained significantly lower IOP for 12 months after surgery, and there was no significant difference afterwards. In patients with PACG, the TRAB group maintained lower IOP only at 1, 3, and 6 months after surgery. However, the PHACO-TRAB group showed significantly lower IOP at 18 months and 36 months after surgery. Conclusions: In patients with POAG, TRAB was more effective in lowering IOP and maintaining filtering bleb. However in patients with PACG, there was no difference in filtering bleb survival between the 2 groups. TRAB was more effective in maintaining IOP during the early period after surgery, but PHACO-TRAB was superior to TRAB beyond 1 year after surgery in patients with PACG.

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