섬유주절제술에서 결막편에 따른 여과포 형태 비교
Bleb Morphology of Fornix-Based Versus Limbus-Based Conjunctival Flaps in Trabeculectomy with Mitomycin C
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목적: Mitomycin C (MMC)를 사용한 섬유주절제술에서 윤부기저결막편과 원개기저결막편으로 수술한 후 여과포형태를 관찰하고 안압및 수술 성공률을 알아보았다. 대상과 방법: MMC를 사용하여 섬유주절제술을 시행 받고 1년 이상 추적관찰이 가능했던 59명 65안을 대상으로 윤부기저결막편군은31명 34안이며, 원개기저결막편군 28명 31안이었다. 술 후 1년 이상 경과된 후 여과포 형태를 Moorfields Bleb Grading System에따라 분류하여 비교하였고, 수술 후 안압과 수술 성공률을 비교하였다. 결과: 윤부기저결막편군에서 여과포 중심 부분의 혈관화 정도가 1.79 ± 0.64로 원개기저결막편군의 2.16 ± 0.73에 비해 의미 있게낮았으며(p=0.042), 낭성 여과포의 발생비율은 높았다(38.2%; 16.1%, p=0.047). 안압과 수술성공률에서는 두 군 간의 의미 있는 차이는 없었다. 결론: MMC를 이용한 섬유주절제술에서 결막편에 따른 안압 및 수술성공률의 차이는 없었지만 윤부기저결막편군에서 여과포 중심부위의 혈관화 정도가 낮고 무혈관성 낭성 여과포 형성이 비교적 많았다.
Abstract
Purpose: To compare the bleb morphology and surgical outcomes of a limbus-based group with those of a fornix-based group who underwent trabeculectomy with mitomycin C (MMC). Methods: Sixty-five eyes of 59 patients who had undergone trabeculectomy with MMC and who were observed for one year or more were included in the present study. A limbus-based conjunctival flap was used for 34 eyes of 31 patients and a fornix-based conjunctival flap for the other 31 eyes of 28 patients. The bleb morphologies were classified and compared after one year or more postoperatively according to the Moorfield Bleb Grading System, and intraocular pressure and success rates were evaluated. Results: The central bleb vascularity of the limbus-based group was statistically significantly lower than that of the fornix-based group (1.79 ± 0.64; 2.16 ± 0.73, p = 0.042). The risk of cystic bleb formation was higher in the limbus-based group (38.2%; 16.5%, p = 0.047). There were no differences in the IOP or success rate between the two groups. Conclusions: There were no differences between the two groups with regard to the IOP or cumulative success rate. However, in the fornix-based group, the central bleb vascularity was lower and the risk of avascular cystic bleb formation was higher than those in the limbus-based group.
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