스테로이드 유발 고안압증 환자에서 선택적 레이저 섬유주성형술의 효용성
The Effectiveness of Selective Laser Trabeculoplasty in Steroid-Induced Ocular Hypertension
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목적: 유리체강내 트리암시놀론 아세토나이드 주입술(IVTA) 후 발생한 스테로이드 유발 고안압증 환자 중 최대 약물 치료에도 안압이조절되지 않는 환자에서 선택적 레이저 섬유주성형술의 효과를 국내 최초로 보고하고자 한다. 증례요약: 최대약물요법에도 안압이 조절되지 않는 스테로이드 유발 고안압증 환자 3명에 선택적 레이저 섬유주성형술을 시행하고안압의 변화를 관찰하였다. 유리체강내 스테로이드 주입술 전 1달 이내의 안압은 평균 13.7 mmHg이었고, 주사 후 안압 상승까지 평균13일이 걸렸으며, 충분한 약물치료에도 안압이 조절되지 않아 레이저를 시행하기까지 평균 15.3주가 걸렸다. 레이저 직전까지의 치료제는 4.3개였으며 안압은 평균 30.7 mmHg였다. 레이저 후 안압은 1일 후 16 ± 3.0 mmHg, 1주 후 19.7 ± 8.0 mmHg, 1개월 후 17± 8.0 mmHg, 3개월 후 12.3 ± 2.9 mmHg, 4-6개월 후 12.3 ± 0.6 mmHg였고 마지막 경과 관찰 시 약물 치료제는 1개로 감소하였다. 결론: 최대약물요법에도 반응하지 않는 스테로이드 유발 고안압증의 치료로 선택적 레이저 섬유주성형술을 고려해볼 수 있다.
Abstract
Purpose: To report the effectiveness of selective laser trabeculoplasty (SLT) in patients with intraocular hypertension refractory to maximum tolerated medical therapy after intravitreal triamcinolone acetonide (IVTA). Case summary: The records of 3 patients with steroid-induced intraocular hypertension that did not respond to maximum tolerated medical therapy were retrospectively reviewed. The patients received SLT instead of filtering surgery or Argon laser trabeculoplasty. The mean intraocular pressure (IOP) of 13.7 mm Hg increased to 30.7 mm Hg within 13 days of IVTA. IOP was uncontrolled despite maximum tolerated medical therapy. Patients underwent SLT 15.3 weeks after IVTA. Mean IOP decreased to 16 ± 3.0 mm Hg after 1 day, 19.7 ± 8.0 mm Hg after 1 week, 17 ± 8.0 mm Hg after 1 month, 12.3± 2.9 mm Hg after 3 months and 12.3 ± 0.6 mm Hg after 4 to 6 months. The number of IOP lowering drugs were decreased to 1 from 4.3 after 6 months of SLT. Conclusions: SLT may be effective and safe for the treatment of steroid-induced intraocular hypertension refractory to maximum tolerated medical therapy.
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