난치성 개방우각녹내장에서 시행한 Trabectome^®을 이용한 섬유주절개술 1예
Ab Interno Trabeculotomy with Trabectome^® for Refractory Primary Open-Angle Glaucoma: A Case Report
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목적: 난치성 개방우각녹내장 환자에서 시행한 Trabectome^Ⓡ (NeoMedix Corp., CA, USA)을 이용한 내측 접근 섬유주절개술(Ab interno trabeculotomy) 1예를 보고하고자 한다. 증례요약: Trabectome^Ⓡ은 관류 및 흡인과 함께 미세전기소작으로 섬유주와 쉴렘관의 내측벽을 제거하는 새로운 녹내장 수술 기구이 다. 원발개방우각녹내장으로 진단 후 섬유주절제술과 아메드장치삽입술을 시행하고 안압하강제 점안 중이나 안압조절이 되지 않는 54세 남자환자에게 Trabectome^Ⓡ을 이용하여 내측 접근 섬유주절개술을 시행하였다. 수술 직후 미세한 전방출혈 이외에 합병증은 발생하지 않았으며 기존에 사용하던 안압하강제(Cosopt^Ⓡ, Alphagan‐P^Ⓡ, Lumigan^Ⓡ)를 지속하면서 술 후 3개월까지 안압이 14‐24 mmHg으로 유지되었다. 결론: 기존의 섬유주절제술이나 방수유출장치 삽입술에 비해 Trabectome^Ⓡ을 이용한 섬유주절개술은 개방우각녹내장에서 새로운 수술 적 치료방법이 될 수 있을 것으로 생각한다.
Abstract
Purpose: To report a case of ab interno trabeculotomy with Trabectome^Ⓡ (NeoMedix Corp., CA, USA) conducted on a refractory primary open angle glaucoma (POAG) patient. Case summary: Trabectome^Ⓡ has microelectrocautery with simultaneous infusion and aspiration of debris and ablates a segment of trabecular meshwork and the inner wall of Schlemm’s canal. The patient, a 54-year-old man had uncontrolled intraocular pressure (IOP) with topical anti-glaucoma medications after trabeculectomy and Ahmed valve implantation for POAG. For the patient, ab interno trabeculotomy with Trabectome^Ⓡ was performed. There were no other postoperative complications except for microhyphema immediately after surgery. The IOP was controlled between 14 to 24 mm Hg up to 3 months postoperatively with topical anti-glaucoma medications (Cosopt^Ⓡ, Alphagan-P^Ⓡ, Lumigan^Ⓡ). Conclusions: Ab interno trabeculotomy with Trabectome^Ⓡ appears to offer a newer method of lowering IOP in POAG than conventional trabeculectomy and glaucoma drainage device surgery.
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