신생혈관녹내장에서 항대사제를 병용한 아메드 장치 삽입술의 수술 성공률 평가
Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at One Year
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목적: 신생혈관녹내장의 치료로 Ahmed 장치 삽입술 시에 술 중 mitomycin C (MMC)와 술 후 5-fluorouracil (5-FU)을 병용한 후 치료성공률을 평가해 보고자 한다. 대상과 방법: 신생혈관녹내장으로 약물치료를 통해 적절한 안압 조절이 불가능했던 40명 40안을 대상으로 하였다. 대상안 모두Ahmed장치 삽입술을 시행하였고 술 중 MMC 및 술 후 5-FU를 병용한 뒤 다음과 같은 기준을 치료 실패로 정의하여 치료 성공률및 합병증 발생 유무를 평가하였다. 1) 연속된 3회 방문 시에 안압이 ＞18 mmHg, 술 전에 비해 ＜20% 미만으로 감소한 경우 및 술후 최종 안압 하강제 사용 개수가 술 전에 비해 2가지 이상 감소하지 못한 경우 2) 추가적인 수술을 필요로 한 경우 3) 심각한 합병증이발생한 경우결과: 술 후 12개월 관찰기간 중 누적 성공률은 77.5%, 술 후 최종 안압 하강제 사용 개수는 0.73±0.78개로 술 전에 비하여 2.18±0.84개 줄었으며 심각한 합병증은 발생하지 않았다. 결론: 신생혈관녹내장 치료 시 Ahmed 장치 삽입술 및 술 중 MMC와 술 후 5-FU의 병용치료는 높은 치료 성공률을 보였으며 1년간의관찰기간 중 대부분의 환자에서 안압이 적절하게 조절되었다.
Abstract
Purpose: To evaluate the outcome after Ahmed valve implantation in patients with neovascular glaucoma when using intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU). Methods: A total of 40 eyes of 40 patients with neovascular glaucoma who received antiglacomatous medication without previous glaucoma surgery were included in the present study. The patients received Ahmed valve implantation and intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence of any of the following: 1) the first of three consecutive visits where intraocular pressure (IOP) was ＞18 mmHg or 20% IOP reduction from baseline and the final number of topical medication did not reduce by at least two from baseline, 2) the need for additional surgery, or 3) the occurrence of a serious complication. Results: The cumulative success rate was 77.5% at 12 months. The final number of topical medication after Ahmed valve implantation was 0.73±0.78, and the change in the number of medication from baseline was -2.18±0.84. Serious complications such as endophthalmitis, valve exposure or prolonged hypotony were not observed . Conclusions: The adjunctive use of intraoperative MMC and postoperative 5-FU with Ahmed valve implantation results in a high success rate and good IOP control and did not show serious complications within the postoperative period.
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