국내 아이스텐트와 아이스텐트 인젝트의 백내장 병합술 성공률 비교와 예후 인자 분석
Short-term Outcomes and Prognostic Factors of Cataract-combined Surgery with iStent versus iStent Inject
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목적: 한국인에서 아이스텐트(iStent®) 또는 아이스텐트 인젝트(iStent inject®) 삽입술 시행 후 치료 효과, 예후 인자, 수술 후 발생한 합병증에 대해 분석하고자 한다. 대상과 방법: 한국인에서 녹내장으로 아이스텐트 또는 아이스텐트 인젝트 삽입술을 단독 혹은 백내장수술과 병합하여 수술 후 6개월 이상 추적 관찰이 가능했던 42안을 대상으로 의무기록을 통하여 후향적으로 분석하였다. 수술 성공 여부는 수술 후 안압이 21 mmHg 미만이며, 수술 전 안압에 비하여 20% 이상 감소하였을 경우로 정의하였다. 결과: 수술 후 6개월 누적 성공률은 아이스텐트 인젝트 단독 삽입술(A군)이 45.3 ± 8.1%, 아이스텐트 단독 삽입술(B군)이 28.6 ± 13.1%, 아이스텐트 인젝트와 백내장수술 병합(A-1군) 81.2 ± 6.8%, 아이스텐트와 백내장수술 병합(B-1군) 27.3 ± 21.8%로 A-1군이 B-1군에 비해 유의하게 높은 성공률(p=0.007)을 보였으며, A군과 B군의 성공률 차이는 유의하지 않았다(p=0.579). 성공 예후 인자를 콕스 회귀분석으로 분석하였을 때, 수술 전 안압이 높을수록 수술 성공률이 높은 것으로 나타났다(hazard ratio 0.80, p=0.02). 결론: 한국인에서 아이스텐트와 백내장수술 병합 시 아이스텐트 인젝트가 아이스텐트보다 안압하강 효과가 좋으며, 수술 전 안압이 높을수록 유의하게 수술 성공률이 높았다.
Abstract
Purpose: To analyze the therapeutic effects, prognostic factors, and complications that occurred after iStent® or iStent inject® implantation in South Korean glaucoma patients. Methods: We retrospectively analyzed 42 eyes of South Korean glaucoma patients, who were followed-up for more than 6 months after iStent® or iStent inject® implantation alone or combined with cataract surgery. Surgical success was defined as an intraocular pressure (IOP) ≤21 mmHg and an IOP reduction ≥20% from preoperative IOP levels. Results: The cumulative success rate at 6 months after surgery was 45.3 ± 8.1% for iStent inject® alone (group A), 28.6 ± 13.1% for iStent® alone (group B), 81.2 ± 6.8% for iStent inject® combined with cataract surgery (group A-1), and 27.3 ± 21.8% for iStent® combined with cataract surgery (group B-1). Group A-1 showed a higher success rate than group B-1 (p = 0.007); the difference in success rates between groups A and B was not statistically significant (p = 0.579). When the success prognostic factors were analyzed by Cox regression analysis, the results showed that a higher preoperative IOP was associated with a higher surgical success rate (hazard ratio 0.80, p = 0.02). Conclusions: In our patient group, iStent inject® was more effective than iStent® in combination with cataract surgery. The higher the preoperative IOP, the higher the surgical success rate; the results were significant.
참고문헌 (16)
- Weinreb RN, "The pathophysiology and treatment of glaucoma : a review", JAMA, 311, pp.1901~1911 (2014)
- Nordstrom BL, "Persistence and adherence with topical glaucoma therapy", Am J Ophthalmol, 140, pp.598~ (2005)
- Glaucoma Laser Trial Research Group, "The Glaucoma Laser Trial (GLT) and glaucoma laser trial follow-up study: 7. results", Am J Ophthalmol, 120, pp.718~731 (1995)
- Musch DC, "Factors associated with intraocular pressure before and during 9 years of treatment in the Collaborative Initial Glaucoma Treatment Study", Ophthalmology, 115, pp.927~933 (2008)
- Rulli E, "Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures : a systematic review and meta-analysis", JAMA Ophthalmol, 131, pp.1573~1582 (2013)
- Jampel HD, "Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study(CIGTS)", Am J Ophthalmol, 140, pp.16~22 (2005)
- Conlon R, "Glaucoma treatment trends : a review", Can J Ophthalmol, 52, pp.114~124 (2017)
- Fingeret M, "The role of minimally invasive glaucoma surgery devices in the management of glaucoma", Optom Vis Sci, 95, pp.155~162 (2018)
- Lavia C, "Minimally-invasive glaucoma surgeries(MIGS)for open angle glaucoma : a systematic review and meta-analysis", PLoS One, 12, pp.e0183142~ (2017)
- Salimi A, "One-year outcomes of second-generation trabecular micro-bypass stents(iStent Inject)implantation with cataract surgery in different glaucoma subtypes and severities", Ophthalmol Ther, 8, pp.563~575 (2019)
- Spiegel D, "Initial clinical experience with the trabecular micro-bypass stent in patients with glaucoma", Adv Ther, 24, pp.161~170 (2007)
- Samuelson TW, "Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract", Ophthalmology, 118, pp.459~467 (2011)
- Fernández-Barrientos Y, "Fluorophotometric study of the effect of the glaukos trabecular microbypass stent on aqueous humor dynamics", Invest Ophthalmol Vis Sci, 51, pp.3327~3332 (2010)
- Fea AM, "Prospective unmasked randomized evaluation of the iStent inject(R)versus two ocular hypotensive agents in patients with primary open-angle glaucoma", Clin Ophthalmol, 8, pp.875~882 (2014)
- Popovic M, "Efficacy and adverse event profile of the iStent and iStent inject trabecular micro-bypass for open-angle glaucoma : a meta-analysis", J Curr Glaucoma Pract, 12, pp.67~84 (2018)
- Ferguson TJ, "iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma : early clinical experience", Eye Vis(Lond), 7, pp.28~ (2020)