눈물주머니코안연결술을 시행한 눈물소관폐쇄에서 수술 중과 수술 후 사용한 마이토마이신 C 효과
Efficacy of Intraoperative Mitomycin C Eye Drops during and after Dacryocystorhinostomy for Canalicular Obstr
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목적: 눈물소관폐쇄 환자에서 눈물주머니코안연결술 중 마이토마이신 C (mitomycin C) 사용 및 수술 후 마이토마이신 C 점안액의 효과를 알아보았다. 대상과 방법: 2012년 6월부터 2016년 6월까지 본원에서 눈물소관폐쇄로 진단되어 눈물주머니코안연결술을 시행한 46명 46안을 대상으로 후향적으로 분석하였다. 눈물점을 확장시킨 후 lacrimal trephine으로 눈물소관폐쇄 부위를 개통하였고, 수술 중 0.02% 마이토마이신 C로 노출된 눈물주머니에 3분간 도포 후 생리식염수 20 mL로 세척하고 실리콘 튜브를 삽입, 수술 후 1일째 항생제 점안, 2일째부터 0.02% 마이토마이신 C와 0.5% 스테로이드 점안액을 1개월간 점안하였다. 수술 전후 전안부 빛간섭단층촬영기를 사용하여 눈물띠 높이를 측정하였고 눈물흘림 정도를 Munk’s score에 따라 기능적 호전을 평가, 관류검사로 해부학적 호전을 평가하였다. 결과: 눈물띠 높이는 비측 571.64 ± 260.51 μm에서 267.16 ± 59.25 μm (p=0.043), 중앙 580.16 ± 186.24 μm에서 271.14 ± 45.10 μm (p=0.018), 가측 480.52 ± 260.23 μm에서 220.16 ± 63.79 μm (p=0.029)로 감소하였다. 기능적 성공률은 93.5% (43/46)였으며 해부학적 성공률은 95.7% (44/46)였다. 결론: 눈물소관폐쇄 시 수술 중 마이토마이신 C의 사용과 수술 이후 마이토마이신 C 점안액 및 스테로이드 점안액을 사용하는 것은 효과적인 치료 방법으로 수술 성공률을 높인다.
Abstract
Purpose: This study investigated the efficacy of intraoperative and postoperative mitomycin C eye drops in patients with canalicular obstructions. Methods: In total, 46 eyes of 46 patients diagnosed with canalicular obstruction at our hospital between June 2012 and June 2016 were analyzed. Canalicular trephination was done and, after applying 0.02% mitomycin C for 3 minutes on the exposed lacrimal sac during endoscopic dacryocystorhinostomy, the area was washed with 20 mL of saline solution, and a silicon tube was inserted. On postoperative day 1, an antibiotic eye drop was applied; beginning on postoperative day 2, 0.02% mitomycin C eye drops were applied, and 0.5% steroid eye drops were applied. Pre- and postoperative anterior segment optical coherence tomography was used to measure the nasal, central, and lateral tear meniscus heights. The extent of functional improvement was assessed by measuring the degree of tear according to Munk’s score, and anatomical improvement was assessed using a syringing test. Results: The nasal tear meniscus height decreased from 571.64 ± 260.51 μm to 267.16 ± 59.25 μm (p = 0.043); central tear meniscus height from 580.16 ± 186.24 μm to 271.14 ± 45.10 μm (p = 0.018); and lateral tear meniscus height from 480.52 ± 260.23 μm to 220.16 ± 63.79 μm (p = 0.029). The functional success rate was 93.5% (43/46), and the anatomical success rate was 95.7% (44/46). Conclusions: Intraoperative and postoperative mitomycin C and steroid eye drops may be an effective treatment for canalicular obstruction patients and should help increase surgical success rates.
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