말기녹내장으로 처음 진단받은 환자의 진단 경로 및 임상양상 분석: 단일 3차 의료기관 경험
Path to Diagnosis and Clinical Characteristics of Advanced Glaucoma at Initial Diagnosis: a Tertiary Single Center Experience
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목적: 건강검진의 확대에도 불구하고 첫 진단 시 말기녹내장으로 진단을 받는 환자들이 적지 않다. 이들의 진단 경로 및 임상양상을 분석하여 연관 인자를 알아보고자 하였다. 대상과 방법: 2016년부터 2018년도까지 3차 의료기관에서 녹내장으로 처음 진단 받은 환자 중에서 연속된 초기 시야검사에서 mean deviation (MD) 값이 -12 dB 이하이며, 상응하는 구조 손상이 확인된 자를 대상으로 하였다. 전체 대상군을 각각 ‘단안, 양안말기녹내장’, ‘고안압, 정상안압녹내장’ 그리고 '인공수정체안, 수정체안'으로 양안성, 치료 전 안압, 그리고 백내장수술 여부에 따라 분류, 비교 분석하였다. 결과: 전체 대상 환자는 73명으로 평균 나이 69.3세, 평균 MD값은 -19.6 dB이었다. 양안 말기녹내장군은 우연히 안과검진을 통해 진단된 경우가 가장 많고(52.2%), 중심 섬 양상의 시야결손이 가장 많았으나(54.2%), 단안군은 녹내장 연관증상으로 진단된 경우가 가장 많고(46.9%), 상하측 양상의 결손이 가장 많았다(42.8%). 고안압녹내장군에서 녹내장연관증상을 주소로 내원한 경우가 68.2%, 정상안압녹내장군에서 22.8%였으며, 중심 섬 양상의 시야결손은 고안압녹내장군에서 43.6%, 정상안압녹내장군에서 29.4%였다. 결론: 본 연구는 말기녹내장의 진단 경로 및 임상양상을 분석한 연구로서, 양안 말기녹내장군에서 안과검진으로 우연히 진단된 경우가 많았다. 세부분석에서 양안 말기녹내장, 고안압녹내장, 인공수정체안에서 중심 섬 양상의 시야결손의 비율이 높았다. 추후 사회경제적 요소 및 다기관 자료를 통한 보완 분석이 필요하다.
Abstract
Purpose: As routine health examinations become more common, many patients first diagnosed with glaucoma have advanced glaucoma. We analyzed the routes to diagnosis and the characteristics of patients initially diagnosed with advanced glaucoma. Methods: We retrospectively retrieved the medical records of patients first diagnosed with advanced glaucoma in our tertiary care center. The inclusion criteria were a mean deviation (MD) less than -12 dB on the visual field test, accompanied by structural damage. All patients were classified in terms of unilateral/bilateral disease, the intraocular pressure before medication, and lens status. We divided patients into those with monocular or binocular advanced glaucoma, high- or normal-pressure glaucoma, and those who were pseudophakic or phakic. Results: We included 73 patients of mean age 69.3 years. The visual field test MD was -19.6 dB. In those with binocular advanced glaucoma, incidental ophthalmic examination was the most common means of diagnosis (52.2%). Central-island visual field defects were the most common defects (54.2%). In those with monocular advanced glaucoma, glaucoma-associated symptoms most commonly triggered diagnosis (46.9%). Both superior and inferiorvisual field defects were the most common defects (42.8%). Glaucoma-associated symptoms were present in 68.2 and 22.8% of patients with high- and normal-pressure glaucoma, respectively. Central-island visual field defects were present in 43.6 and 29.4% of those with high- and normal-pressure glaucoma, respectively. Conclusions: We analyzed the routes to diagnosis and the clinical characteristics of patients with advanced glaucoma. In those with binocular disease, glaucoma was most commonly diagnosed on incidental ophthalmic examination. Central-island visual field defects were the most common defects in patients with binocular and high-pressure glaucoma, and the pseudophakic group. A multi-center longitudinal study on risk factors for delayed glaucoma diagnosis is needed.
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