섬유주 미세우회 스텐트삽입술 실패 후 시행한 섬유주절제술의 1년 임상 성적
One-year Result of Trabeculectomy Following a Failed Trabecular Micro-bypass Stent
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목적: 섬유주 미세우회 스텐트삽입술에 반응하지 않는 원발개방각녹내장 환자에서 시행한 섬유주절제술의 1년 임상 성적을 알아보고자 하였다. 대상과 방법: 섬유주 미세우회 스텐트삽입술이 실패하여 마이토마이신C를 이용한 섬유주절제술을 시행한 원발개방각녹내장 환자의 의무기록을 후향적으로 분석하였다. 술 후 경과 관찰 기간이 최소 12개월 이상인 환자들을 대상으로 Kaplan-Meier 생존분석을 이용하여 섬유주 미세우회 스텐트삽입술이 수술 성적에 미치는 영향에 대하여 분석하였다. 완전 수술 성공은 안압하강제를 사용하지 않고 안압이 18 mmHg 이하이고, 20% 이상 하강한 경우로 정의하였다. 결과: 섬유주 미세우회 스텐트군은 9명 10안, 대조군은 10명 10안이었다. 섬유주 미세우회 스텐트군과 대조군의 수술 후 12개월의 완전 성공률은 각각 80%, 90%였다(p=0.584). 섬유주 미세우회 스텐트군에서 평균 안압은 수술 전 29.0 ± 7.4 mmHg, 마지막 방문시 12.4 ± 3.1 mmHg였다(p<0.001). 대조군에서 평균 안압은 수술 전 29.2 ± 7.5 mmHg, 마지막 방문시 12.1 ± 4.1 mmHg였고(p<0.001), 수술 전, 그리고 마지막 방문시 두 군 사이에 유의한 차이는 없었다(각각 p=0.828, p=0.387). 결론: 본 연구를 통하여 이전 섬유주 미세우회 스텐트삽입술 여부에 관계없이 원발개방각녹내장 환자에서 마이토마이신C를 이용한섬유주절제술은 안압을 하강시키는 데 도움이 됨을 알 수 있었다.
Abstract
Purpose: To evaluate the efficacy of trabeculectomy with mitomycin C (MMC) for primary open angle glaucoma (POAG) in eyes refractory to a trabecular micro-bypass stent. Methods: We reviewed the medical records of patients with POAG who underwent trabeculectomy with MMC after failed trabecular micro-bypass stent implantation. All patients had a ≥12 months follow-up. We compared surgical outcomes according to trabecular micro-bypass stent implantation using a Kaplan-Meier survival analysis. Complete surgical success was defined as intraocular pressure (IOP) ≤18 mmHg and IOP reduction ≥20% without medication. Results: A total of 19 patients (20 eyes) were included; 10 eyes of nine patients in the trabecular micro-bypass stent group and 10 eyes of 10 patients in the control group. The cumulative probabilities of complete success after trabeculectomy with MMC were 80% and 90% after 1 year in the trabecular micro-bypass stent and control groups, respectively (p = 0.584). Mean IOP decreased from 29.0 ± 7.4 mmHg preoperatively to 12.4 ± 3.1 mmHg at the final visit in the trabecular micro-bypass stent group (p < 0.001). Mean IOP decreased from 29.2 ± 7.5 mmHg preoperatively to 12.1 ± 4.1 mmHg at the final visit in the control group (p < 0.001). The preoperative and final IOP were not significantly different between the two groups (p = 0.828, p = 0.387, respectively). Conclusions: Trabeculectomy with MMC was an effective method for controlling IOP in patients with POAG refractory to a trabecular micro-bypass stent.
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