녹내장환자에서 백내장수술 후 안압하강에 영향을 미치는 전방각경 점수 및 술 전 인자
Effect of Preoperative Factors and Gonioscopy on Intraocular Pressure Reduction after Phacoemulsification in Glaucoma
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목적: 녹내장환자에서 수정체유화술 후 안압에 영향을 주는 전방각경 점수를 포함한 술 전 인자에 대해 알아보고자 하였다. 대상과 방법: 녹내장환자 중 백내장수술을 받은 182안을 대상으로 후향적 의무기록 분석을 시행하였다. 나이, 안압, 안축장, 전방 깊이, 수정체 위치, 굴절력을 술 후 6개월째에 비교 분석하였다. 술 전 전방격경 점수는 4사분면의 Shaffer 전방각경 grading을 합하여 계산하였다. 단변량 및 다변량 회귀분석을 이용하여 위 인자들과 술 후 안압의 관계를 분석하였다. 결과: 환자들의 평균 나이는 72.8 ± 9.5세, 평균 술 전 안압은 16.4 ± 3.7 mmHg로 측정되었으며, 평균 1.2개의 안압하강제를 사용하고 있었다. 술 후 6개월째에 평균 2.7 ± 2.2 mmHg의 안압하강을 보였다. 다변량 분석상 술 전 안압(β=0.55, p<0.001). 전방 깊이(β=-0.67, p=0.02), 전방각경 점수(β=-0.29, p<0.001) 및 intraocular pressure/anterior chamber depth (IOP/ACD)비(β=0.58, p=0.01)가 통계적으로 유의하게 술 후 6개월의 안압하강과 연관성을 보였다. 결론: 녹내장환자에서 수정체유화술 후 안압하강과 관련된 술 전 인자는 술 전 안압, 전방 깊이, 전방각경 점수 그리고 IOP/ACD비였다. IOP/ACD비와 전방각경 점수는 백내장수술 후 안압하강을 예측하는 데에 도움이 될 것으로 생각된다.
Abstract
Purpose: To evaluate a new gonioscopy score and preoperative factors as a potential predictor for intraocular pressure (IOP) reduction after phacoemulsification. Methods: This is a retrospective review of 182 eyes with glaucoma of either open or narrow angles that underwent phacoemulsification. Preoperative variables such as age, IOP, refractive errors, anterior chamber depth (ACD), axial length, and lens position were evaluated at 6 months after surgery. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants. To determine variables associated with IOP change at 6 months, univariate and multivariate linear regression analysis was performed. Results: The mean age of the patients was 72.8 ± 9.5 years and the average preoperative IOP was 16.4 ± 3.7 mmHg with 1.2 glaucoma medications. The mean IOP reduction after phacoemulsification was 2.7 ± 2.2 mmHg at postoperative 6 months. Preoperative IOP (β = 0.55, p < 0.001), gonioscopy score (β = -0.29, p < 0.001), ACD (β = -0.67, p = 0.02), and IOP/ACD ratio (β = 0.58, p = 0.01) were associated with IOP reduction at 6 months. Conclusions: Preoperative predictors for IOP reduction after phacoemulsification were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio in patients with glaucoma. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.
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