한국인에서 선천백내장수술을 받은 환자들의 녹내장 발생 위험인자에 대한 분석
Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients
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목적: 선천백내장수술을 받은 환아에서 장기관찰 결과 녹내장 발생 위험인자를 알아보고자 하였다. 대상과 방법: 선천백내장으로 진단 받고 본원 또는 타원에서 백내장수술을 받은 환아 91명 148안을 대상으로 의무기록을 후향적으로 분석하였다. 이차녹내장의 진단은 안압이 21 mmHg를 초과하면서, 각막 직경, 안축장, 또는 유두함몰비가 증가하거나 안압 조절을 위해 수술을 시행한 경우로 하였고, 대상 환자들의 임상 양상 및 녹내장 위험 인자를 분석하기 위해 백내장수술 시 나이, 양안 여부, 핵백내장 유무, 백내장수술 방법 및 인공수정체 유무, 백내장수술 후 녹내장을 진단 받기까지의 기간, 경과관찰 기간, 가장 최근 최대교정 시력, 굴절 오차, 경과관찰 하면서 측정된 최고 안압을 분석하였다. 결과: 술 후 녹내장이 발생한 눈은 35안(23.6%), 녹내장을 진단 받은 환자 중 녹내장수술을 시행한 눈은 11안(31.4%), 평균 3.4회의 녹내장수술을 받았다. 백내장수술 이후 녹내장 발생까지의 기간은 평균 112.2 ± 113.1개월이었다. 수정체관류흡인술만 시행한 경우는 일차인공수정체삽입술을 시행한 경우보다 녹내장 발생 위험이 유의하게 높았다(p=0.001). 선천백내장수술 이후 녹내장 발생 위험 요인으로는 3개월 미만에서 수술한 경우, 핵백내장, 일차 인공수정체 삽입보다는 무수정체안으로 나타났으며, 이차 인공수정체 삽입의 경우 녹내장 발생 위험이 증가하는 경향을 보였다(p=0.03, p=0.006, p<0.001, p=0.052). 결론: 선천백내장수술을 받은 환아에서 무수정체안의 경우 녹내장 발생 위험이 높고, 3개월 미만에서 수술한 경우, 핵백내장이 이차녹내장의 위험인자로 나타났다. 선천백내장수술을 한 환아들은 녹내장 발생 위험을 항상 갖고 있기 때문에 조기 발견을 위해서 장기적인 모니터링이 필요하다.
Abstract
Purpose: To assess the risk of development of secondary glaucoma after congenital cataract surgery using a long-term follow- up study. Methods: In total, 148 eyes of 91 patients who underwent congenital cataract surgery at our hospital or other hospitals were included in a retrospective chart review. A diagnosis of secondary glaucoma was made if the intraocular pressure (IOP) exceeded 21 mmHg and the corneal diameter, axial length, or the cup-to-disc ratio increased, or surgery was performed to control the IOP. To analyze the clinical features and risk factors of secondary glaucoma, we evaluated the mean age at cataract surgery, binocularity, presence of a nuclear cataract, methods of cataract surgery, presence of an intraocular lens (IOL), duration of diagnosis of secondary glaucoma after cataract surgery, duration of follow-up, recent best-corrected visual acuity, and refractive errors. Results: Thirty-five eyes (23.6%) were diagnosed with secondary glaucoma as a complication of congenital cataract surgery. Of these, 11 eyes (31.4%) were treated with glaucoma surgery a mean of 3.4 times. The mean duration from congenital cataract surgery to diagnosis of glaucoma was 112.2 ± 113.1 months. Patients with aphakia had a higher risk of developing secondary glaucoma compared with patients undergoing primary IOL implantation (p = 0.001). Younger age (<3 months at surgery), a nuclear cataract, and aphakia were risk factors for the development of secondary glaucoma (p = 0.03, p = 0.006, and p < 0.001, respectively), and the risk of developing secondary glaucoma increased with secondary IOL implantation (p = 0.052). Conclusions: Secondary glaucoma after congenital cataract surgery was more common in patients with secondary IOL implantation, aphakia, a younger age (<3 months), and a nuclear cataract. Patients who underwent congenital cataract surgery had an increased risk for developing secondary glaucoma. Long-term monitoring of the IOP and optic nerve is therefore required for these patients.
참고문헌 (23)
- Asrani S, "Does primary intraocular lens implantation prevent "aphakic" glaucoma in children?", J AAPOS, 4, pp.33~39 (2000)[DOI]
- Kui Dong Kang, "Comparison of Delayed-Onset Glaucoma and Early-Onset Glaucoma after Infantile Cataract Surgery", Korean Journal of Ophthalmology, 20(1), pp.41~46 (2006), 대한안과학회
- Mills MD, "Glaucoma following childhood cataract surgery", J Pediatr Ophthalmol Strabismus, 31, pp.355~360 (1994)
- Lundvall A, "Complications after early surgery for congenital cataracts", Acta Ophthalmol Scand, 77, pp.677~680 (1999)[DOI]
- Chak M, "Incidence of and factors associated with glaucoma after surgery for congenital cataract: findings from the British Congenital Cataract Study", Ophthalmology, 115, pp.1013~1018 (2008)[DOI]
- Kirwan C, "Glaucoma in aphakic and pseudophakic eyes following surgery for congenital cataract in the first year of life", Acta Ophthalmol, 88, pp.53~59 (2010)[DOI]
- Trivedi RH, "Incidence and risk factors for glaucoma after pediatric cataract surgery with and without intraocular lens implantation", J AAPOS, 10, pp.117~123 (2006)[DOI]
- Beck AD, "Glaucoma-related adverse events in the Infant Aphakia Treatment Study: 1-year results", Arch Ophthalmol, 130, pp.300~305 (2012)[DOI]
- Freedman SF, "Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study", JAMA Ophthalmol, 133, pp.907~914 (2015)[DOI]
- El Shakankiri NM, "The timing of surgery for congenital cataracts: delayed surgery for best surgical outcomes", J AAPOS, 20, pp.192~193 (2016)[DOI]
- Kuhli-Hattenbach C, "Risk factors for complications after congenital cataract surgery without intraocular lens implantation in the first 18 months of life", Am J Ophthalmol, 146, pp.1~7 (2008)[DOI]
- Cape CJ, "Phenotypic variation in ophthalmic manifestations of MIDAS syndrome (microphthalmia, dermal aplasia, and sclerocornea)", Arch Ophthalmol, 122, pp.1070~1074 (2004)[DOI]
- Rabiah PK, "Frequency and predictors of glaucoma after pediatric cataract surgery", Am J Ophthalmol, 137, pp.30~37 (2004)[DOI]
- Swamy BN, "Secondary glaucoma after paediatric cataract surgery", Br J Ophthalmol, 91, pp.1627~1630 (2007)[DOI]
- Lambert SR, "Long-term risk of glaucoma after congenital cataract surgery", Am J Ophthalmol, 156, pp.355~361 (2013)[DOI]
- Sukhija J, "Outcome of primary intraocular lens implantation in infants: Complications and rates of additional surgery", J Cataract Refract Surg, 42, pp.1060~1065 (2016)[DOI]
- Mataftsi A, "Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis", JAMA Ophthalmol, 132, pp.1059~1067 (2014)[DOI]
- Magnusson G, "Glaucoma following congenital cataract surgery: an 18-year longitudinal follow-up", Acta Ophthalmol Scand, 78, pp.65~70 (2000)[DOI]
- Wong IB, "Incidence of early-onset glaucoma after infant cataract extraction with and without intraocular lens implantation", Br J Ophthalmol, 93, pp.1200~1203 (2009)[DOI]
- Chen W, "Timing and approaches in congenital cataract surgery: a randomised controlled trial", The Lancet, 388, pp.S52~ (2016)
- Kumar M, "Scleral-fixated intraocular lens implantation in unilateral aphakic children", Ophthalmology, 106, pp.2184~2189 (1999)[DOI]
- Jacobi PC, "Scleral fixation of secondary foldable multifocal intraocular lens implants in children and young adults", Ophthalmology, 109, pp.2315~2324 (2002)[DOI]
- Pakravan M, "Trabeculectomy with mitomycin C versus Ahmed glaucoma implant with mitomycin C for treatment of pediatric aphakic glaucoma", J Glaucoma, 16, pp.631~636 (2007)[DOI]