원발개방각녹내장 환자에서 섬유주절제술 후 점안 스테로이드 치료 효과 비교
Comparison of the Efficacy of Topical Steroids after Trabeculectomy in Patients with Primary Open-angle Glaucoma
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목적: 원발개방각녹내장 환자에서 섬유주절제술 후 점안 스테로이드 사용에 따른 수술 성공률과 안압하강 효과를 비교 분석하고자 하였다. 대상과 방법: 원발개방각녹내장으로 섬유주절제술을 시행 받고 1년 이상 추적관찰이 가능했던 84명 84안을 대상으로 하였다. 수술 후 사용한 점안 스테로이드(0.5% loteprednol etabonate [LE], 1% rimexolone [RMX], 1% prednisolone acetate [PDA])에 따라 환자를 세 군으로 분류하였다. 세 군 간의 수술 전후의 시력, 안압, 녹내장 약제 개수와 수술 성공률 및 합병증을 비교하였다. 결과: 섬유주절제술 후 1년간의 추적관찰 동안 세 군 모두 수술 전에 비해 유의한 안압하강과 녹내장약제 개수의 감소를 보였으나 각 군 간의 유의한 차이는 보이지 않았다. 수술 후 1년 성공률은 LE군 68.2%, RMX군 67.0%, PDA군 65.9%로 술 후 점안 스테로이드에 따른 수술 성공률의 차이는 없었고(p=0.88) 술 후 합병증도 유의한 차이는 보이지 않았다. 결론: 원발개방각녹내장 환자에서 섬유주절제술 후 1년 수술 성공률 및 합병증, 시력, 안압하강, 녹내장약제 개수의 감소에 있어 LE와 RMX는 PDA와 동등한 효과를 보였다. 따라서 원발개방각녹내장 환자에서 섬유주절제술 후 LE와 RMX 또한 효과적이며 안전하게 사용할 수 있을 것으로 생각된다.
Abstract
Purpose: To compare the surgical outcomes and intraocular pressure (IOP) reduction after trabeculectomy in patients with primary open-angle glaucoma (POAG) according to treatment with three different postoperative topical steroids. Methods: A total of 84 eyes of 84 patients who had undergone trabeculectomy for POAG and were followed-up at least 1 year were included in this study. According to the postoperative topical steroid treatment, the patients were divided into three groups involving 0.5% loteprednol etabonate (LE), 1% rimexolone (RMX), and 1% prednisolone acetate (PDA). The mean IOP change, mean number of topical anti-glaucoma medication changes, 1-year success rate, and complication percentage were compared among the three groups. Results: There were significant reductions in the IOP and number of anti-glaucoma medications during the postoperative 1-year follow-up in all of the groups (all, p < 0.05), but there were no differences among the three groups. Postoperative 1-year success rates (68.2% in the LE group, 67.0% in the RMX group, and 65.9% in the PDA group; p = 0.88) and complication percentages of trabeculectomy were not significantly different among the three groups. Conclusions: There were no statistical differences in the 1-year success rate, complication percentage, visual acuity, IOP, and number of anti-glaucoma medications among treatment regimens. LE and RMX were as effective and safe as PDA after trabeculectomy in patients with POAG.
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