무봉합 유리체절제술 후 발생한 신생혈관녹내장 환자에서 시행한 섬유주절제술의 수술 성적
Intravitreal Bevacizumab and Subsequent Trabeculectomy with Mitomycin C for Neovascular Glaucoma with Previous Sutureless Vitrectomy
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 23게이지 경결막 무봉합 유리체절제술 후 발생한 신생혈관녹내장 환자에서 유리체강내 베바시주맙 주입술 후 시행한 섬유주절제술의 수술 성적을 알아보고자 하였다. 대상과 방법: 내과적 치료에 반응하지 않는 신생혈관녹내장 환자를 대상으로 유리체강내 베바시주맙(1.25 mg/0.05 mL)을 주입 후, 마이토마이신 C를 이용한 섬유주절제술을 시행하였다. 술 후 경과관찰 기간이 최소 6개월 이상인 환자들을 대상으로 이전 무봉합유리체절제술 시행 여부에 따라 무봉합 유리체절제술군과 대조군으로 나누고 Kaplan-Meier 생존분석을 이용하여 무봉합 유리체절제술이 섬유주절제술의 수술 성적에 미치는 영향에 대해 분석하였다. 결과: 무봉합 유리체절제술 시행안은 12명 12안, 대조군은 15명 15안이었다. 무봉합 유리체절제술군과 대조군의 수술 후 12개월 성공률은 각각 82.5%, 73.3%였고, 두 군 간 성공률의 차이는 없었다(p=0.523). 수술 전 평균 안압은 무봉합 유리체절제술군과 대조군 사이에는 유의한 차이가 없었고(p=0.347), 수술 후 마지막 방문 시 안압도 두 군 사이에 유의한 차이가 없었다(p=0.300). 두 군 모두에서 수술 후 마지막 방문 시의 안압은 수술 전에 비하여 유의하게 감소하였다(p=0.002, p=0.001). 결론: 본 연구를 통하여 이전 무봉합 유리체절제술 여부에 관계없이 신생혈관녹내장에서 유리체강내 베바시주맙 주입술 후 시행하는 섬유주절제술은 안압을 하강시키는 데 도움이 됨을 알 수 있었다.
Abstract
Purpose: To evaluate the efficacy of intravitreal bevacizumab and subsequent trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG) in eyes that underwent previous 23-gauge transconjunctival sutureless vitrectomy (TSV). Methods: This was a retrospective, comparative, and consecutive case series study. We reviewed the medical records of patients with NVG who underwent trabeculectomy with MMC after intravitreal bevacizumab (1.25 mg/0.05 mL) injection and compared the surgical outcomes according to 23-gauge TSV history. Surgical success was defined as an intraocular pressure (IOP) of ≥6 mm Hg and ≤21 mm Hg without additional glaucoma surgery or loss of light perception. The main outcome measures were postoperative IOP control, visual acuity, and complications. Results: A total of 27 patients (27 eyes) were included; 12 patients with 23-gauge TSV history (TSV group) and 15 patients without vitrectomy history (nonvitrectomized group). The cumulative probability of success after trabeculectomy with MMC was 82.5% and 73.3% after one year for the TSV group and the nonvitrectomized group, respectively (p = 0.523). Mean IOP decreased from 37.3 ± 9.0 mm Hg preoperatively to 12.8 ± 6.2 mmHg at the final visit in the TSV group (p = 0.002). Mean IOP decreased from 40.3 ± 9.7 mm Hg preoperatively to 17.8 ± 11.7 mm Hg at the final visit in the nonvitrectomized group (p = 0.001). Preoperative and final IOP were not significantly different between the two groups. Complications were comparable between the groups. Conclusions: Intravitreal bevacizumab injection and subsequent trabeculectomy with MMC is an effective method for controlling IOP in patients with NVG associated with sutureless vitrectomy.
참고문헌 (24)
- Goto A., "Frequency and risk factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy", J Glaucoma, 22, pp.572~576 (2013)
- Broadway DC., "Local effects of previous conjunctival incisional surgery and the subsequent outcome of filtration surgery", Am J Ophthalmol, 125, pp.805~818 (1998)
- Broadway DC., "Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva", J Glaucoma, 10, pp.237~249 (2001)
- Takihara Y., "Trabeculectomy with mitomycin C for neovascular glaucoma: prognostic factors for surgical failure", Am J Ophthalmol, 147, pp.912.e1~918.e1 (2009)
- Kiuchi Y., "Trabeculectomy with mitomycin C for treatment of neovascular glaucoma in diabetic patients", Ophthalmologica, 220, pp.383~388 (2006)
- Nissen NN., "Vascular endothelial growth factor mediates angiogenic activity during the proliferative phase of wound healing", Am J Pathol, 152, pp.1445~1452 (1998)
- Hu DN., "Vascular endothelial growth factor is increased in aqueous humor of glaucomatous eyes", J Glaucoma, 11, pp.406~410 (2002)
- Tripathi RC., "Increased level of vascular endothelial growth factor in aqueous humor of patients with neovascular glaucoma", Ophthalmology, 105, pp.232~237 (1998)
- 염명인, "증식성 당뇨망막병증의 유리체절제술 후 신생혈관녹내장 발생의 예측 인자: 양안 비교 연구", 대한안과학회지, 56(8), pp.1229~1235 (2015), 대한안과학회
- Inoue T., "Prognostic risk factors for failure of trabeculectomy with mitomycin C after vitrectomy", Jpn J Ophthalmol, 56, pp.464~469 (2012)
- Yanyali A., "Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment", Int J Ophthalmol, 5, pp.226~230 (2012)
- Ahn SJ., "Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy", Eye(Lond), 26, pp.796~802 (2012)
- Alkawas AA., "Management of neovascular glaucoma with panretinal photocoagulation, intravitreal bevacizumab, and subsequent trabeculectomy with mitomycin C", J Glaucoma, 19, pp.622~626 (2010)
- Fakhraie G., "Surgical outcomes of intravitreal bevacizumab and guarded filtration surgery in neovascular glaucoma", J Glaucoma, 19, pp.212~218 (2010)
- Miki A., "One-year results of intravitreal bevacizumab as an adjunct to trabeculectomy for neovascular glaucoma in eyes with previous vitrectomy", Eye(Lond), 25, pp.658~659 (2011)
- 허현도, "신생혈관녹내장에서 베바시주맙의 전방과 유리체내 동시 주입과 유리체내 단독 주입의 치료 효과", 대한안과학회지, 55(7), pp.1039~1048 (2014), 대한안과학회
- 정희영, "증식당뇨망막병증 환자에서 유리체절제술 후신생혈관녹내장 발생의 위험인자 분석", 대한안과학회지, 54(12), pp.1868~1874 (2013), 대한안과학회
- Itakura H., "Persistent secretion of vascular endothelial growth factor into the vitreous cavity in proliferative diabetic retinopathy after vitrectomy", Ophthalmology, 111, pp.1880~1884 (2004)
- Chen CH., "Adjunctive intravitreal bevacizumab-combined trabeculectomy versus trabeculectomy alone in the treatment of neovascular glaucoma", J Ocul Pharmacol Ther, 26, pp.111~118 (2010)
- 이유현, "신생혈관녹내장 환자에서 섬유주절제술 전 유리체강내베바시주맙 주입술의 효과", 대한안과학회지, 56(6), pp.917~924 (2015), 대한안과학회
- Takihara Y., "Combined intravitreal bevacizumab and trabeculectomy with mitomycin C versus trabeculectomy with mitomycin C alone for neovascular glaucoma", J Glaucoma, 20, pp.196~201 (2011)
- Chilov MN., "Bevacizumab(Avastin)for the treatment of neovascular glaucoma", Clin Experiment Ophthalmol, 35, pp.494~496 (2007)
- Iliev ME., "Intravitreal bevacizumab(Avastin)in the treatment of neovascular glaucoma", Am J Ophthalmol, 142, pp.1054~1056 (2006)
- Li Z., "Inhibition of vascular endothelial growth factor reduces scar formation after glaucoma filtration surgery", Invest Ophthalmol Vis Sci, 50, pp.5217~5225 (2009)