유리체절제술 후 장기 녹내장 발생률 비교
Long Term Incidence Rate of Glaucoma after Pars Plana Vitrectomy
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목적: 유리체절제술 후 녹내장 발생률을 살펴보고 무수정체안과 유수정체안에서 녹내장 발생률 차이에 대해 비교 분석하고자 하였다. 대상과 방법: 2007년 1월부터 2014년 5월까지 유리체절제술을 받은 환자를 대상으로 후향적으로 의무기록을 분석하였다. 술 후 녹내장 발생 여부를 조사하였으며 안저검사나 시신경모양 단층촬영에서 신경망막섬유층 결손이 관찰되는 경우, 시야검사에서 녹내장성시야 변화가 관찰되는 경우 녹내장으로 진단하였다. 결과: 총 333명 평균 연령 57.09 ± 13.43세의 유리체절제술을 받은 환자가 연구에 참여하였고, 평균 경과관찰 기간은 56.23 ± 10.85 개월이었다. 술 후 1일째 안압을 제외하고 나머지 경과관찰 기간 중에는 유리체절제술안과 비수술안 사이에 통계적으로 유의한 차이가 없었다. 비수술안 315안 중 10안, 유리체절제술을 받은 351안 중 69안이 경과관찰 중 녹내장으로 진단 받았고 두 군 사이에 녹내장 발생에 유의한 차이가 있었다(p＜0.01, Chi square test). 녹내장으로 진단 받은 유리체절제술안이 정상 유리체절제술안에 비해 유의하게 높은 안압이 관찰되었다(p＜0.001, Repeated Measures Analysis of variance [RM-ANOVA]). 백내장 수술 여부가 녹내장으로 진행 가능한 위험인자로 분석되었다(p=0.0497, Chi square test). 결론: 유리체절제술 환자에서 녹내장 발생률이 증가하며, 위수정체안의 경우 녹내장 발생을 더욱 증가시킬 수 있다. 따라서 유리체절제술 환자, 특히 백내장 수술을 동시에 시행 받은 환자의 경우 정기적인 안압 측정 및 적절한 처치가 필요하다.
Abstract
Purpose: To evaluate the incidence rate of postoperative glaucoma after pars plana vitrectomy (PPV) and to compare incidence rate of glaucoma between phakic and pseudophakic eyes. Methods: Retrospective chart review of patients who underwent PPV between January 2007 and May 2014. The outcome measure was the presence or absence of postoperative glaucoma, defined as definitive loss of neuro-retinal rim defect on fundus exam or showing glaucomatous change on a visual field test that warranted maintenance of ocular hypotensive therapy. Results: There were 333 patients average age 57.09 ± 13.43 included this study. Patients were followed for an average of 56.23 ± 10.85 months. There was no significant difference in mean intra ocular pressure (IOP) between the vitretomized eyes with unoperative eyes, except in mean IOP at one day postoperatively (p = 0.012). In unoperative eyes, 10 of 315 (3.1%) were newly diagnosed as postoperative glaucoma. For the vitrectomized eyes, 69 of the 351 (19.6%) were newly diagnosed as postoperative glaucoma. There was a significant difference in incidence rate of glaucoma between the two groups (p < 0.001, chi-square test). There was a significantly higher IOP in glaucoma eyes compared with normal eyes (p < 0.001, Repeated Measures Analysis of variance [RM-ANOVA]). A possible risk factor for the development of glaucoma after PPV was cataract surgery (p = 0.0497, chi-square test). Conclusions: The incidence of glaucoma in patients with PPV is higher than in normal eyes. The incidence seems to increase particularly in those who have a pesudophakic eye. Patients who underwent PPV, especially in the pseudophakic state, need to have their IOP monitored carefully and managed properly by an ophthalmologist.
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