개방각 녹내장 환자와 폐쇄각 녹내장 환자에서 녹내장 삼중수술의 효과
Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma
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목적: 개방각 녹내장 환자와 폐쇄각 녹내장 환자에서 녹내장 삼중수술의 효과를 안압과 굴절력 측면에서 비교하였다. 대상과 방법: 개방각 녹내장과 폐쇄각 녹내장으로 녹내장 수술과 백내장 수술을 동시에 시행 받은 환자 중 1년 이상 추적관찰이 가능했던 환자들을 포함시켰다. 수술 전후의 시력, 안압, 시야, 굴절력, 안압약 사용 개수 및 합병증 발생 빈도 등을 측정하여, 수술 전후의안압 하강 정도, 굴절력 예측 오차 등을 비교하였다. 결과: 수술 후 1년째 안압은 개방각 녹내장과 폐쇄각 녹내장 환자군에서 각각 13.39 ± 2.25 mmHg, 13.41 ± 2.79 mmHg였고(p=0.981), 수술 전후 안압 변화(수술 후 안압-수술 전 안압)는 각각 4.51 ± 6.35 mmHg, 9.11 ± 8.27 mmHg로 유의미한 차이를보였다(p=0.042). 안압이 조절되지 않아 재수술을 시행한 경우는 두 그룹 모두 한 명도 없었다. 수술 후 안압이 수술 전에 비해 10%, 20% 이상 감소한 비율은 개방각 녹내장에 비해 폐쇄각 녹내장군에서 유의하게 높은 것으로 나타났다(p=0.035, p=0.013). 수술 후굴절률의 예측 오차는 개방각 녹내장과 폐쇄각 녹내장 환자에서 각각 -0.84 ± 0.88 D, -0.13 ± 0.65 D로 나타났다(p=0.008). 결론: 개방각 녹내장 환자와 폐쇄각 녹내장 환자 모두에서 녹내장 삼중수술은 효과적이나, 개방각 녹내장 환자보다 폐쇄각 녹내장환자에서 안압 하강의 정도와 굴절력 예측의 정확도가 더 좋을 것으로 생각된다.
Abstract
Purpose: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. Methods: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. Results: The IOP at 1 year postoperatively was 13.39 ± 2.25 mm Hg, 13.41 ± 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 ± 6.35 mm Hg, 9.11 ± 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 ± 0.88 D and -0.13 ± 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. Conclusions: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.
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