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마이토마이신을 사용한 섬유주절제술 후 여과포 관리에 대한 석상 봉합의 유용성

The Usefulness of External Bandage Suture for Management of Bleb after Trabeculectomy with Mitomycin C

임진호|김상우|우제문|안재환|이승주
대한안과학회 (The Korean Ophthalmological Society)|2013.02|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제54권 제2호|pp. 272-279

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키워드

LeakageTrabeculectomyHypotonyExternal bandage sutureHyperfiltration
주제분류안과학

초록

목적: 마이토마이신을 보조적으로 사용한 섬유주절제술에서 술 후 여과포 관리에 대한 석상 봉합의 유용성에 대하여 알아보고자 한다. 대상과 방법: 섬유주절제술을 시행한 후, 과여과 및 국소 누출로 인한 지속적인 저안압 또는 저안압 황반병증이 발생한 경우와 과여과로인하여 심한 여과포의 부종이 지속되는 10명의 환자를 대상으로 석상 봉합을 시행하여 술 전과 술 후 4주 차의 안압 변화 및 합병증유무를 관찰하였다. 결과: 석상봉합을 시행하기 전 평균 안압은 5.8 ± 2.0 (3.0-9.0) mmHg, 시행한 후 평균 안압은 14.1 ± 8.5 (4.0-32.0) mmHg으로통계학적으로 유의 있게 증가하였다(p=0.008). 시술 후 시력은 전반적으로 증가하는 소견을 보였으나 통계적으로 유의하지는 않았으며, 1명의 환자에서 무혈관 여과포에서 지속되는 국소 누출 소견을 보여 무혈관 결막을 제거하고 결막 전진술을 시행하였다. 결론: 석상봉합은 여과포에 최소한의 영향으로 국소 누출 및 과여과를 교정함으로써 섬유주절제술 후 발생하는 저안압 및 과도한 결막부종의 교정에 좋은 대안이 될 수 있다.

Abstract

Purpose: To evaluate the usefulness of external bandage suture for bleb-related management that follows trabeculectomy with mitomycin C. Methods: External bandage sutures were performed on 10 patients having hypotony maculopathy, persistent low intraocular pressure (IOP) caused by either hyperfiltration or focal leakage, or a persisting large bleb caused by hyperfiltration and who received trabeculectomy using mitomycin C as an adjuvant treatment. The changes in IOP measured before and 4 weeks after the procedure along with complication incidences were evaluated. Results: The mean IOP 4 weeks after the procedure compared with the mean IOP prior to the procedure increased from 5.8 ± 2.0 mm Hg (3.0-9.0 mm Hg) to 14.1 ± 8.5 mm Hg (4.0-32.0 mm Hg), with statistical significance (p = 0.008). After the procedure, improvement in visual acuity was observed but without statistical significance. One patient had persistent focal leakage from an avascular bleb and conjunctival advancement with removal of the avascular conjunctiva was performed. Conclusions: An external bandage suture can be a good alternative for correction of post-trabeculectomy hypotony and severe chemosis with minimal effect on blebs while correcting focal leakage and hyperfiltration.

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