유리체절제술과 가스주입술 후 체위에 따른 안압의 변화
Postural Effect on Intraocular Pressure in Gas-Filled Eyes after Vitrectomy
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목적: 유리체절제술과 눈속가스충전술을 시행한 환자에서 자세에 따른 안압의 변화를 알아보았다. 대상과 방법: 수술을 받지 않은 환자들을 1군, 백내장수술을 받은 환자를 2군, 유리체절제술과 백내장 수술을 받은 환자를 3군, 유리체절제술, 백내장 수술, 눈속가스충전술을 받은 환자를 4군으로 정하고 비접촉안압계, 골드만압평안압계, 전자식안압계로 앉은 자세에서안압을 측정하였다. 전자식안압계를 이용하여 바로 누운 자세와 엎드린 자세에서도 안압을 측정해 보았다. 결과: 앉은 자세에서 측정한 안압은 네 군 간에 차이가 없었다. 네 군 모두 앉은 자세에 비해 바로 누운 경우 평균 2.04 mmHg 엎드린경우 평균 2.06 mmHg 증가했다. 누운 자세와 앉은 자세 간의 안압 차이는 4군에서 3.61 mmHg로 1, 2, 3군의 평균 1.55 mmHg보다유의하게 높았다(p=0.003, ANOVA test). 엎드린 자세와 앉은 자세 간의 안압 차이 또한 다른 군에 비해 4군에서 3.82 mmHg로 유의하게 높았다(p=0.001, ANOVA test). 결론: 유리체절제술 및 눈속가스충전술을 시행한 경우 앉은 자세에서 엎드린 자세로 변화할 때 평균 3.8 mmHg의 안압이 증가하였다. 눈속가스충전술 후 일정 기간 동안 엎드린 자세를 유지해야 하므로 자세에 따른 안압상승을 고려해야 한다.
Abstract
Purpose: To assess the influence of body position on intraocular pressure (IOP) in patients who underwent vitrectomy and intraocular gas tamponade. Methods: Patients who did not undergo any surgery were defined as Group 1. The remaining patients were divided into 3groups according to the surgery performed (Group 2; cataract surgery, Group 3; vitrectomy and cataract surgery, Group 4;vitrectomy with intraocular gas tamponade and cataract surgery). IOP was measured by a non-contact tonometer,Goldmann applanation tonometer, and Tono-Pen in the sitting, supine, and prone positions. Results: The difference of IOP measured in the sitting position among the 4 groups was not significant. IOP was significantly elevated by 2.04 mm Hg on average when the posture was changed from sitting to supine or prone in all 4groups. The IOP discrepancy between supine and sitting positions was significantly greater in group 4 by 3.61 mm Hg than the other groups (p = 0.003, ANOVA test). The IOP difference between the prone and sitting position was also significantly higher in group 4 by 3.82 mm Hg than the other groups (p = 0.001, ANOVA test). Conclusions: The patients with vitrectomized gas tamponade eyes had a mean IOP increase of 3.82 mm Hg when the position was changed from sitting to prone. When performing vitrectomy and intraocular gas tamponade on patients in the prone position, an IOP elevation should be monitored thoroughly.
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