프로스타글란딘계 점안제를 사용한 환자에서 마이토마이신씨가 섬유주절제술에 미치는 영향
Effects of Mitomycin C on Trabeculectomy Outcomes in Patients Who Preoperatively Used Prostaglandin Ophthalmic Solution
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 수술 전 프로스타글란딘(prostaglandin, PG)계 안압강하제를 사용한 원발개방각녹내장 환자에서, 섬유주절제술 시 마이토마이신씨(mitomycin C, MMC)를 사용하면 수술 성공률을 높일 수 있는지를 알아보고자 하였다. 대상과 방법: 원발개방각녹내장으로 섬유주절제술을 받은 환자 중 수술 전에 PG계 점안제를 사용 하지 않은 17명(A군)과, PG계 점안제를 3개월 이상 사용한 환자 중 수술 시 MMC를 사용하지 않은 10명(B군)과 MMC를 사용한 14명(C군)이 대상이었다. 안압강하제 사용여부에 관계없이 안압이 6 이상, 18 mmHg 이하인 경우 수술성공으로 정했다. 결과: 수술 후 4년 경과 시 누적수술성공률은 A와 B군, B와 C군 사이에는 유의한 차이가 있었으나(p=0.008, 0.036, Log rank test),A와 C군 사이에는 차이가 없었다(p=0.813, Log rank test). 결론: 섬유주절제술 이전에 PG계 점안제를 3개월 이상 사용한 원발개방각녹내장 환자는 PG 제제를 사용하지 않은 환자보다 누적수술성공률이 낮았다. 그러나 수술 중 MMC를 사용하면, 비슷한 누적수술성공률을 얻을 수 있다고 생각한다.
Abstract
Purpose: To investigate whether mitomycin C (MMC) results in an improved trabeculectomy outcome in primary open-angle glaucoma patients who preoperatively used prostaglandin (PG) ophthalmic solution. Methods: The subjects consisted of three groups of primary open-angle glaucoma patients who underwent trabeculectomy. Group A consisted of 17 patients who did not use PG ophthalmic solution preoperatively, while Group B consisted of ten patients who used PG ophthalmic solution for at least three months but were not treated with MMC during the operation,and Group C consisted of 14 patients who used PG ophthalmic solution for at least three months and were treated with MMC during the operation. The operation was considered successful when the intraocular pressure ranged from 6 to 18mmHg, regardless of application of ocular hypotensive agents. Results: Four years after the operation, differences of the cumulative success rate between Group A and B (p = 0.008) and between Group B and Group C (p = 0.036) were statistically significant, but differences between Group A and C were not (p = 0.813) (Log rank test results). Conclusions: The cumulative success rate of trabeculectomy in primary open-angle glaucoma patients who used PG ophthalmic solution for at least three months was lower than that of patients who did not use PG ophthalmic solution. However,the intraoperative administration of MMC increased the cumulative success rate of trabeculectomy in patients who did use PG ophthalmic solution for at least three months to a level similar to patients who did not use PG ophthalmic solution.
참고문헌 (24)
- Friedman DS, "An evidence-based assessment of risk factors for the progression of ocular hypertension and glaucoma", Am J Ophthalmol, 138(3 Suppl), pp.19~31 (2004)
- Nouri-Mahdavi K, "Outcomes of trabeculectomy for primary open-angle glaucoma", Ophthalmology, 102, pp.1760~1769 (1995)
- Park JS, "The effect of topical antiglaucomatous medication on the outcome of trabeculectomy", J Korean Ophthalmol Soc, 40, pp.1352~1361 (1999)
- Wong TT, "Prolonged antiscarring effects of ilomastat and MMC after experimental glaucoma filtration surgery", Invest Ophthalmol Vis Sci, 46, pp.2018~2022 (2005)
- Chen CW., "Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin-C", Trans Asia Pacific Acad Ophthalmol, 9, pp.172~177 (1983)
- Sherwood MB, "Long-term morphologic effects of antiglaucoma drugs on the conjunctiva and Tenon’s capsule in glaucomatous patients", Ophthalmology, 96, pp.327~335 (1989)
- Johnson DH, "The effect of long-term medical therapy on the outcome of filtration surgery", Am J Ophthalmol, 117, pp.139~148 (1994)
- Broadway DC, "Adverse effects of topical antiglaucoma medication. Ⅱ. The outcome of filtration surgery", Arch Ophthalmol, 112, pp.1446~1454 (1994)
- Gwynn DR, "Conjunctival structure and cell counts and the results of filtering surgery", Am J Ophthalmol, 116, pp.464~468 (1993)
- Watson P, "A six-month, randomized, double- masked study comparing latanoprost with timolol in open-angle glaucoma and ocular hypertension. The Latanoprost Study Group", Ophthalmology, 103, pp.126~137 (1996)
- Nagasubramanian S, "Intraocular pressure-reducing effect of PhXA41 in ocular hypertension. Comparison of dose regimens", Ophthalmology, 100, pp.1305~1311 (1993)
- Feldman RM, "Conjunctival hyperemia and the use of topical prostaglandins in glaucoma and ocular hypertension", J Ocul Pharmacol Ther, 19, pp.23~35 (2003)
- "The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. The AGIS Investigators", Am J Ophthalmol, 130, pp.429~440 (2000)
- Cairns JE, "Trabeculectomy. Preliminary report of a new method", Am J Ophthalmol, 66, pp.673~679 (1968)
- WuDunn D, "A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy", Am J Ophthalmol, 134, pp.521~528 (2002)
- Goldenfeld M, "5-Fluorouracil in initial trabeculectomy. A prospective, randomized, multicenter study", Ophthalmology, 101, pp.1024~1029 (1994)
- Lee HK, "The additive effect of Xalatan (0.005% Latanoprost) to beta adrenergic receptor blocker in patients with open angle glaucoma", J Korean Ophthalmol Soc, 39, pp.169~176 (1998)
- Stewart WC, "Conjunctival hyperemia in healthy subjects after short-term dosing with latanoprost, bimatoprost, and travoprost", Am J Ophthalmol, 135, pp.314~320 (2003)
- Parrish RK, "A comparison of latanoprost, bimatoprost, and travoprost in patients with elevated intraocular pressure: a 12-week, randomized, masked-evaluator multicenter study", Am J Ophthalmol, 135, pp.688~703 (2003)
- Skuta GL, "Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery", Ophthalmology, 99, pp.438~444 (1992)
- Hong SJ, "The effects of mitomycin C on trabeculectomy", J Korean Ophthalmol Soc, 37, pp.1570~1575 (1996)
- 이종흔, "섬유주절제술 전 MMC 결막하주사의 수술 결과와 합병증", 대한안과학회지, 43(2), pp.10~302 (2002), 대한안과학회
- 송승, "녹내장 환자의 섬유주절제술에 대한 장기적 고찰", 대한안과학회지, 44(3), pp.21~684 (2003), 대한안과학회
- Hong C, "Effects of topical mitomycin C on glaucoma filtration surgery", Korean J Ophthalmol, 7, pp.1~10 (1993)