섬유주절제술 후 홍채절개부를 통한 유리체탈출 1예
A Case of Vitreous Prolapse through Iridectomy Site after Trabeculectomy
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목적: 원발개방각녹내장 환자에서 섬유주절제술 후 홍채절개부를 통해 탈출한 유리체가 섬유주절제부위를 폐쇄시켜 안압이 상승한환자에서 앞유리체절제술의 치료효과를 보고하고자 한다. 증례요약: 약물로 안압이 조절되지 않는 인공수정체안 원발개방각녹내장 환자에게 섬유주절제술을 시행하였다. 수술 후 3개월부터 점차여과포가 소실되고 안압이 증가하여 앞방각경검사를 시행한 결과 홍채절개부를 통해 유리체가 앞방 내로 탈출되어 섬유주절제부위가폐쇄된 소견을 발견하였다. 약물치료와 야그레이저를 이용한 유리체가닥절단을 시도하였으나 실패하였고 안압이 조절되지 않아 앞유리체절제술을 시행하여 앞방으로 탈출된 유리체를 제거하였다. 앞유리제절제술 시행 후 여과포가 기능을 회복하였고 안압이 정상화되어경과관찰 중이다. 결론: 섬유주절제술 후 앞방 내로 유리체가 탈출되어 섬유주절제부위를 폐쇄시키는 합병증은 흔치 않은 수술 후 합병증으로 앞유리체절제술만으로 좋은 치료효과를 경험하였기에 보고하는 바이다.
Abstract
Purpose: To report the results of anterior vitrectomy for obstruction of the aqueous outflow shunt by prolapsed vitreous strands after trabeculectomy. Case summary: Trabeculectomy was performed on a pseudophakic primary open angle glaucoma patient with uncontrolled intraocular pressure under maximum tolerable medical therapy. Three months after trabeculectomy, the bleb flattened and the intraocular pressure elevated. On gonioscopic examination, vitreous strands prolapsed through the iridectomy site obstructing the inner ostium. The maximum tolerable medical therapy and Nd:YAG laser vitreolysis were attempted, but the intraocular pressure was not controlled. Anterior vitrectomy was performed to remove the prolapsed vitreous strands. After anterior vitrectomy, the bleb regained filtering function and the intraocular pressure was stabilized. Conclusions: In a case with a prolapsed vitreous into the anterior chamber obstructing the outflow shunt of the aqueous humor after trabeculectomy, anterior vitrectomy showed therapeutic effects.
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