섬유주절제술과 심부 공막 절제술 이후 발생하는 수술로 인한 각막 난시의 변화 비교
Comparison of Surgically Induced Corneal Astigmatism Following Trabeculectomy and Deep Sclerectomy with Collagen Implant
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목적: 개방각 녹내장에서 섬유주절제술과 심부 공막절제술 후 발생한 각막 난시를 비교하였다. 대상과 방법: 2001년 1월부터 2003년 12월까지 시행 받은 섬유주절제술 16안, 심부 공막절제술 21안의 술 전, 술 후 1일, 1주, 1개월,3개월, 6개월, 1년째 측정한 시력, 안압, 각막 곡률값을 후향적으로 비교 분석하였다. 술 후 각막 난시의 변화는 벡터 분석 방법을 사용하였고, 마이토마이신 사용 여부, 진단명, 술 후 안압 등에 따른 세부 분석을 시행하였다. 결과: 섬유주절제술 군 평균 연령이 심부 공막절제술보다 높았다(51.63 ± 12.73 vs. 39.95 ± 15.09, p=0.015). 두 군 모두 시력은 수술직후 감소하였다 서서히 회복하였고, 술 후 1달, 6달의 안압은 섬유주절제술 군에서 더 낮았다(p=0.046, 0.029). 술 후 발생한 각막난시의 두 군간 유의한 차이는 없었고, 시간이 지나면서 줄어들었다. 수술 직후 직난시 경향을 보였고, 심부 공막절제술 군에서 마이토마이신을 사용한 경우 각막 난시 발생이 적었다. 결론: 섬유주절제술과 심부 공막절제술 후 발생한 각막 난시는 수술 방법에 따른 유의한 차이는 없었다.
Abstract
Purpose: To compare surgically induced corneal astigmatism following trabeculectomy versus deep sclerectomy and collagen implant (DSCI). Methods: 37 consecutive eyes of 28 patients having glaucoma surgeries for uncontrolled open-angle glaucoma were retrospectively analyzed. 16 eyes had trabeculectomy and 21 eyes had DSCI. Visual acuity, intraocular pressure (IOP) and autorefractokeratometry of both groups were evaluated preoperatively and 1, 7 days, 1, 3, 6, 12 months postoperatively. Postoperative changes in corneal astigmatism were evaluated using vector analysis. Results: Mean age was 51.63 ± 12.73 years in the trabeculectomy group and 39.95 ± 15.09 years in the DSCI group and differed between groups (p = 0.015). Visual acuity was significantly decreased after surgery compared with preoperative values and was improved slowly in both groups. Intraocular pressure was lower in the trabeculectomy group than in the DSCI group at postoperatively 1 and 6 months (p = 0.046 and 0.029, respectively). There was no significant difference in surgically induced corneal astigmatisms (SIA) between both surgeries, which decreased over time in the group with stable postoperative IOP. They showed with-the-rule astigmatism immediate postoperatively. The DSCI group with MMC showed less SIA than the group without MMC. Conclusions: Surgically induced astigmatisms following trabeculectomy and deep sclerectomy with collagen implant were not differ significantly between two surgeries.
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