난치 녹내장에서 마이크로펄스 공막경유섬모체광응고술의 단기 임상효과
Short-term Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma Patients
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목적: 난치 녹내장환자를 대상으로 마이크로펄스 공막경유섬모체광응고술을 시행하여 그 효과를 알아보고자 하였다. 대상과 방법: 마이크로펄스 공막경유섬모체광응고술을 시행 후 6개월간 경과 관찰이 가능했던 난치 녹내장환자 23명 23안을 대상으로 의무기록을 후향적으로 분석하였다. 결과: 안압은 시술 전 39.3 ± 15.8 mmHg에서 6개월 뒤 23.8 ± 15.4 mmHg (p=0.002), 녹내장약물의 수는 시술 전 2.6 ± 0.6개에서 6개월 뒤 1.8 ± 1.1개로(p=0.018) 유의하게 감소하였다. 시술의 성공은 시술 후 안압이 6-21 mmHg이거나 20% 이상 하강한 경우로 정의하였으며, 6개월 뒤 성공률은 65.2%였다. 합병증으로는 결막하출혈 6안(26.1%), 통증 16안(69.6%), 전방염증 17안(73.9%) 및 저안압 2안(8.7%)이 발생하였다. 결론: 마이크로펄스 공막경유섬모체광응고술은 난치 녹내장환자에서 단기적으로 안압과 녹내장 약물의 수를 감소시키는 데 유용한 시술임을 보여주었다. 향후 최대의 효과 및 안전성을 제공할 수 있는 최적의 레이저 세팅에 대한 연구가 필요할 것으로 보인다.
Abstract
Purpose: We evaluated the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in refractory glaucoma patients. Methods: A retrospective chart review was performed for 23 eyes of 23 patients with refractory glaucoma who were followed for 6 months after MP-TSCPC. Results: The mean preoperative intraocular pressure (IOP) was 39.3 ± 15.8 mmHg and the mean number of antiglaucoma medications was 2.6 ± 0.6. Both significantly decreased at 6 months to 23.8 ± 15.4 mmHg (p = 0.002) and 1.8 ± 1.1 (p = 0.018). Surgical success was defined as a postoperative IOP decrease from 6-21 mmHg or more than 20% reduction from baseline. The success rate was 65.2% at 6 months. Complications of MP-TSCPC included subconjunctival hemorrhage in 6 eyes (26.1%), ocular pain in 16 eyes (69.6%), anterior chamber inflammation in 17 eyes (73.9%), and hypotony in 2 eyes (8.7%). Conclusions: MP-TSCPC in patients with refractory glaucoma showed a reduction in IOP and the number of antiglaucoma medications in the short-term. However, additional studies are needed to determine the optimal laser settings for maximum efficacy and safety.
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