난치성 신생혈관 녹내장에서 유리체강내 베바시주맙과 구후 트리암시놀론 동시 주사 효과
Effect of Simultaneous Intravitreal Bevacizumab and Retrobulbar Triamcinolone Injection in Refractory Neovascular Glaucoma
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목적: 시력회복 가능성이 없는 신생혈관 녹내장 환자에서 유리체강내 베바시주맙과 구후 트리암시놀론 주사를 한 후 그 효과를 알아보고자 하였다. 대상과 방법: 2008년 10월부터 2009년 5월까지 본원 안과에서 신생혈관 녹내장으로 진단 받은 환자 중 시력회복의 가능성이 없고,안압 상승과 통증을 동반하였으나 녹내장 수술을 받지 못한 환자 15명 15안을 대상으로 주사 전 후 안압 및 통증 정도, 신생혈관의변화, 시력변화를 조사하였다. 결과: 15명의 환자 중 남자는 10명, 여자는 5명이었고, 평균 연령은 62.50±12.79세였다. 원인 질환으로는 당뇨가 9명으로 가장 많았고,중심망막정맥폐쇄 4명, 중심망막동맥폐쇄 1명, 포도막염 1명이 있었다. 주사 후 안압은 유의한 감소를 보였고(p＜0.001), 통증 정도,결막충혈 정도도 유의하게 감소되었다(p＜0.001, ＜0.001). 또한 신생혈관의 퇴행은 1회 주사 후 2달째, 13안(87%)에서 퇴행상태가유지되었다. 결론: 유리체강내 베바시주맙과 구후 트리암시놀론 동시 주사는 난치성 신생혈관 녹내장 환자에게서 어느 정도 안압 하강을 유도하거나 통증을 경감시킬 수 있는 간단한 치료라 생각된다.
Abstract
Purpose: To identify the regression of neovascularization and relief of other symptoms after intravitreal bevacizumab and retrobulbar triamcinolone injection in neovascular glaucoma patients with no possibility of visual acuity recovery. Methods: A total of 15 eyes in 15 patients with neovascular glaucoma, who had no possibility of visual acuity recovery and could not be treated with surgical intervention despite pain from October 2008 to May 2009, were reviewed retrospectively. Changes in degree of pain, conjunctival injection, revascularization, and visual acuity were evaluated after injection. Results: Ten of the 15 (67%) neovascular glaucoma patients were male, with a mean age of 62.50±12.79 years. The most common prediposing ocular disease was diabetic retinopathy (9; 60%), and the others were central retinal vein occlusion (4: 26%),central retinal artery occlusion (1; 7%), and uveitis (1; 7%). Change in intraocular pressure was significant (p＜0.001), as were decreases in the degrees of pain and conjunctival injection (p＜0.001, <0.001) after the injections. Regression of neovascularization continued in 13 patients (87%) after two months. Conclusions: Intravitreal bevacizumab and retrobulbar triamcinolone injection is a safe intervention that can substantially relieve pain experienced by neovascular glaucoma patients.
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