한국인 연소성개방각녹내장 환자에서 섬유주절제술의 장기 성적
Long-Term Outcomes of Trabeculectomy in Korean Patients with Juvenile Open-Angle Glaucoma
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목적: 한국인 연소성개방각녹내장 환자에서 마이토마이신 C를 이용한 섬유주절제술의 성공률과 이에 영향을 미치는 인자에 대하여알아보았다. 대상과 방법: 2004년 1월부터 2013년 1월까지 섬유주절제술을 시행받은 연소성녹내장 환자 29명 29안의 의무기록을 후향적으로 분석하였다. 수술 전과 술 후 1주, 1, 3, 6, 12개월째와 18개월 이후 마지막 방문시의 안압을 기록하고, 합병증 발생 여부를 조사하였다. 수술성공은 약물사용 여부와 관계 없이 안압이 21 mmHg 이하거나 수술 전 안압보다 20% 이상 하강한 경우로 정의하였다. 수술실패와관련된 위험인자를 Cox 비례위험회귀분석으로 알아보았다. 결과: 평균연령은 24.6 (± 8.9)세였고, 평균 추적관찰 기간은 24.3 (± 20.8)개월이었다. 총 추적관찰 기간동안 전반적인 수술의 성공률은 82.8%였고, 카플란-마이어 생존분석법을 통해 구한 수술의 누적성공률은 1년째 100%, 2년째 87.4% 3년째 78.7%이었다. Cox 비례위험회귀분석 결과 수술실패와 유의한 관련성을 보이는 인자는 찾을 수 없었다. 술 후 합병증으로는 수술 직후 저안압(n=19, 65.5%),저안압성 황반병증(n=8, 27.6%), 테논낭포(n=8, 27.6%)가 가장 빈번하게 관찰되었으며, 대부분에서 추가적인 시술 또는 경과 관찰로모두 호전되었고, 테논낭포가 관찰되었던 8안 중 2안은 재수술이 필요하였다. 시력에 영구적으로 영향을 미칠만한 합병증은 관찰되지않았다. 결론: 한국인 연소성개방각녹내장에서 마이토마이신 C를 이용한 섬유주 절제술은 효과적인 치료방법으로 생각된다.
Abstract
Purpose: To evaluate the outcomes and prognostic factors of trabeculectomy with mitomycin C in Korean patients with juvenileopen-angle glaucoma (JOAG). Methods: A retrospective review was performed on 29 eyes with JOAG who had undergone trabeculectomy betweenJanuary 2004 and January 2013. Intraocular pressure (IOP) and postoperative complications were monitored at 1 day preoperatively,at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively, and at final follow-up afterpostoperative 18 months. Surgical success was defined as a final IOP of <21 mm Hg or <80% of preoperative IOP, regardlessof the use of anti-glaucoma medication. Prognostic factors for surgical success or failure were analyzed by the Coxproportional hazards model. Results: Mean (± standard deviation) age at trabeculectomy was 24.6 (± 8.9) years, and mean follow-up period was 24.3(± 20.8) months. The overall success rate was 82.8% at final follow-up. The Kaplan-Meier cumulative probabilities of surgicalsuccess were 100% at 1 year, 87.4% at 2 years, and 78.7% at 3 years postoperatively. The Cox proportional hazardsmodel failed to determine any significant factors that were associated with surgical failure. The three most frequent postoperativecomplications were immediately postoperative hypotony (n = 19, 65.5%), hypotony maculopathy (n = 8, 27.6%),and encapsulated bleb (n = 8, 27.6%), most of which were resolved after a minor procedure or observation. Two of 8 eyeswith encapsulated bleb required a second surgery. There were no vision-threatening severe complications. Conclusions: Trabeculectomy with MMC may be an effective treatment in Korean JOAG patients.
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