생분해성 콜라겐 기질을 이용한 섬유주절제술 2예
Trabeculectomy With Biodegradable Collagen Material: A Report of Two Cases
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목적: 여러 차례 안과 수술 병력이 있는 2명의 젊은 환자에서 최근 출시된 생분해성 콜라겐 기질을 이용하여 시행한 섬유주절제술의단기 관찰의 결과를 보고하고자 한다. 증례요약: 당뇨망막병증과 유리체출혈로 유리체절제술과 공막돌륭술을 시행한 후 안압상승을 보이는 43세 여자 환자에게 mitomycin C (MMC)와 콜라겐 기질을 사용하여 섬유주절제술을 시행하였고, 망막박리로 유리체절제술과 공막돌륭술을 시행한 후 안압상승을 보이는 28세 여자 환자에게 MMC를 이용한 섬유주절제술 시행 후 저안압이 발생하여 콜라겐 기질을 결막하 공간에 삽입하였다. 첫번째증례는 술 후 3개월에 안압 상승하여 needling을 시행하고, 술 후 8개월까지 안압하강제(CosoptⓇ, XalatanⓇ)를 사용하면서 16-19 mmHg 으로 유지되었다. 두번째 증례는 술 후 1주 안압상승 이후 안압하강제(CombiganⓇ)를 사용하면서 술 후 9개월까지 14-21 mmHg으로유지되었다. 결론: 섬유주절제술시 생분해성 콜라겐 기질을 사용하는 것이 저안압 예방과 여과포 유지에 도움이 되며, 특히 고위험군에서 MMC 등의 항대사제와 함께 사용함으로써 수술 실패를 줄일 수 있을 것이다.
Abstract
Purpose: To report two cases of trabeculectomy with biodegradable collagen material conducted on two post-vitrectomy patients. Case summary: The first patient was a 43-year-old woman with uncontrolled increased intraocular pressure (IOP) after pars plana vitrectomy with scleral buckling for diabetic retinopathy and vitreous hemorrhage. Another patient, a 28-year-old woman with aphakia, also had uncontrolled increased IOP after pars plana vitrectomy with encircling scleral buckling for retinal detachment. For both of these patients, we performed trabeculectomy using mitomycin C and recently developed biodegradable collagen matrix. In the first case, the IOP was increased three months after the surgery, for which needling was done. After needling,the IOP was well controlled in the range of 16 to 19 mmHg up to eight months postoperatively with stilling anti-glaucomatous eyedrops (CosoptⓇ, XalatanⓇ). In the second case, IOPwas increased one week after the surgery, but it was well controlled between 14 to 21 mmHg up to nine months postoperatively with anti-glaucomatous eye drops (CombiganⓇ). Conclusions: Biodegradable collagen matrix can possibly reduce the surgical failure of trabeculectomy and it is especially suitable for high risk patients when combined with anti-metabolic agents like MMC.
참고문헌 (8)
- Teng CC, "Histology and mechanism of filtering operations", Am J Ophthalmol, 47, pp.16~33 (1959)
- Addicks EM, "Histologic characteristics of filtering blebs in glaucomatous eyes", Arch Ophthalmol, 101, pp.795~798 (1983)
- Kitazawa Y, "Trabeculectomy with Mitomycin", Arch Ophthalmol, 109, pp.1693~1698 (1991)
- Skuta GL, "Intraoperative mitomycin versus postoperative 5-fluorouracil in high risk glaucoma filtering surgery", Ophthalmology, 99, pp.438~440 (1992)
- Cairns JE, "Trabeculectomy-preliminary report of a new method", Am J Ophthalmol, 66, pp.673~679 (1968)
- Chen HS, "Control of filtering bleb structure through tissue bioengineering: An animal model", Invest Ophthalmol Vis Sci, 47, pp.5310~5314 (2006)
- Dietlein TS, "Modern concepts in antiglaucomatous implant surgery", Graefes Arch Clin Exp Ophthalmol, 246, pp.1653~1664 (2008)
- Aptel F, "Ultrasound biomicroscopy and optical coherence tomography imaging of filtering blebs after deep sclerectomy with new collagen implant", Eur J Ophthalmol, 19, pp.223~230 (2009)