섬유주절제술 후 여과포형성에 실패한 환자에서 마이토마이신씨를 이용한 주사침복원술의 효과

• Published in: Daihan angwa haghoi jabji Vol. 47; no. 7; pp. 1087 - 1092
• Main Authors: 노인호, In Ho Roh, 형성민, Sung Min Hyung
• Format: Journal Article
• Language: Korean
• Published: 대한안과학회 31.07.2006
• Subjects: Filtering bleb; Mitomycin C; Needle revision; Needle revision; Filtering bleb; Mitomycin C
• ISSN: 0378-6471

목적 : 섬유주절제술 후 시행한 주사침복원술(needle revision, NR)에서 마이토마이신씨(mitomycin C, MMC) 결막하주사의 효과와 실패인자에 대하여 알아보고 하였다. 대상과 방법 : 섬유주절제술 후 실패한 환자를 세극등현미경 하에서 26G 주사바늘로 NR을 시행하였다. 16안은 NR만, 15안은 MMC를 결막하 주사하였다. 결과 : 각 눈에 1.6±1.6회의 NR을 시행하였으며, 섬유주절제술 후 첫 번째 NR은 1.3±1.2개월에 하였고, 마지막 NR 후 관찰기간은 평균 24.4±20.4개월이었다. 시술 전 안압은 27.9±11.6㎜Hg였고 최종 관찰 시는 18.8±13.0㎜Hg였다(p=0.005). 18㎜Hg이하로 유지된 경우는, NR만 시행한 군은 62.5%, MMC를 결막하 주사한 군은 100% (p=0.018)로, 전체 성공률은 80.3%였다. 또한, 섬유주절제술 시 MMC를 사용하지 않은 눈(p=0.141)과 시술 전 안압이 25㎜Hg를 초과한 눈(p=0.173)에서 실패율이 높았다. 결론 : 섬유주절제술 후 실패한 경우 MMC를 이용한 NR은 여과포 재형성에 효과적이다. 그러나, 섬유주절제술 시 MMC를 사용하지 않은 경우와 NR 전 안압이 높은 경우는 NR 후에도 여과포형성에 실패하는 경향을 보였다.<한안지 47(7):1087-1092, 2006> Purpose: To evaluate the effects of needle revision (NR) with and without mitomycin C (MMC) for failed filtering blebs after trabeculectomy, and to identify risk factors for failure. Methods: Thirty-one eyes whose intraocular pressure (IOP) did not decrease after cutting of scleral flap sutures were recruited. NR was performed with a 26-gauge needle under a slit-lamp. Immediately following NR, 15 eyes received subconjunctival injection of 0.002㎎ (0.02㎎/ml) MMC at the adjacent conjunctiva. Results: First NR was done at 1.3±1.2 months (range, 0.2~6.5 months) after trabeculectomy, and a mean of 1.6±1.6 NRs per patient were done. The follow-up period was 24.4±20.4 months (range, 6.0~87.4 months) after the last NR. Pre-NR mean IOP was 27.9±11.6㎜Hg and post-NR final IOP was 18.8±13.0㎜Hg (p=0.005). The success rate, defined as IOP ≤18㎜Hg with or without medication, was 80.3% (25 eyes of 31 eyes). The success rate was higher in the group receiving NR with adjunctive MMC (100%) than in the group receiving NR without MMC (62.5%) (p=0.018). Patients who underwent trabeculectomy without adjunctive MMC and those who had pre-NR IOP >25㎜Hg showed a higher failure rate, though with no statistical significance (p=0.141 and p=0.173, respectively). Conclusions: NR followed by subconjunctival injection of MMC is an effective and safe method for the treatment of the failed filtering blebs after trabeculectomy. Trabeculectomy without adjunctive MMC and pre-NR IOP higher than 25㎜Hg were risk factors for failure of NR. J Korean Ophthalmol Soc 47(7):1087-1092, 2006