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신생혈관 녹내장에서 Diode 레이저 모양체 광응고술과 Ahmed 녹내장밸브 삽입술의 치료효과 비교
김황기(Hwang-Ki Kim),손용호(Yong-Ho Sohn) 대한검안학회 2011 Annals of optometry and contact lens Vol.10 No.2
목적: 신생 혈관 녹내장을 치료하는데 녹내장 밸브 삽입술과 레이저 모양체 광응고술의 치료 효과와 유용성을 알아보고자 하였다. 대상과 방법: 신생혈관 녹내장으로 진단받고, 시술 후 6개월 이상 추적 관찰이 가능했던 환자 중 Nd:YAG 레이저 모양체 광응고술을 시술 받은 25명, 25안(1군)과 Ahmed 녹내장 밸브 삽입술을 받은 환자 23명, 25안(2군)의 병록 기록에서 시술 후 안압 조절 효과, 시력 변화, 합병증 등을 후향적으로 조사하여 두 가지 방법의 치료 효과를 비교분석하였다. 결과: 안압 하강 효과로 본 수술 성공률은 Ahmed 밸브 삽입술이 나은 성적을 보였다. 시술 후 시력이 변화가 없는 경우가 1군에서 24안(96%), 2군에서 18안(72%)이었고, 호전된 경우는 1군에서는 없고 2군에서 6안(24%), 악화된 경우는 두 군 모두 각각 1안(4%)이었다. 합병증으로는 1군에서 홍채모양체염 19안, 전방 출혈 9안, 안구통 5안, 각막상피 결손 1안, 안구로 1안 등이 있었고, 2군에서는 전방출혈 12안, 섬유막성 홍채모양체염 11안, 저안압 5안, 얕은 전방 5안, 안구통 2안, 각막상피결손 2안, 밸브관의 폐쇄 1안 등이 있었는데, 모두 보존적 치료로 호전되었다. 결론: 안압 조절 효과는 2군에서 더 나은 결과를 보였으나, 각각의 시술 특성에 맞는 적응증을 확립하고, 두 시술의 단점을 보완한다면 더 효과적으로 신생혈관 녹내장을 치료할 수 있으리라고 사료된다. Purpose: To investigate the therapeutic effect and the usefulness of diode laser trans-scleral cyclophotocoagulation and Ahmed valve implantation in the management of neovascular glaucoma. Methods: The medical records of the patients with neovascular glaucoma who had been treated with diode laser cyclophotocoagulation (group 1, 25 eyes of 25 patients) or Ahmed valve implantation (group 2, 25 eyes of 23 patients) with follow-up period of at least 6 months were reviewed retrospectively. Results: The therapeutic effects of these two different surgical options were compared and analyzed in terms of IOP (intraocular pressure)-lowering effect, vision preservation, and complications. As for IOP-lowering effect, the success rate is higher in Ahmed valve implantation group with statistical significance than in Diode laser cyclophotocoagulation group, except postoperative 3 and 4 months (Pearsons chi-square test, p<0.05). Twenty four eyes (96%) in group 1 (CPC) and eighteen eyes (72%) in group 2 (Shunt operation) kept their preoperative visual acuity after treatment. Improvements of visual acuity were noted in six eyes (24%) in group 2 and none of eyes in group 1. Reduced visual acuity were noted in one eye (4%) in each group respectively. Complications included iridocyclitis (76%), hyphema (36%), ocular pain (20%), corneal epithelial defect (4%), phthisis (4%) in group 1, and hyphema (48%), fibrinous iridocyclitis (44%), hypotony (29%), shallow anterior chamber (20%), ocular pain (8%), corneal epithelial defect (8%), blocked tube (4%) in group 2. All the complications were improved with the conservative treatment in both groups. Conclusions: Although intraocular pressure (IOP)-lowering effect was better and stable in group 2, neovascular glaucoma would be managed more effectively with establishing proper indications and complementing the demerits of each procedure.
포도막염에 의한 이차개방각녹내장에서 마이토마이신 섬유주절제술과 아메드밸브삽입술의 임상성적
김주연,심형섭,김황기,손용호.Joo Yeon Kim. MD. Hyoung Sub Shim. MD. Hwang Ki Kim. MD. Yong Ho Sohn. MD. PhD 대한안과학회 2010 대한안과학회지 Vol.51 No.4
Purpose: To assess and compare the clinical outcomes of primary trabeculectomy with mitomycin C and Ahmed valve implantation for secondary open-angle glaucoma following uveitis. Methods: This study was conducted retrospectively on 30 eyes of 25 patients with open-angle glaucoma secondary to uveitis that had undergone trabeculectomy with mitomycin C and 33 eyes of 24 patients that had undergone Ahmed valve implantation. The clinical outcome indicators used in this study were intraocular pressure (IOP), number of anti-glaucoma agents, surgical success rate and occurrence of complications. Results: Mean IOP and surgical success rate in patients who had undergone trabeculectomy with mitomycin C after a 12 month postoperative period were 14.0±8.2 mmHg and 76.7%, respectively, while those of patients with Ahmed valve implantation were 13.2±7.7 mmHg and 81.8%. The data did not show clinical significance. There was greater risk of surgical failure in patients at a younger age and/or with diabetes mellitus in cases of having gone through trabeculectomy with mitomycin C. Conclusions: Both trabeculectomy with mitomycon C and Ahmed valve implantation can be considered as primary surgical treatments for patients with open-angle glaucoma secondary to uveitis. However, trabeculectomy with mitomycin C should only be applied to a limited extent in patients that are young and/or have diabetes mellitus. J Korean Ophthalmol Soc 2010;51(4):575-580
폴리프로필렌과 실리콘 재질의 아메드 방수유출장치의 효과와 안전성 비교
배준성,이남호,김황기,손용호.Joon Sung Bae. M.D.. Nam Ho Lee. M.D.. Hwang Ki Kim. M.D.. Yong Ho Sohn. M.D.. Ph.D. 대한안과학회 2008 대한안과학회지 Vol.49 No.5
Purpose: To compare the safety and efficacy of polypropylene and silicone Ahmed glaucoma valves (AGVs). Methods: The medical records of 62 consecutive refractory glaucoma patients who had undergone AGV implantion from March 2003 to December 2005 were reviewed retrospectively. Among the 62 patients, 32 patients underwent polypropylene AGV implantation (group P) and the other 30 patients underwent silicone AGV implantation (group S). Postoperative IOP, the complication rate, and the success rate were compared between the two groups. Results: The life-table success rates for the group P were 81.3% at 6 months and 71.2% at 12 months, and the success rates for the group S were 89.9% at 6 months and 78.6% at 12 months, showing no significant difference between the two groups. Complications, including non-tube-related complications, were observed more frequently in the group S, but there was no significant difference between the two groups. Conclusions: The silicone AGV can reduce IOP effectively but may be associated with non-tube-related complications. J Korean Ophthalmol Soc 49(5):791-797, 2008
배숭환,권영아,김황기,손용호,Soong Hwan Bae,Young A Kwon,Hwang Ki Kim,Yong Ho Sohn 대한안과학회 2006 대한안과학회지 Vol.47 No.11
Purpose: This study examines the changes in axial length after trabeculectomy and Ahmed glaucoma valve implantation surgery. Methods: In the forty three eyes of the 42 patients who had the uncontrolled glaucoma, 22 eyes of 21 patients having trabeculectomy and 21 eyes of 21 patients having Ahmed glaucoma valve implantation from October 2004 to September 2005 at Kim`s Eye Hospital were analyzed prospectively. These patients had IOP and axial length measurements preoperatively, at 1 week, 1 month, and 3 months after surgery and refractive power measurements preoperatively, at 3 months after surgery. Axial length was measured by IOL Master?. Results: There was a statistically significant reduction in IOP after 3 months of 26.6±11.2 mmHg overall, 22.4±8.4 mmHg following trabeculectomy, and 30.9±12.3 mmHg after Ahmed glaucoma valve implatation (p<0.001). There was a statistically significant reduction in axial length after 3 months of -0.24±0.10 mm overall, -0.21±0.1 mm after trabeculectomy and -0.28±0.1 mm after Ahmed glaucoma valve implantation. Conclusions: There was a statistically significant decrease in axial length after both trabeculectomy and Ahmed glaucoma valve implantation. We must consider the influence of axial length change on refraction in planning combined glaucoma and cataract surgery or future IOL implantation.
포스너-슐로스만 증후군 환자에서 녹내장 발생의 임상 요인
박원호,정윤석,한계숙,손용호.Won-Ho Park. M.D.. Yoon-Suk Jung. M.D.. Kye-Sook Han. M.D.. Yong-Ho Sohn. M.D. 대한안과학회 2005 대한안과학회지 Vol.46 No.4
Purpose: To determine the factors that affect glaucomatous change and the clinical course of patients with Posner-Schlossman syndrome. Methods: A retrospective analysis of 52 eyes of 51 patients who had been diagnosed with Posner-Schossman syndrome between January 1995 and June 2003 was performed. We analysed the factors by the age of onset, the duration of disease, the number of attacks, the highest intraocular pressure, the cup/disc ratio of affected eye and unaffected fellow eye during attacks, and visual field change. Results: Twelve (23.1%) of 52 eyes revealed significant glaucomatous change. The number of attacks showed statistically significant difference between the two groups who had developed glaucoma and who had not (P=0.021). But the age of onset, the duration of disease, and the highest intraocular pressure during attack did not show statistically significant difference (P>0.1). Conclusions: From this study, we observed that the only factor influencing glaucomatous change in patients with Posner-Schlossman syndrome was the number of attacks. So in case of recurrent attacks, close observation and aggressive treatment is mandatory.