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신생혈관녹내장에서 시행된 아메드밸브삽입술과 23게이지 유리체절제술 병합술의 장기 성적 분석
정영호(Young Ho Jung),김용우(Yong Woo Kim),허장원(Jang Won Heo),박기호(Ki Ho Park),정진욱(Jin Wook Jeoung) 대한안과학회 2016 대한안과학회지 Vol.57 No.5
목적: 신생혈관녹내장안을 대상으로 시행한 아메드밸브삽입술과 23게이지 유리체절제술 병합 수술의 장기치료 성적을 분석해 보고자 하였다. 대상과 방법: 신생혈관녹내장 진단 후 아메드밸브삽입술과 유리체절제술 병합 수술 시행 후 최소 6개월 이상 경과 관찰한 35명 36안을 대상으로 수술 성공률, 합병증, 그리고 수술 생존기간에 영향을 주는 인자에 대해 후향적으로 분석하였다. 수술 후 녹내장약제의 사용과 무관하게 안압이 6-21 mmHg로 조절된 경우를 성공으로, 경과관찰 중 안압이 조절되지 않거나, 시력이 광각무로 변하면 실패로 정의하였다. 결과: 수술 후 평균 경과 관찰 기간은 34.0 ± 31.7개월이었다. 총 수술 성공률은 63.2%였고, 기간별 수술 성공률은 술 후 6개월에 83.3%, 1년에 72.7%, 그리고 3년에 63.2%였다. 수술로부터 안압 조절 실패 혹은 광각무로 변화까지의 기간을 생존 기간으로 정의하였을 때, 중심망막정맥폐쇄안(20.2 ± 30.5개월)이 증식당뇨망막병증안(33.1 ± 30.8개월)에 비해, 수술 전 유수정체안(18.8 ± 25.5개월)이 인공수정체안(37.7 ± 35.4개월)에 비해 수술 생존기간이 유의하게 짧았다(p<0.05). 다변량 분석에서 수술 전 유수정체안이 수술생존기간을 유의하게 단축시켰다(위험비=5.626, p=0.030). 결론: 신생혈관녹내장안을 대상으로 시행한 아메드밸브삽입술과 유리체절제술 병합 수술의 수술 3년 후 성적은 비교적 양호하였다. 수술 전 수정체 상태가 수술 생존 기간에 영향을 줄 수 있으므로 이에 대한 고려가 필요하겠다. Purpose: To investigate the surgical outcome of Ahmed glaucoma valve implantation (AVI) combined with 23-gauge vitrectomy in eyes with medically uncontrolled neovascular glaucoma (NVG). Methods: Thirty six eyes of 35 NVG patients who underwent AVI combined with 23-gauge vitrectomy and have been followed-up at least 6 months after surgery and were retrospectively reviewed. Surgical success was defined as the control of intraocular pressure (IOP) between 6 and 21 mm Hg, irrespective of the use of topical IOP lowering medications. Surgical failure was defined as the failure of IOP control or visual acuity aggravated to no light perception after the surgery. Overall success rate, median survival time, and clinical factors associated with survival time were investigated. Results: The overall success rate was 63.2% after a mean of 34.0 ± 31.7 months postoperative follow-up. The success rate was 83.3% at postoperative 6 months, 72.7% at postoperative 12 months and 63.2% at postoperative 3 years. The underlying retinal diseases were proliferative diabetic retinopathy (PDR, n = 20, 55.5%), central retinal vein occlusion (CRVO, n = 12, 33.3%), ocular ischemic syndrome (n = 2, 5.6%), and other retinal vascular diseases (n = 2, 5.6%). The survival times were significantly shorter in eyes with CRVO (20.2 ± 30.5 months) compared to PDR (33.1 ± 30.8 months), and in phakic eyes (33.1 ± 30.8 months) compared to pseudophakic eyes (37.7 ± 35.4 months) (p < 0.05). In the multivariate analysis, preoperative phakic eyes were significantly associated with a shorter survival time (hazard ratio = 5.626, p = 0.030). Conclusions: Combined surgery of Ahmed glaucoma valve implantation and 23-gauge vitrectomy showed favorable outcome in the treatment of medically uncontrolled NVG. Preoperative lens status may affect the long-term success rate in such patients.
두경부암에서 저용량 Cisplatin 기반 매주 요법의 항암방사선 동시치료의 독성과 예비 임상 결과
김태용(Tae-Yong Kim),김경주(Kyoung Ju Kim),김기환(Ki Hwan Kim),김지은(Ji Eun Kim),박선원(Sun-Won Park),오소원(So Won Oh),정영호(Young Ho Jung) 대한두경부종양학회 2011 대한두경부 종양학회지 Vol.27 No.1
Purpose:Concurrent chemoradiotherapy(CCRT) with 3 weekly cisplatin is the standard treatment of lo-cally advanced head and neck cancer(HNC). The aim is to evaluate the efficacy and toxicities of low-dose week-ly cisplatin-based CCRT, which was devised to reduce the toxicity of CCRT. Method:We retrospectively ana-lyzed HNC patients who received low-dose weekly cisplatin-based CCRT between 2008 and 2010. Cisplatin 35mg/m 2 was weekly given to all patients during radiotherapy. The efficacy was evaluated by the degree of clinical response, treatment failure and survival. The toxicity was evaluated by hematologic toxicities and oral mucositis. Results:A total of 27 patients were analyzed and median age was 59(range 31-81). The ratio of administered dose of radiotherapy and cisplatin to planned dose were 0.98 and 0.93, respectively. Complete re-mission and partial remission were 73% and 23%, respectively. Treatment failure was observed in 8(30%) pa-tients. 1-year survival rate and 1-year disease free survival rate were 82% and 59%, respectively. Overall surviv-al and progression-free survival did not reach median time. Grade 3/4 anemia, neutropenia, thrombocytopenia and oral mucositis were observed in 11%, 19%, 7% and 32% of patients, respectively. In terms of administered cycles, however, only 1-3% of grade 3/4 hematologic toxicities occurred among total 190 cycles. Severe oral mucositis were statistically associated with old age(p=0.003). Treatment failure had no statistical relation with age, pathology, primary site and stage. Conclusion:Low-dose weekly cisplatin-based CCRT seemed to deliv-er enough dose of cisplatin and to show low drop-out rate and good efficacy with low hematologic toxicities.