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김은경,형성민,Eun-Kyung Kim,Sung-Min Hyung 대한안과학회 2005 대한안과학회지 Vol.46 No.9
Purpose: To investigate the effect of stepwise procedures on high intraocular pressure (IOP) after trabeculectomy. Methods: A retrospective review was coducted on the medical records of patients who underwent trabeculectomy between January 1997 and December 2002. at the Chungbuk National University Hospital. Analysis included 136 eyes from 118 patients who received at least 6 months of follow-up care (mean 22.4±18.1 months). High IOP during the early postoperative period was identified in 104 of the 136 eyes, and these were treated by the following methods in a stepwise manner: ① cotton-tip application (a slow, steady eyeball pressure with a sterile cotton tip was favored), ② scleral flap suture cutting (26-gauge needle), ③ needling of the bleb (without antimetabolites), ④ additional antiglaucoma medication. If none of the above management techniques was successful, the surgery was repeated. After cotton tip application or scleral flap suture cutting, patients were divided into the recovery group (IOP was reduced) and the non-recovery group. Results: Success rates were 11.8% for cotton-tip application, 15.4% for scleral flap suture cutting, 0.7% for needling without antimetabolites, and 28.7% for additional antiglaucoma medication. The overall success rate was 80.1%. Pre-interventional factors associated with the non-recovery group were higher preoperative IOP (p=0.003) and diabetes (p=0.017). Conclusions: Four procedures were used, in a stepwise manner, to reduce IOP following trabeculectomy. IOP was found to decrease to desirable levels without the use of antiglaucoma medication in 27.9% of all subjects.
섬유주절제술 후 여과포형성에 실패한 환자에서 마이토마이신씨를 이용한 주사침복원술의 효과
노인호,형성민,In Ho Roh,Sung Min Hyung 대한안과학회 2006 대한안과학회지 Vol.47 No.7
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 mg (0.02 mg/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 mm Hg and post-NR final IOP was 18.8±13.0 mm Hg (p=0.005). The success rate, defined as IOP ≤18 mm 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 mm 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 mmHg were risk factors for failure of NR.