(1)Journal of the Korean Glaucoma Society

전체 글

(1)Journal of the Korean Glaucoma Society 2017;6(2):49-54. Original Article. ࣼ੭૲઻ૂी൲ӘਉӘܾઌഡસ৊৒અௗ‫ܾࣳݑ‬૒޻Ԟ‫ݴ‬ઊੋഡ ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी Transconjunctival Suturing of Scleral Flap Using Illuminator in Eyes with Hypotony Following Trabeculectomy 박수진1, 안종호1, 남동흔1, 이종연1, 유정권2, 김용연2 Su Jin Park, MD1, Jong Ho Ahn, MD1, Dong Heun Nam, MD, PhD1, Jong Yeon Lee, MD, PhD1, Chungkwon Yoo, MD, PhD2, Yong Yeon Kim, MD, PhD2 a⃽‫⦺ݡ‬Ʊ᮹ŝ‫⦺ݡ‬ʙᄲᬱᦩŝ⦺Ʊᝅ Łಅ‫⦺ݡ‬Ʊ᮹ŝ‫ᦩ⦺ݡ‬ŝ⦺Ʊᝅ 1. Department of Ophthalmology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea. 2. 목적: ࣼ੭૲઻ૂी ൲ ӘਉӘܾ ઌഡ સ৊৒ઊ ࠋࣥഢ ӄੌ ઺ࠒघ५, ‫ݼࠆޅ܆ޔ‬, સ৊৒ ൠࠉ࠾଑ ‫ڢ‬અ ഥ࠾଑ઊ ࠋࣥഢ ़ ઔ‫د‬. ઊ‫ܟ‬ഡ ӘਉӘܾ ઌഡ સ৊৒੹ ӯીട‫ ܾ੶ࠩࠒ ؘ‬ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥीઅ ઑࣛҿӘਭ ࡂ૒ ૒޻Ԟ ࣏ੋઅ ੭ੋऀ ਉࡘਁ ‫ف‬നࣳ ૒࣏ടӋઘ ടਔ‫د‬. 대상과 방법: ൲ലહ੶ܾ અߗԞܿ੹ ҩ౸ടਉ ѿ஍‫ ف‬Ԣ࠾੘ ৊Әਁࣳ 2013‫ ך‬1ਖ਼ࡘౡ ഡ ޻અ ीઘਁ અന १ര‫ ټ‬185޻ਁ ‫ف‬ഡ ࣼ੭૲઻ૂी ૻ ӘਉӘܾ ઌഡ સ৊৒੶ܾ ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी੹ १രഡ 8޻੹ ‫ ܾ੶ࣛف‬ടਔ‫د‬. ़ी ઺൲ ৊৒Ә १ܲ ࠹൛ ࠃ ஷѿહ ഥ࠾଑੹ ૒࣏ടਔ‫د‬. ӄҿ‫ ޅ‬Ӗ‫ޅ‬೟ࡊഥी ૻ ࡂ૒૒޻Ԟ‫ੋ࣏ ݴ‬ടਉ Ӗ‫ޅ‬೟અ १ઌऀઊ ലࣛ‫ؘٻ‬଒‫ ݴ‬೤ѿടਔ‫د‬. ઘ‫ؘݑ‬ ૻ੥҈(࣏࡚੥҈)੶ܾ ૂ१ടਔ‫د‬. 결과: ൝ઘ‫ڝ‬અ ़ी ઺ ৊৒੸ 3 mmHg (2.25, 4.0)ઊৼӋ ी ൲ 1ઍ 9 mmHg (4.5, 13) 7ઍ 7 mmHg (5.0, 8.0) 1ґਖ਼ 6.5 mmHg (4.5, 8.5) 3ґਖ਼ਁ 9 mmHg (6.5, 11.75)ܾ ़ी ઺Ә ࡻӯടਉ ޾‫ ڛ‬१ઽਁࣳ ੭અടҲ ࣛ०ടਔ‫(د‬p =0.018, p =0.017, p =0.011, p =0.012). १ܲ(logMAR)੸ ़ी ઺ 1.0 (0.70, 1.85)ਁࣳ ़ी ൲ 1ઍ 0.76 (0.325, 1.775), 1૲ 0.70 (0.325, 1.300), 1ґਖ਼ 0.60 (0.1125, 1.675) 3ґਖ਼ 0.30 (0.375, 1.650)੶ܾ, ़ी ઺Ә ࡻӯടਉ ़ी ൲ 1ઍ੹ ૂ਼ഡ ԓ ઊ൲ १ઽ‫ ؘࣳਁڝ‬੭અടҲ ൑઺‫(دৼٻ‬p =0.168, p =0.042, p =0.027, p =0.028). 8৊ ૻ 3৊ਁࣳ ࡂ૒૒޻Ԟ‫ੋ࣏ ݴ‬ഢ ‫ ڹ‬ਉӘ೩ ࠄ Ӗ‫ޅ‬೟અ ӄӆࡘઅ १ઌऀઊ ലࣛ‫دৼٻ‬. ࠗࡴࣘ઒ी १ ीઘѿ ଓા ഑‫܅‬ઊࠂ੹ १രട޷ࣳ ࠗࡴ ґࠒ৒੹ ൜ઌന ࡂ‫ ؘ‬ҫ੸ ी ൲ ஢Ԟ સ৊৒ ࠃ સ৊৒Ә Ӛܳ‫ ټ‬ഥ࠾଑અ ࠋࣥ੥സ੹ ਙௐട‫ ؘ‬ٙ ٩੒ઊ ‫ ٽ‬ҫ੶ܾ Ԟ‫دټف‬. 결론: ӘਉӘܾ ઌഡ સ৊৒અ ௗ‫ ܾࣳݑ‬ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी੸ ൭Әહઊৼ੶޵ ૒޻Ԟઅ ࣏ੋ੸ ઍࡘઅ ӄੌਁࣳ १ઌऀ੹ ‫׬‬ઊ‫ ؘ‬ٙ ٩੒ઊ ‫دৼٻ‬. Key words: Ocular hypotension, Microscopy, Glaucoma, Trabeculectomy, Intraocular pressure. 서론 ࣼ੭૲઻ૂी ൲ સ৊৒અ ࡽ٩‫ ؘ‬1.3-30%Ԫ଒ ࡂӋ‫ٻ‬Ӌ ઔ Received: 2017. 10. 31. Accepted: 2017. 11. 11.. Revised: 2017. 11. 7.. Corresponding Author: Jong Yeon Lee, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-458-2711, Fax: +82-32-460-3358 E-mail: jongyeonlee@gmail.com. www.koreanglaucoma.org. ‫د‬.1 ࣼ੭૲઻ૂी ൲ 4-6૲ ઊֳਁ ઍ१હઌ સ৊৒ઊ ࠋࣥഢ ़ ઔ੶޵ ઊ १Ԟઅ સ৊৒੸ Ӗ‫ޅ‬೟અ ‫ؖ‬ॠഡ ࡊഥ, ৊ֳਐ଑੶ܾ ઌഡ ࠒ़࡚ࡻઅ ҆घ, േ৙ࠒ़ણ࠸ ಶӧ, ‫ݼࠆޅ܆ޔ‬, ҿ‫ࡊޅ‬ഥ ࡘ੥ ൒੸ ਉӘ೩ਁࣳ ࠒ़‫׿‬஺, ޾৩ஔന‫ݼ‬, ౏࣒౏़൭घৱૂ ૂ֢ ࠭ౌୱ‫ ૂز‬Ҏ੸ ࠒ़࣒ࣥৱૂૂ ಉਉ ‫ڢ‬ઊ ੘ઌઊ ‫ ़ ٽ‬ઔ ‫د‬.2-4 સ৊৒ઊ ࠋࣥട޷ ֥१, ৊ஸણઅ ҆घਭ തՌ ७ഡ ӄੌ.

(2) 50. JOURNAL OF THE KOREAN GLAUCOMA SOCIETY. 9ROXPH_1XPEHU. ઺ࠒघ५, સ৊৒ ൠࠉ࠾଑Ә ‫ڢ ݼࠆޅ܆ޔ‬અ ഥ࠾଑ઊ ࠋࣥഢ ़ ઔ‫د‬.3-7 સ৊৒અ ௗ‫ ࠩࠒݑ‬ਊ१ ੘ઌਁ ‫ ܅گ‬ҿીടҲ ‫دټ‬. ਉӘ೩ਁ ࣳ ૒઻‫ٻ‬଒ ৌ‫׿ ؘ‬஺ઊ ઔ੹ ӄੌ compression eye patch, ҿ ‫ޅ‬ઘѿઊ२, ਉӘ೩અ ઻ૂ, Ӗ‫ޅ‬೟અ ߚૂ १ scleral patch graft ࠒࠩ ‫ڢ‬ઊ ઔ‫د‬.8-13 ࣼ੭૲઻ૂी ൲ ѿણ ඕഡ સ৊৒અ ੘ઌઌ ӘਉӘઅ ӄੌਁ‫ ؘ‬ਉӘ೩ֳ ઘѿേ৙૲઒ी cryotherapy, compression eye patch, compression suture, ҿ‫د ੹ޅ‬१ ਍Ӌ Ӗ‫ޅ‬ ೟੹ થࡊഥട‫ڢ ࠩࠒ ؘ‬ઊ ࡂӋ‫ٻ‬ৰ ਴‫د‬.8-10,14-18 Shirato ‫ڢ‬ઊ ҿ‫د ੹ޅ‬१ ਍଒ ৌӋ Ӗ‫ޅ‬೟੹ થࡊഥട‫ ؘ‬ӄҿ ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी੹ घґഡ ઊ൲ 3೟અ ന਼ ਌Ӵ ‫ߚץ‬અ ҿӘѿ ൭Әહઌ ҫ੶ܾ ࡂӋ‫ٻ‬Ӌ ઔ੶֢ ઊਁ ‫ف‬ഡ ӵֳઅ ਌ӴҿӘ ࡂ Ӌ‫ ؘ‬ৈଓ ઊ‫ݗ‬ৰ଒଒ ৌ৔‫د‬.1,19-22 ۙഡ ઊ ीԞ‫ ݴ‬१രഢ ‫ڂ ڹ‬. Figure 1. Schematic diagram of conventional surgical microscope. and illuminator.. Ղ੎ ҿ‫ޅ‬ട ૒ଓઊ ઔ‫ ؘ‬ӄੌ ӘਉӘ‫ ټ‬ਉӘ೩ ౖࣛਁࣳ Ӗ‫ޅ‬೟ અ ӄӆ‫ ݴ‬ી൜ඥ Ӛ୵ടԞ ৰܱ੎ ‫ز‬ઽઊ ઔ‫د‬.23 ઊਁ ࡅ સઘ‫ڝ‬. ೟ࡊഥी੹ १രടਔ‫(د‬Fig. 1). ़ी १ ౖࣛਁ ‫ ܅گ‬ഡ ӕਁࣳ. ੸ ӘਉӘܾ ઌഡ સ৊৒੹ ӯીടԞ ੥ന ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी. ं ӕԪ଒ ࡊഥ੹ १രടਉ ҿ‫ ޅ‬੥ਁ ‫ ੹ڠޓ‬ம‫ف‬ഡ ઙҲ ‫ڝކ‬. ੹ १രട޷ࣳ ࡂ૒ ૒޻Ԟ‫ੋ࣏ ݴ‬ടਉ Ӗ‫ޅ‬೟ ӄӆࡘઅ १ઌऀ. ৼ‫د‬. Balanced Salt Solution (BSS)‫૲ ֳ ࠒ઺ ݴ‬઒ടਉ ઺ࠒ੹. ઊ ലࣛ‫ؘٻ‬଒ ૒࣏ടਔӋ ઊ ़ीਁ ‫ف‬ഡ ઑࣛӄӘ‫ࡂ ݴ‬ӋടӋ. હ‫ؽ‬ഡ ԩઊܾ ੭଒ടӋ ਉӘ೩અ ࠹൛‫ ݴ‬Ӛ୵ഡ ൲ਁ ़ी੹ ‫ބ‬. ઘ ഡ‫د‬.. ߗ‫ݼ‬ടਔ‫د‬. ़ी ઺ ԓ‫ݼ‬Ӌ ़ी ൲ 1ઍ, 1૲, 1ґਖ਼, 3ґਖ਼Ԫ଒અ ൝ઘઅ १. 대상과 방법. ܲ ৊৒ ஷѿહ ഥ࠾଑ਁ ‫ف‬ഡ ઑࣛҿӘ‫ ݴ‬૒࣏ടਔ‫د‬. ౿ӆ࡚ࣴ ੸'^ !IBM Corp., Armonk, NY, USA)ܾ. 2013‫ ך‬1ਖ਼ࡘౡ 2017‫ ך‬11ਖ਼Ԫ଒ ѿ஍‫ ف‬Ԣ࠾੘ ৊Әਁࣳ १ര. ࡻ޾़ ࠒࠩ੶ܾ ࡚ࣴടਔ‫د‬. ޾‫ ڛ‬१ܲௐી੸ फ़‫ ܫג‬ୱಠ‫ ݴ‬ઊ. ‫ࣼ ټ‬੭૲઻ૂी ૻ 3ґਖ਼ ઊࣛ ஷહӚ୵ઊ ѿ‫؟‬ടਔَ 185৊. ੋടਔ੶޵ ౿ӆ࡚ࣴ੹ ੥ടਉ LogMARܾ ࠹൝ടਔ‫د‬. ઘ‫ؘݑ‬. ૻ ӘਉӘܾ ઌടਉ ࠋࣥഡ સ৊৒੶ܾ ઌടਉ ӄҿ‫ ޅ‬Ӗ‫ޅ‬೟ ࡊ. ૻ੥҈(࣏࡚੥)੶ܾ ૂ१ടਔ‫د‬.. ഥी੹ १٩ഡ 8޻ 8৊ਁ ‫ف‬നࣳ ઑࣛԞܿ੹ ൲ലહ੶ܾ ૒࣏ട ਔ‫د‬. ਉӘ೩અ ‫׿‬஺ܾ ઌഡ સ৊৒અ ӄੌ‫ૂࠔ ؘ‬ടਔ‫د‬. ઑࣛ਌. 결과. Ӵ੯‫ݼ‬੥੘൦ਁࣳ‫ ࡅ ؘ‬਌Ӵਁ ‫ف‬ഡ ൲ലહ અߗԞܿҩ౸‫ ݴ‬० ઌടਔӋ ി॰ౄࣷ৲੹ ૴़ടਔ‫د‬.. અߗԞܿҩ౸‫ ݴ‬౿ടਉ ੥ Ԟҁ ‫ٳ‬৊ ࣼ੭૲઻ૂी੹ ࠊ੸. ࡅ ਌Ӵਁࣳ સ৊৒અ Ԟ૴੸ 5 mmHg ઊടܾ ടਔӋ, ӘਉӘ. 185৊ ૻ 8޻ 8৊અ ‫ࣛف‬ઘѿ ૒࣏‫دৼٻ‬. ‫ࣛف‬ઘઅ ೤ԑ ֢ઊ‫ؘ‬. ܾ ઌഡ સ৊৒ઊ ઔӋ १ܲસട֢ સ৊৒ ൠࠉ࠾଑, ‫ݼࠆޅ܆ޔ‬. 58.9ंਔӋ ഡ ޻ઊ ਉઘਔӋ ‫ࣛف ݳد‬ઘ 7޻੸ ޾‫֪ ڂ‬ઘਔ‫د‬.. ‫ڢ‬અ ഥ࠾଑ઊ ‫ ࣳ޷ٻࠉٳ‬ઑࣛ ӄӘѿ ࡂ૔હ ௗ‫੾ࠉ ਁݑ‬ട଒. ‫ֳפ‬ણ ૚‫ ؘݩ‬੘ࠋґࠒҀ‫ֳפ‬ણ 2৊, ңଚࡻ‫ֳפؙ‬ણ 2৊, ઊ. ৌ‫ ؘ‬ҫ੶ܾ ಹ‫ ټز‬ӄੌਁ ‫ف‬നࣳ ़ी੹ ҿીടਔ‫د‬.. ୱऀ ‫ֳפ‬ણ 2৊, ਼ࣛऀ ‫ֳפ‬ણ 1৊, ३ࣥേӚ‫ֳפ‬ણ 1৊ઊৼ‫د‬.. ઽ৊ ‫ބ‬௃ടਁ ‫ޣ‬સ ़ीെ߸ӄ ૒޻Ә ࡂ೟હ੶ܾ ੭‫ݼ‬ஔ઻. ़ी ૻ ࣏ੋഡ ‫ބ‬ઊ౸‫ބ‬ઊ३અ ‫׫‬٩‫ ؘ‬0.04%, 0.02%‫ ݴ‬ҀҀ 4. ૂीਁࣳ ࣏ੋ‫ ؘٻ‬૒޻Ԟ(23-gauge endoilluminator, Xenon. ৊, 4৊ਁࣳ ࣏ੋടਔ‫د‬. ़ी੸ ࣼ੭૲઻ૂी ൲ 19ઍ(ૻ੥҈,. BrightStar Ilumination System, DORC, Zuidland, Nether-. range 3-126ઍ)ਁ १രടਔӋ ‫ ࡚ࡘف‬2ӕઅ Ӗ‫ޅ‬೟ਁ ࡊഥ੹ १. alands)‫ ݴ‬ઊੋടਉ ‫ ڂ‬૒޻ടਁࣳ ਉӘ೩ ࠄ Ӗ‫ޅ‬೟અ ӄӆࡘઅ. രടਔ‫د‬.. १ઌऀ੹ Ӛ୵ടਉ ࡻӯടਔ‫د‬. ࡂ૒ ૒޻Ԟ‫ੋ࣏ ݴ‬ഢ ‫़ ؘਁڹ‬. ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी ઺ ৊৒੸ 3 mmHg (2.25, 4.0)ਔ੶޵ ़. ीെ߸ӄઅ Ӡ੘੸ ֎Ӌ ૒޻ԞӠ੘੹ ఈ ౖࣛਁࣳ ़ीെ߸ӄ. ी ൲ 1ઍପ 9 mmHg (4.5, 13), 7ઍପ 7 mmHg (5.0, 8.0), 1ґਖ਼. ੹ ౿ടਉ ़ीࡘ੥‫ ݴ‬Ӛ୵ട޷ࣳ ੘ൌ ࠅ‫ؙ‬અ 10-0֢ઍ݀ ࡊഥ. ପ 6.5 mmHg (4.5, 8.5), 3ґਖ਼ପ 9 mmHg (6.5, 11.75)ܾ ़ी ઺. ࣏(Ethicon Inc., Somerville, NJ, USA)‫ ݴ‬ઊੋടਉ ӄҿ‫ޅ‬Ӗ‫ޅ‬. ৊৒੸ ़ी ઊ൲ ޾‫ ڛ‬१ઽઅ ৊৒Ә ౿ӆહ੶ܾ ੭અഡ ୱઊ‫ݴ‬. Journal of the Korean Glaucoma Society.

(3) 51. SJ Park, et al. : Illuminator-assisted transconjunctival suture. Table 1. IOP course and number of suture of all patients before and after transconjunctival suture of scleral flap using illuminator. IOP (mmHg) No.. Diagnosis. Preop. Applied sutures. Postop Day 1. Postop Day 7. Postop Day 30. Postop Day 90. 1. POAG. 4. 3. 8. 19 (2). 12. 11. 2. POAG. 2. 2. 13. 6. 7. 8. 3. PXF. 1. 2. 1. 5. 4. 10. 4. PXF. 4. 2. 6. 8. 9. 12. 5. Secondary glaucoma. 3. 2. 13. 8 (1). 7. 13. 6. Secondary glaucoma. 5. 1. 10. 5. 6. 8. 7. NVG. 3. 2. 15. 8. 4. 6. 8. Traumatic glaucoma. 3. 1. 4. 5. 6. 5. Median IOP (interquartile range). 3 (2.25, 4.0). 9 (4.5, 13). 7 (5.0, 8.0). 6.5 (4.5, 8.5). 9 (6.5, 11.75). Parenthesis: number of suture lysis within 7days after surgery. IOP = intraocular pressure; Preop = preoperative; Postop = postoperative ; POAG = primary open angle glaucoma; PXF = pseudoexofoliation glaucoma; NVG = neovascular glaucoma Table 2. Median visual acuity of all patients before surgery and during follow-up. Preoperatively Median logMAR. 1.000. Postoperatively Day 1. Day 7. Month 1. Month 3. 0.7600. 0.7000. 0.6000. 0.3000. A. B. Figure 2. Comparisons of visibility of the margin of scleral flap between conventional surgical microscope and illuminator. (A) Conven-. tional surgical microscope. (B) Illuminator, margin of sclera flap (black arrow). ࡂਔ‫ (د‬p=0.018, p=0.017, p=0.011, p=0.012). Table 1ਁ ޾‫ف ڛ‬. 1.675), 3ґਖ਼ 0.30 (0.375, 1650)੶ܾ, ़ी ઺Ә ࡻӯടਉ ़. ࣛઘઅ ৊৒ ӄӘ‫ૂ ݴ‬१ടਔ‫د‬. ़ी ൲ ޾‫ ڛ‬१ઽ ࣏ઊਁ‫ ؘ‬৊. ी ൲ 1ઍ੹ ૂ਼ഡ ԓ ઊ൲ १ઽ‫ ؘࣳਁڝ‬੭અടҲ ൑઺‫دৼٻ‬. ৒અ ౿ӆહઌ ୱઊ‫ ؘ‬৺ৼ‫د‬. 2৊ਁࣳ‫़ ؘ‬ी ൲ ৊৒ઊ ࣛ०ട. ( p=0.168, p=0.042, p=0.027, p=0.028)(Table 2).. ਉ ஷѿહઌ suture lysis‫ ݴ‬१രടਔ‫د‬.. 8৊ ૻ 3৊ਁࣳ Ԟ૔ ़ीെ߸ӄ ૒޻ਁ ࡻടਉ ࡂ૒ ૒޻Ԟ‫ݴ‬. १ܲ(logMAR)੸ ़ी ઺ 1.0 (0.70, 1.85)ਁࣳ ़ी ൲ 1ઍ. ࣏ੋയ੹ ‫ ڹ‬ਉӘ೩ ࠄ Ӗ‫ޅ‬೟ ӄӆࡘઅ १ઌऀઊ ലࣛ‫ ؘٻ‬ҫ੶. 0.76 (0.325, 1.775), 1૲ 0.70 (0.325, 1.300), 1ґਖ਼ 0.60 (0.1125,. ܾ ಹ‫(دৼٻز‬Fig. 2). ़ी ൲ ஢Ԟ 2৊ਁࣳ ߸ৢഡ ‫׿‬஺ઊ ઔৼ. www.koreanglaucoma.org.

(4) 52. JOURNAL OF THE KOREAN GLAUCOMA SOCIETY. 9ROXPH_1XPEHU. A. B. C. D. Figure 3. Clinical photographs for case 2. (A) Overfiltering bleb. (B) Margin of scleral flap (white arrow) under illuminator. (C) Two transconjunctival scleral flap sutures under surgical microscope (arrows). (D) Two scleral flap sutures under conjunctiva on 7 days after the surgery (arrows).. ੶֢ ़ीહ ௗ‫ ݑ‬৺ઊ ࡂ઺હ ௗ‫ ܾݑ‬൑઺‫دৼٻ‬. 8৊ ޾‫ࣳਁڂ‬. ҆ਐ bleb scarringઅ ੌܱѿ ઔ‫د‬.22 ‫ ࣳ܅گ‬ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी. ৊৒੹ ً ‫׬‬ઊԞ ੥ടਉ ஷѿહઌ ़ीહ ௗ‫ ݴݑ‬१രഡ ਙ‫ؘ‬. ੸ ӘਉӘܾ ઌഡ સ৊৒੹ ӯીട‫ؘ‬ٙ ઔৰࣳ ࡻ௝।હઊ޷ࣳ. ৺ৼ‫د‬. ൠࠉࡘ ૲‫ݵ‬ઊ֢ ‫ ڂ޾ ؘݼࠆ ࠆ܆ޔ‬൑઺‫ৼٻ‬Ӌ ਉӘ೩. ൭Әહઌ ़ीઌ ҫ੶ܾ ࣥҀ‫دټ‬.. ҆ਐ ‫ڢ‬અ ஷѿહઌ ഥ࠾଑੸ Ӛ୵‫ٻ‬଒ ৌ৔‫د‬.. ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी ൲ १ҁઊ ଒֢޷ࣳ ࡊഥ࣏ѿ ҿ‫ܾ੶ࠄ ޅ‬ ઊ‫ ࣳ޷ٻٳ‬ҿ‫٘ ܾ੶ޅ‬ઊ‫ ؘ‬ҫ੹ Ӛ୵ഢ ़ ઔৼ‫د‬. ԓ Әીਁࣳ. 고찰. suture relaxationਁ અന ़ी ൲ 1ઍਁ ࡻന 1૲, 1‫ ش‬१ ৊৒ઊ ടҋട‫ ؘ‬ਙ(2ࠤ[Fig. 3], 6ࠤ ൝ઘ)ѿ ઔৼَ ҫ੶ܾ ࡂઊ֢ ౿ӆ. ࡅ ਌ӴҿӘ ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी੹ ઊੋടਉ ़ी ൲ ಡ࠺ഡ ഥ࠾଑ ৺ઊ ӘਉӘܾ ઌഡ સ৊৒੹ ൭Әહ੶ܾ ӯીഢ ़ ઔৼ 19. હ੶ܾ ԓ ୱઊ‫ ؘ‬੭અട଒ ৌ৔‫د‬. ࡅ ਌Ӵ‫ ؘ‬ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी १ ૒޻Ԟ‫ ݴ‬ઊੋഢ ӄੌ Ӗ‫ޅ‬. ੻੹ ্ ़ ઔৼ‫د‬. 2003‫ ਁך‬Shirato ‫ ڢ‬ઊ ஋੻੶ܾ ӘਉӘܾ. ೟અ १ઌऀઊ ലࣛ‫ؘٻ‬଒‫ ݴ‬೤ѿടਔ‫د‬. Ԟ૔અ ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊ. ઌഡ સ৊৒ ൝ઘਁࣳ ҿ‫ ੹ޅ‬ӄ੭ട‫ ؘ‬Ӗ‫ޅ‬೟ ࡊഥࠩ੹ ࡂӋഡ. ഥीਁࣳ Shirato ‫ڢ‬19੸ Ӗ‫ޅ‬೟અ ӄӆѿ ઝ ࡂઊ଒ ৌ‫ ؘ‬ӄੌ ޷. ࠅ ઔ‫د‬. ઘѿേஓ੹ ૲઒ട‫ࡻ ਁࠩࠒ ؘ‬ടਉ ൭Әહઊ޷ࣳ ஷѿ. ࡊ(cotton tip)੹ ઊੋടਉ compressionടң֢, Hoskin lens‫ ݴ‬ઊ. હઌ ৊৒ ࣛ० १ ࡊഥ࣏‫ૂ ݴ‬ңട‫ࠩࠒ ؘ‬ઊ ѿ‫؟‬ഡ ણઽઊ ઔ. ੋട‫ૂ ੹ࠩࠒ ؘ‬৊ഡ ࠅ ઔ‫د‬. ട଒‫ ކ‬સ৊৒ ౖࣛઅ ‫ ੹؁‬৒ࠆ. ‫د‬. Ԟ૔અ ҿ‫ޅ‬೟੹ ਍ৰࣳ થࡊഥട‫ ੸ࠩࠒ ؘ‬൭Әહઊ޷ࣳ ३. ട‫ ؘ‬ҫ੸ ‫ٻ‬٩ܿ ഗട‫ ؘ‬ҫઊ ૝੹ ҫ੶ܾ ࣥҀ‫ٻ‬ৰ ़ी १ ૒. ݊ഢ ‫ކ‬ഡ ࠒࠩ੶ܾ ࡂӋ‫ٻ‬Ӌ ઔ଒‫ ކ‬௝।હઌ ࠒࠩઊԞ ‫ਁߚڹ‬. ޻੹ ‫ݱد‬Ҳ ടਔ੹ ‫ ڹ‬१ઌऀઊ ലࣛ‫ؘٻ‬଒‫ ݴ‬૒࣏ടਔ‫د‬. ԓ‫ܟ‬. Journal of the Korean Glaucoma Society.

(5) SJ Park, et al. : Illuminator-assisted transconjunctival suture. ֢ ҿ‫ޅ‬ઊ ৥੸ ӄੌਁࣳ‫ ؘ‬ৰ‫ ؖ‬ી٩ १ઌऀઊ ലࣛ‫ৼٻ‬଒‫ ކ‬ா േઊ ७ടң֢ ҿ‫ޅ‬ട ૒ଓઊ ‫ڂ‬Ղ੎ ӄੌਁࣳ‫ ؘ‬१ઌऀ ലࣛਁ ૂৢઊ ઔৼ‫د‬. Ӡഠ ઻೟੹ ઊੋഢ ़ ઔ‫ ؘ‬ԞӴ֢ ਉӘ೩‫׿ ݴ‬ ‫ ࣳ޷ݱ‬Ӗ‫ޅ‬೟ ૲࠹ Ӵ૒ߜ੹ ઝ Ӛ୵ഢ ़ ઔ‫ ؘ‬ԞӴѿ ґࠋ‫دټ‬ ޷ ࡂ‫ د‬٩੒ઊ ‫ ़ ٽ‬ઔ੹ ҫ੶ܾ ࣥҀ‫دټ‬.. 53. 1987;28:477-81. 3. Brubaker RF, Pederson JE. Ciliochoroidal detachment. Surv Ophthalmol 1983;27;281-9. 4. Uhm KB, Lee JS, Kim TW, et al. Hypotony after trab '$

(6)

(7) 1996;37:1709-21.. ਉӘ೩ ৈܑઅ Ӗ‫ޅ‬೟અ Ӵ૒ਁ ‫ف‬നࣳ હ઻ഡ १ઌऀ੹ ൜ࡂട. '

(8)

(9) %

(10)

(11) '

(12) -. ޷ࣳ ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥीઊ १ര‫ ؘٻ‬ҫઊ ਉ‫ࡊ ࠤ ܟ‬ഥ੹ १٩.

(13)

(14)

(15)

(16) -. ട‫ ؘ‬ҫ੹ ૵ਉࣳ ஺േ, ҆ਐ, scarring, ਉӘ೩અ ‫׿‬஺Ә ़ी ५. tomy, phacotrabeculotomy and advanced non-penetrating. ೂઅ ੥സ٩‫֯ ݴ‬ஷ‫ ؘ‬ٙ ച੄ഢ ҫ੶ܾ ࣥҀഡ‫د‬. ଒ԙԪ଒ ࡅ ीԞਁ ‫ف‬നࣳ ‫ࠋ ੹ߚץ‬೵ഡ ं ԓ‫ݜ‬અ ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी ҿ Ә‫޷ࡂ ݴ‬, ़ी ൲ ৊৒ઊ ࣛ०ട଒ ৌ৔ң֢ ‫د‬१ સ৊৒ઊ ࠋ. phacotrabeculectomy. Semin Ophthalmol 2001;16:158-61. ' %

(17)

(18)

(19)

(20) £· ' fect of trabeculectomy on astigmatism. J Glaucoma 2016;25:e308-12.. ࣥടਉ થࡊഥीઊ ച੄യَ ӄੌѿ 15޻ ૻ 5޻, 53޻ ૻ 9޻, 56. 7. Kook MS, Kim HB, Lee SU. Short-term effect of mito-. ޻ ૻ 21޻੶ܾ ҀҀ ࡂӋടਔ‫د‬.1,21,22 ࡅ ਌Ӵਁࣳ‫़ ؘ‬ी ൲ 5-6. mycin-C augmented trabeculectomy on axial length and. mmHgઌ ӄੌѿ 2޻ਁࣳ ઔৼ଒‫ ކ‬७Ҁഡ ഥ࠾଑ઊ ৺ৰ ઑࣛહ. corneal astigmatism. J Cataract Refract Surg 2001;27:51823.. ੶ܾ થ़ीઊ १ര‫ٻ‬଒‫ ؘ‬ৌ৔‫د‬. ࡅ ਌Ӵઅ હ੸ ‫ࣛف‬ઘ़, ࣼ. ' Z $@'=

(21) . ੭૲઻ૂी १ ࣏ੋഡ ‫ބ‬ઊ౸‫ބ‬ઊ३ ‫׫‬٩, ਉӘ೩ ࠃ Ӗ‫ޅ‬೟અ. chamber after glaucoma operations. Arch Ophthalmol. ౖࣛਁ ‫ف‬ഡ Ԟܿ ࡘથ ‫ ڢ‬ਉ‫ ܟ‬ઊ੭ܾ ଓાહઌ ࡻӯ‫ ؘ‬ৰܶ଒‫ކ‬. 1962;68:473-7.. ࡅ ਌ӴҿӘਁࣳ‫ ؘ‬થࡊഥीઊ १ര‫ٻ‬଒ ৌ৔َ ઊ੭ ૻ ട֢ܾ. 9. Hill RA, Aminlari A, Sassani JW, Michalski M. Use of. ࡂ૒૒޻Ԟ‫ੋ࣏ ݴ‬ടਉ ી൜ഡ Ӗ‫ޅ‬೟ ࡊഥ੹ १٩യَ ҫ੹ ࣥ. a symblepharon ring for treatment of over-filtration and. Ҁന ࡆ ़ ઔ‫د‬. ട଒‫ ކ‬થ़ीઅ ੘ઌਁ‫ ؘ‬ਉ‫ ܟ‬ѿ଒ ੄घѿ Ӛ ਉഢ ҫઊܾ߳ ࡂ‫ ੸އ د‬൝ઘ‫ف ਁڝ‬നࣳ ஷѿહઌ ਌Ӵѿ ച੄ ഢ ҫઊ‫د‬.. leaking blebs after glaucoma filtration surgery. Ophthalmic Surg 1990 21:707-10 ^'@$ @#'

(22)

(23) surgery for glaucoma. Ophthalmic Surg 1979;10:17-34.. ࡅ ਌Ӵઅ ഡӆઽ੶ܾ ‫ࣛف‬ઘ ़ѿ હ੸ ઽ ਼ਁ٩ ़ी ઺ ࢅ. 11. Shields MB, Scroggs MW, Sloop CM, Simmons RB.. ҁࣽ‫ز‬௖஬ਕ੹ ઊੋടਉ ਉӘ೩અ ‫ڂ‬Ռ‫ ݴ‬ௐીടਔ‫ࡂ ޷د‬૒. Clinical and histopathologic observations concerning hy-. ૒޻Ԟઅ ੭ੋऀਁ ‫ف‬ടਉ ી‫ܞ‬હઌ ҿӘ‫ ݴ‬٩஺ട‫ ؘ‬ٙ ٩੒ઊ ‫ ़ ٽ‬ઔৼ੹ ҫ੶ܾ ࣥҀ‫دټ‬..

(24)

(25)

(26) ' Am J Ophthalmol 1993;116:673-83. \'%

(27) #=

(28) #'@

(29)

(30)

(31) . ҿ݀હ੶ܾ ӄҿ‫ޅ‬Ӗ‫ޅ‬೟ࡊഥी੸ ӘਉӘܾ ઌഡ સ৊৒੹ ӯ. term intraocular pressure control after donor scleral patch. ીട‫ ؘ‬ٙ ઔৰࣳ ࡻӯહ ‫ز‬ाട޷ࣳ٩ ൭Әહઌ ़ीઑ੹ ্ ़. grafting for trabeculectomy-induced hypotony maculopa-. ઔৼ‫د‬. ࡂ૒૒޻Ԟѿ ઍࡘઅ ӄੌਁࣳ Ӗ‫ޅ‬೟ ӄӆࡘઅ १ઌऀ ੹ ലࣛ१ఇ ़ी Ӵ૒ߜ੹ ࡂ‫ د‬൭Әહ੶ܾ Ӛ୵ട޷ࣳ ़ी੹ ଔരട‫ؘ‬ٙ ٩੒ઊ ‫دৼٻ‬. ‫ ࣳ܅گ‬ৗ੶ܾ٩ ઊ ीԞਁ ‫ف‬ഡ १ઌ ऀ੹ ലࣛ१ౄ‫़ ؘ‬ीԞӴਭ ࠒࠩઅ ґࠋઊ ଒ङહ੶ܾ ച੄ഢ ҫ੶ܾ ࣥҀഡ‫د‬.. thy. J Glaucoma 1995;4:200-10. 13. Buxton JN, Lavery KT, Liebmann JM, et al. Reconstruc

(32)

(33)

(34) ' Ophthalmology 1994;101:635-9. Q'$>'

(35)

(36) intrableb injection of autologous blood. Arch Ophthalmol 1993;111:827-30.. References '

(37)

(38)

(39)

(40) '£

(41)

(42)

(43)

(44) junctival scleral flap resuturing for hypotony after glau

(45) Z

(46) = £

(47) 2008;246:1751-6. 2. Toris CB, Pederson JE. Aqueous humor dynamics in experimental iridocyclitis. Invest Ophthalmol Vis Sci. www.koreanglaucoma.org. 15. Douvas NG. Cystoid bleb cryotherapy. Am J Ophthalmol 1972;74:69-71. 16. Cleasby GW, Fung WE, Webster RG Jr. Cryosurgical clo '=

(48) ¥ \© ¤¥\¤' '%

(49) #=

(50) #'

(51)

(52) blood injection and bleb compression sutures to treat hypotony maculopathy. J Glaucoma 1999;8:384-7. 18. Zacharia PT, Deppermann SR, Schuman JS. Ocular hy-.

(53) 54. JOURNAL OF THE KOREAN GLAUCOMA SOCIETY. 9ROXPH_1XPEHU.

(54)

(55) '= $.

(56)

(57)

(58) . Ophthalmol 1993;116:314-36.. maculopathy after trabeculectomy. Can J Ophthalmol. 19. Shirato S, Maruyama K, Haneda M. Resuturing the scleral

(59)

(60)

(61)

(62) ' Am J Ophthalmol 2004;137:173-4. 20. Eha J, Hoffmann EM, Wahl J, Pfeiffer N. Flap suture--a simple technique for the revision of hypotony maculopa

(63) 'Z

(64) Arch Clin Exp Ophthalmol 2008;246:869-74. 21 Letartre L, Basheikh A, Anctil JL, et al. Transconjunctival. 2009;44:567-70. 22. Eha J, Hoffmann EM, Pfeiffer N. Long-term results after transconjunctival resuturing of the scleral flap in

(65) '= $

(66) 2013;155:864-9. \¤'£

(67) % ¸ '

(68)

(69)

(70)

(71)

(72)

(73) suturing. J Glaucoma 2017;26:e110-2.. Journal of the Korean Glaucoma Society.

(74)