안압상승으로 의뢰된 환자들의 원인 질환 및 치료 경과 = Etiology and Management of Referred Patients with Intraocular Pressure Elevation

국문 초록 (Abstract)

목적: 1차 병원에서 안압상승으로 의뢰된 환자들의 원인 질환 및 임상 양상에 대해 알아보았다. 대상과 방법: 2016년 7월부터 2017년 7월까지 안압상승으로 본원에 의뢰된 환자들의 의무기록을 후향적으로 조사하였다. 골드만압평안압계로 측정한 치료 전 안압이 22 mmHg 이상이면서 본원에서 치료 후 6개월까지 경과관찰한 환자들을 대상으로 하였다. 안압상승을 유발한 기저 질환별 유병률 분석 및 일차녹내장과 이차녹내장군의 특징을 비교 분석하였다. 결과: 총 127명의 환자들의 평균 나이는 59.3 ± 16.8세였고, 치료 전 평균 안압은 31.7 ± 10.5 mmHg였다. 안압상승의 원인으로 고안압증이 22.0%, 일차녹내장이 31.5%, 이차녹내장이 46.5%를 차지하였고, 일차녹내장 중 원발개방각녹내장(20.5%)이, 이차녹내장 중 안염증에 의한 녹내장(12.6%)이 가장 높은 비율을 보였다. 양 군 비교 시 치료 후 6개월까지의 안압하강률은 비슷하였으나(52.1% vs. 53.9%, p=0.603), 이차녹내장군은 안압하강제 이외의 약물 및 수술을 시행한 비율이 일차녹내장군에 비해 유의하게 높았다(p<0.05). 치료 후 시력 호전 정도는 이차녹내장군에서 유의하게 더 컸으나(p=0.004), 6개월째 안전수지 이하의 시력을 보인 환자의 비율은 이차녹내장군에서 유의하게 더 높았다(p=0.027). 결론: 안압상승의 원인은 다양하며, 기저 질환에 따라 치료 방법 및 예후에 차이가 있으므로, 초진 시 안압상승의 원인 감별에 주의를 기울여야 할 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Purpose: To investigate the underlying causes and clinical characteristics of patients referred with intraocular pressure (IOP) elevation. Methods: We retrospectively reviewed the medical records of patients who were referred with IOP elevation from July 2016 to July 2017. Patients with baseline IOP ≥ 22 mmHg and those who were treated and followed up for 6 months were included. The prevalence rates of the underlying diseases that caused IOP elevation were evaluated and the clinical characteristics were compared between patients with primary and secondary glaucoma. Results: A total of 127 patients were included (mean age, 59.3 ± 16.8 years; baseline IOP, 31.7 ± 10.5 mmHg). Among the study participants, 22.0%, 31.5%, and 46.5% had been diagnosed with ocular hypertension, primary glaucoma, and secondary glaucoma, respectively. Among the causes of IOP elevation, open-angle glaucoma (20.5%) had the highest prevalence rate among those with primary glaucoma and inflammation-related glaucoma (12.6%) was the most prevalent cause among those with secondary glaucoma. In a comparison between patients with primary and secondary glaucoma, the percentage of IOP reduction was not significantly different at 6 months after treatment (52.1% vs. 53.9%, p = 0.603). However, the rate of patients treated with drugs other than IOP lowering agents or who underwent surgery was significantly higher in the secondary glaucoma group compared with the primary glaucoma group (all p < 0.05). At 6-month follow-up, the secondary glaucoma group showed significantly higher improvement rates of visual acuity (p = 0.004), but had a larger proportion of patients with a visual acuity of less than or equal to finger count (p = 0.027). Conclusions: Treatment and visual outcome can vary depending on the underlying cause of IOP elevation. Therefore, a thorough examination for determining the cause of IOP elevation is recommended at the initial stage.

목차 (Table of Contents)

• Abstract 대상과 방법 결과 고찰 REFERENCES 국문초록

참고문헌 (Reference)

1 이관복, "녹내장의 진단 경로" 대한안과학회 57 (57): 794-799, 2016

2 Nickells RW, "Under pressure: cellular and molecular responses during glaucoma, a common neurodegeneration with axonopathy" 35 : 153-179, 2012

3 Foster PJ, "The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district" 118 : 1105-1111, 2000

4 Baskaran M, "The prevalence and types of glaucoma in an urban chinese population: The Singapore Chinese Eye Study" 133 : 874-880, 2015

5 Colton T, "The distribution of intraocular pressures in the general population" 25 : 123-129, 1980

6 Moon Y, "Risk factors associated with glaucomatous progression in pseudoexfoliation patients" 26 : 1107-1113, 2017

7 Kim KE, "Prevalence, awareness, and risk factors of primary open-angle glaucoma: Korea National Health and Nutrition Examination Survey 2008-2011" 123 : 532-541, 2016

8 Kim CS, "Prevalence of primary open-angle glaucoma in central South Korea the Namil study" 118 : 1024-1030, 2011

9 Megaw R, "Posner-Schlossman syndrome" 62 : 277-285, 2017

10 Cho HK, "Population-based glaucoma prevalence studies in Asians" 59 : 434-447, 2014

11 Quigley HA, "Optic nerve damage in human glaucoma. II. The site of injury and susceptibility to damage" 99 : 635-649, 1981

12 Shazly TA, "Neovascular glaucoma: etiology, diagnosis and prognosis" 24 : 113-121, 2009

13 Hayreh SS, "Neovascular glaucoma" 26 : 470-485, 2007

14 Leydhecker W, "Intraocular pressure in normal human eyes" 133 : 662-670, 1958

15 Sharrawy T, "Glaucoma, 2nd ed. Vol. 1" Elsevier Ltd. 325-731, 2015

16 Siddique SS, "Glaucoma and uveitis" 58 : 1-10, 2013

17 Lee EJ, "Factors associated with the retinal nerve fiber layer loss after acute primary angle closure: a prospective EDI-OCT study" 12 : e0168678-, 2017

18 "European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options" 101 : 130-195, 2017

19 Zheng Y, "Epidemiologic characteristics of 10 years hospitalized patients with glaucoma at shanghai eye and ear, nose, and throat hospital" 95 : e4254-, 2016

20 Al-Bahlal A, "Changing epidemiology of neovascular glaucoma from 2002 to 2012 at King Khaled Eye Specialist Hospital, Saudi Arabia" 65 : 969-973, 2017

21 Kyari F, "A Population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey" 15 : 176-, 2015