원발성 선천 녹내장 환자의 시력예후 및 약시요인 분석 = Visual Outcome in Children With Congenital Glaucoma

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the prognosis of vision and the development of amblyopia in primary congenital glaucoma patients.
Methods: The author reviewed 38 eyes of 22 primary congenital glaucoma patients and evaluated variables such as age at time
of surgery and at the last visit, preoperative IOP, Cup-to-disc(CD) ratio, corneal diameter, refractive error, axial lengths and IOP,
CD ratio and visual acuity at the last visit. According to visual acuity, the patients were divided into 3 groups, good (＞0.5), fair
(0.1~0.5), and poor (＜0.1). The amblyopia was defined when BCVA was below 0.8 and no evidence of progression of glaucoma.
There were 4 types of amblyopia: deprivation, anisometropic, strabismic and organic. The author compared the 3 groups and
evaluated factors affecting the vision as well as the prevalence of amblyopia.
Results: There were 17 eyes in the good group, 4 eyes in the fair group and 17 eyes in the poor group (p＜0.05). Amblyopia
developed in 17 eyes with 7 eyes showing deprivation amblyopia. Anisometropic and organic amblyopia were each found in 4 eyes,
and strabismic amblyopia was found in 2 eyes. The postoperative IOP and CD ratio and preoperative CD ratio were significantly
lower in the good group than the other groups (p＜0.05).
Conclusions: Final VA was poor in 45% of eyes with primary congenital glaucoma, and amblyopia developed in 45% of these eyes.
The prognosis for vision may be related to the treatment of glaucoma and amblyopia.

국문 초록 (Abstract)

목적: 원발 선천 녹내장 환자들의 시력예후 및 약시요인에 대해 알아보고자 하였다.
대상과 방법: 원발 선천 녹내장으로 진단받은 23명 38안을 대상으로 수술시 연령, 수술 종류, 수술 전후 안압, 술전 각막직경, 수술
전후 CD 비율 등을 조사하였고 최종교정시력에 따라 좋음(＞0.5), 양호(0.1~0.5), 불량(＜0.1)으로 분류하였으며 최종교정시력에 관여
하는 요인을 분석하였다. 녹내장성 변화 없이 시력 0.8 미만을 약시안으로 정의하고 사시약시, 부동시약시, 시자극 결핍약시, 기질약시
로 분류하였다.
결과: 교정시력은 좋은 군에 속하는 경우가 17안, 양호군이 4안, 불량군에 속하는 경우가 17안이었다. 약시는 17안으로 이중 시자극
결핍약시에 속하는 경우가 7안으로 가장 많았다. Good group에서는 수술 후 CD 비율이 다른 군에 작았으며, 수술 후 안압이 유의하게
낮았다(p＜0.05).
결론: 원발 선천 녹내장 환아의 시력 예후는 약 45%에서 불량한 결과를 보였으며 약시의 비율은 전체 환자의 약 45%였다. 녹내장 치료가
시력 예후에 가장 중요한 요소였고 약시 치료 병행 또한 필요하다고 생각된다.

참고문헌 (Reference)

1 Gollamudi SR, "Visual outcome after surgery for Peters’ anomaly" 15 : 31-35, 1994

2 Kargi SH, "Visual acuity in children with glaucoma" 113 : 229-238, 2006

3 Morgan KS, "Treatment of congenital glaucoma" 92 : 799-803, 1981

4 Biglan AW, "The visual results following infantile glaucoma surgery" 16 : 377-381, 1979

5 Taylor RH, "The epidemiology of pediatric glaucoma: the Toronto experience" 3 : 308-15, 1999

6 Wallace DK, "Surgical results of secondary glaucomas in childhood" 105 : 101-111, 1998

7 Kushner BJ, "Successful treatment of functional amblyopia associated with juvenile glaucoma" 226 : 150-153, 1988

8 Haas J, "Principles and problems of therapy in congenital glaucoma" 7 : 140-146, 1968

9 Morin JD, "Primary congenital glaucoma a survey" 9 : 17-28, 1974

10 Yang LL, "Peters’anomaly. A synopsis of surgical management and visual outcome" 14 : 467-477, 2001

11 Mandal AK, "Outcome of surgery on infants younger than 1 month with congenital glaucoma" 110 : 1909-1915, 2003

12 Barkan O, "Operation for congenital glaucoma" 25 : 552-568, 1942

13 Jaafar MS, "Normal intraocular pressure in children: a comparative study of the Perkins applanation tonometer and the pneumatonometer" 30 : 284-287, 1993

14 Pensiero S, "Normal intraocular pressure in children" 29 : 79-84, 1992

15 Rice NS, "Management of infantile glaucoma" 56 : 294-298, 1972

16 O’Reilly J, "Long-term visual results following primary trabeculectomy for infantile glaucoma" 79 : 472-475, 2001

17 Mandal AK, "Long-term surgical and visual outcomes in Indian children with developmental glaucoma operated on within 6 months of birth" 111 : 283-290, 2004

18 Richardson KT Jr, "Long-term functional results in infantile glaucoma" 71 : 836-837, 1967

19 Richardson KT Jr, "Long-term functional results in infantile glaucoma" 71 : 833-836, 1967

20 Barsoum-Homsy M, "Incidence and prognosis of childhood glaucoma: a study of 63 cases" 93 : 1323-1327, 1986

21 Haas JS, "End results of treatment" 59 : 333-341, 1955

22 Beck AD, "Diagnosis and management of pediatric glaucoma" 14 : 501-512, 2001

23 Bermejo E, "Congenital eye malformation: clinical-epidemiological analysis of 1,124,654 consecutive births in spain" 75 : 497-504, 1998

24 Morin JD, "Causes of loss of vision in congenital glaucoma" 98 : 1575-1576, 1980

25 Von Noorden GK, "Binocular Vision and Ocular Motility, 6th ed" Mosby 246-, 2002

26 Robin AL, "An analysis of visual acuity, visual fields, and disk cupping in childhood glaucoma" 88 : 847-858, 1979

27 Broughton WL, "An analysis of treatment of congenital glaucoma by goniotomy" 91 : 566-572, 1981

28 Clothier CM, "Amblyopia in congenital glaucoma" 99 : 427-431, 1979