가토에서 시행된 홀미움레이저 공막절개술에 대한 마이토마이신의 영향

Abstract

[한글]

녹내장여과수술은 전방과 결막하공간사이에 인위적으로 통로를 만들어서 방수가 잘 유출되도록 하여 안압을 하강시키는 수술요법이다. 이러한 녹내장여과수술의 성공여부는 전방과 결막하공간사이의 인위적인 누공 및 여과포가 멀마나 기능을 유지하며 안압을 낮추느냐에 달려있으며 이 누공의 기능상실이 일어나는 가장 근원적인 이유는 수술시 가해지는 조직손상에 의한 상처치유과정과 상처조직의 형성이다. 이러한 관점에서 수술시 조직손상이 적은 홀미움레이저를 이용한 녹내장여과수술이 소개되었으며 상처조직의 형성을 억제하기 위하여 항암제인 마이토마이신의 사용이 도입되고 있다. 이에 저자는 조직손상이 비교적 적은 홀미움레이저 공막절개술에 섬유아세포증식을 억제하는 능력이 좋은 마이토마이신의 결막하주사를 병용하면 홀미움레이저 공막절개술의 효과가 개선되리라 생각하여 20안의 가토안을 대상으로 실험하였다. 20안의 가토안중 10안은 대조군으로 하여 홀미움레이저 공악절개술 3시간전 생리식염수를 결막하주사하고 나머지 IG안은 실험군으로 정하여 수슬 3시간전에 0.2㎎의 마이토마이신을 결막하주사한 뒤 홀미움레이저 공막절개술을 시행하였다. 술후 여과포가 유지되면서 안압이 술전에 비하여 낮게 유지되는 기간을 수술성공유지기간으로 정하여 이를 두군에서 비교하였다.

평균수술성공유지기간은 대조군에서 5.1±2.51일, 실험군에서 29.8±12.57 일이었으며, 실험군의 평균 수술성공유지기간이 대조군에 비하여 매우 유의할 정도로 길었다(p value=0.002). 대조군의 경우 수술후 5일째에는 안압이 수술전과 비슷하게된 반면, 실험군의 경우에 있어서는 수술후 35일째에도 통계학적으로 유의할만한 안압하강이 관찰되었다. 이러한 실험결과를 통하여 가토안에서 수술 3시간전에 마이토마이신을 결막하주사하는 것이 홀미움레이저 공막절개술의 성공률을 향상시키는데 도움은 줄 수 있을 것으로 생각된다.

The Effects of Mitomycin C on the Holmium Laser Sclerostomy in Rabbits

Sung Soo Kim

Dept. of Medical Science The Graduate School, Yonsei University

The glaucoma filtering surgery is a surgical procedure to make a artificial

channel between anterior chamber and subconjunctival space of eye. The intraocular

pressure becomes lower due to drainage of aqueous humor through this channel.

Success of glaucoma filtering surgery is related with function of this channel and

filtering bleb for reducing intraocular pressure and the main causes of failure in

glaucoma filtering surgery were wound healing process and subsequent scar formation

followed by tissue injury during the surgical procedure. In this respect holmium

laser sclerostomy for reducing tissue injury in surgical procedure was introduced

and topical mitomycin C-a kind of anticancer drug-has been used for inhibition of

scar formation. The authors expected better effects of holmium laser sclerostomy

with local mitomycin C application land the experiment was performed on twenty eyes

of pigmented rabbits. Twenty eyes of rabbits were divided into two groups(each

group contains ten eyes). 0.5 ml of normal saline was injected into subconjunctival

space three hours before holmium laser sclerostomy in control group(10 eyes) and

0.04% mitomycin C(0.2 mg) was injected subconjunctivally three hours before holmium

laser sclerostomy in experimental group(10 eyes). And then holmium laser

sclerostomy was performed on all twenty eyes of rabbits. The duration of success

maintenence in operation was defined as period with low intraocular pressure

compared to preoperative intraocular pressure and presence of filtering blebs in

each group. After the holmium laser sclerostomyi the chance of intraocular pressure

was measured and appearance of filtering blob was observed. As a results, the mean

duration of success meintenence was 5.1±2.51 days in the control group and

29.8±12.57 days in the experimental group. Statistically the mean intraocular

pressure of control group on the fifth day after procedure was not significant. In

contrast the experimental group showed significantly low intraocular pressure on

the 35th day after operatien. In these results, the subconjunctival injection of

0.04% mitomycin C 3 hours before the Holmium laser sclerostomy was rewarded as

effective to maintain the success of holmium laser sclerostsmy.

[영문]

The glaucoma filtering surgery is a surgical procedure to make a artificial channel between anterior chamber and subconjunctival space of eye. The intraocular pressure becomes lower due to drainage of aqueous humor through this channel.

Success of glaucoma filtering surgery is related with function of this channel and filtering bleb for reducing intraocular pressure and the main causes of failure in glaucoma filtering surgery were wound healing process and subsequent scar formation followed by tissue injury during the surgical procedure. In this respect holmium laser sclerostomy for reducing tissue injury in surgical procedure was introduced and topical mitomycin C-a kind of anticancer drug-has been used for inhibition of scar formation. The authors expected better effects of holmium laser sclerostomy

with local mitomycin C application land the experiment was performed on twenty eyes of pigmented rabbits. Twenty eyes of rabbits were divided into two groups(each group contains ten eyes). 0.5 ml of normal saline was injected into subconjunctival

space three hours before holmium laser sclerostomy in control group(10 eyes) and 0.04% mitomycin C(0.2 mg) was injected subconjunctivally three hours before holmium laser sclerostomy in experimental group(10 eyes). And then holmium laser sclerostomy was performed on all twenty eyes of rabbits. The duration of success maintenence in operation was defined as period with low intraocular pressure compared to preoperative intraocular pressure and presence of filtering blebs in each group. After the holmium laser sclerostomyi the chance of intraocular pressure

was measured and appearance of filtering blob was observed. As a results, the mean duration of success meintenence was 5.1±2.51 days in the control group and 29.8±12.57 days in the experimental group. Statistically the mean intraocular pressure of control group on the fifth day after procedure was not significant. In contrast the experimental group showed significantly low intraocular pressure on the 35th day after operatien. In these results, the subconjunctival injection of

0.04% mitomycin C 3 hours before the Holmium laser sclerostomy was rewarded as effective to maintain the success of holmium laser sclerostsmy.