무수정체안에서 4-고리형 인공수정체 삽입 후 폐쇄루프형으로 공막고정하는 술기의 임상 성적
Closed-loop Scleral Fixation with 4-eyelet Intraocular Lens Implantation for Aphakia: Clinical Outcomes
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목적: 무수정체안에서 4-고리형 인공수정체를 전방에 삽입한 후에 폐쇄루프형으로 공막에 고정하는 변형된 술기를 소개하고 임상성적을 조사한다. 대상과 방법: 2019년 5월부터 2022년 6월까지 4-고리형 인공수정체를 전방에 삽입하고 공막고정술을 시행한 39안의 의무기록을 후향적으로 분석하였다. 전방 내에 4-고리형 인공수정체를 삽입한 후 9-0 polypropylene 바늘을 인공수정체 고리에 루프 형태로 통과시키고 광학부를 후방 중심에 위치시키고 매듭으로 고정하였다. 수술 전과 6개월 후 시력, 안압, 굴절이상, 각막내피세포밀도를 비교하고 술 후 부작용을 기술하였다. 결과: 수술은 평균 62세 환자군에서 백내장수술 중 합병증(20.5%), 무수정체안(20.5%), 복잡한 백내장에 대한 단계적 수술(12.8%), 외상성(30.8%) 및 비외상성(12.8%) 인공수정체 탈구, 수정체 탈구(5.1%) 원인으로 시행되었다. 수술 후 최대교정시력(0.40 logarithm of the minimum angle of resolution [logMAR])은 수술 전(0.69 logMAR)보다 유의하게 높았다(p=0.018). 수술 전 목표 굴절력과 수술후 구면대응치는 높은 일치도를 보였다(p=0.002, intraclass correlation coefficient=0.616). 수술 후 안압상승(7.7%), 저안압(5.1%), 수포성각막병증(5.1%), 황반부종(5.1%)의 합병증이 있었고 대부분(78%) 단기간의 약물 치료로 호전되었으며, 인공수정체 재탈구는 없었다. 결론: 본문에서 소개된 변형된 공막고정술 술기는 간단하고 빠르게 무수정체를 효과적으로 교정할 수 있었다. 폐쇄루프 봉합사를 조정해 광학부 중심 잡기가 용이하고 4개 지지부에 고정되어 안정적일 뿐 아니라 합병증 발생 위험도 낮았다.
Abstract
Purpose: We present a modified, closed-loop scleral fixation technique. We inserted a 4-eyelet intraocular lens (IOL) into the anterior chamber prior to fixation. We investigated the clinical results. Methods: We retrospectively reviewed 39 eyes (39 patients) that underwent modified four-point scleral fixation of an inserted lens in our center from May 2019 to June 2022. The surgical procedure features conjunctival peritomy, 4-eyelet IOL insertion, eyeball penetration using a 9-0 polypropylene needle, eyelet placement using an ab externo technique to form a continuous loop, centering of the optic, and tying of a knot. We compared preoperative and 6-month postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure, and refraction errors, and described postoperative complications. Results: The mean patient age was 62 years. The indications for surgery included complicated cataracts (20.5%), aphakia (20.5%), staged surgery for complicated cataract (12.8%), non-traumatic IOL dislocation (30.8%), traumatic IOL dislocation (12.8%), and crystalline lens dislocation (5.1%). The postoperative BCVA (0.40 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the preoperative BCVA (0.69 logMAR) (p = 0.018). The postoperative spherical equivalent and the target diopter measurement were in high agreement (p = 0.002, intraclass correlation coefficient = 0.616). All of ocular hypertension (7.7%), hypotony (5.1%), bullous keratopathy (5.1%), and macular edema (5.1%) were noted, but 78% of the conditions improved with short-term medication. There was no re-dislocation of a fixated IOL. Conclusions: Our surgical technique simply and rapidly treats aphakia. Optic repositioning was easy, the IOL stability high, and the risk of complications during IOL fixation low.
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