조기 및 후기 인공수정체 탈구 발생의 위험인자 및 임상 양상
Risk Factors for Early and Late Intraocular Lens Dislocation
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목적: 인공수정체 탈구 환자를 대상으로 위험요인 및 임상 양상에 대해서 조사하고자 한다. 대상과 방법: 본원에서 수정체낭외적출술, 초음파유화술, 유리체절제술 백내장동시수술 시행 후 2011년 1월부터 2021년 12월까지 인공수정체 탈구를 진단받은 환자들의 의무기록을 후향적으로 분석하였다. 환자의 인구학적 특성, 수술 관련 인자(수술 시간, 수술자, 술중 합병증)을 조사하였으며 조기 및 후기 탈구, 양안 탈구에 따른 위험요인의 차이를 분석하였다. 결과: 환자 68명 71안의 탈구 진단 당시 평균 연령은 63.3세였으며 남자(77.5%)가 여자보다 많았고 고도근시(9안), 망막박리(8안), neodymium-doped yttrium aluminum garnet 후낭절개술(6안), 정상안압녹내장(6안)이 보고되었다. 조기 탈구가 후기 탈구에 비해낭외탈구의 비율이 높고, 백내장수술 당시 연령이 높고 수술 시간이 길었으며, 술 중 합병증 발생도 높았으나 후기 탈구는 정상 대조군과 비교하여 수술 시간의 차이는 없었다. 유리체절제술과 백내장동시수술은 초음파유화술과 탈구 발생률의 차이가 없었으며 유리체절제술을 받은 눈이 후기 탈구에서만 7안 있었다. 양안 탈구안 7명 중 색소망막염(1명), 망막박리(2명), 고도근시(1명)이 보고되었으며 단안 탈구보다 연령이 낮았다. 결론: 인공수정체의 조기 탈구는 술 중 합병증과 연관이 있으나 후기 탈구는 술 중 합병증보다는 환자의 기저 특성과 상관관계를보였다. 유리체절제술은 조기 탈구보다는 후기 탈구와 연관이 있어 보였으나 통계적으로 유의하진 않아 추가 연구가 필요할 것으로보인다.
Abstract
Purpose: To evaluate risk factors predisposing to intraocular lens (IOL) dislocation after cataract surgery. Methods: The medical and surgical records of patients diagnosed with IOL dislocation between January 2011 and December 2021 after undergoing extracapsular cataract extraction, phacoemulsification, and phacoemulsification with pars plana vitrectomy at Hallym University Sacred Heart Hospital were reviewed retrospectively. Preoperative factors (ocular parameters and demographics) and intra-operative factors (surgery time, surgeon, and intra-operative complications) were compared according to early, late, and bilateral dislocation. Results: In 68 patents and 71 eyes, the average age at the diagnosis of dislocation was 63.3 years, and there were more males (77.5%) than females. Possible major factors predisposing to IOL dislocation were high myopia (9 eyes), retinal detachment (8 eyes), neodymium-doped yttrium aluminum garnet capsulotomy (6 eyes), and normal tension glaucoma (6 eyes). The rate of out-of-the bag dislocation was higher in early dislocation than in late. Early dislocation had a significantly older age, longer surgery time, and higher intraoperative complication rate during cataract surgery than did late dislocation. There was no difference in surgery time for late dislocated eyes compared to non-dislocated eyes. There was no difference in the incidence of dislocation between phacoemulsification and phacoemulsification with pars plana vitrectomy; there were seven eyes with prior vitrectomy only, with late dislocation. Of the seven patients with bilateral IOL dislocation, one had retinitis pigmentosa, two had retinal detachment, and one had high myopia. Bilateral dislocation patients were significantly younger at the time of cataract surgery, compared to unilateral dislocation patients. Conclusions: Early dislocation was associated with long surgery time and intraoperative complications, while late dislocation had no significant correlation with surgery-related factors. A history of vitrectomy and combined vitrectomy with cataract surgery seemed to be associated with late dislocation, but this association was not significant.
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