섬유주절제술이 시행된 녹내장 환자에서 인공수정체 공막고정술의 목표 굴절력 예측 정확도
Predictive Accuracy of Refraction after Transscleral Fixation of Intraocular Lenses in Trabeculectomized Eyes with Glaucoma
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목적: 섬유주절제술이 시행된 녹내장 환자에서 이차 인공수정체 공막고정술을 시행하였을 때 목표 굴절력의 예측정확도와 안압의변화를 알아보고자 하였다. 대상과 방법: 섬유주절제술을 시행받았던 녹내장 환자 중 인공수정체 탈구로 유리체절제술과 함께 이차 인공수정체 공막고정술을 시행받은 환자의 의무기록을 후향적으로 분석하였다. SRK/T 공식을 이용하여 계산된 목표 굴절력과 술 후 측정된 굴절력을 구면대응치로 환산하여 두 값의 차이가 ± 0.5 diopters (D)와 ± 1.0 D 이내인 경우를 조사하여 굴절력 예측 정확도를 계산하였으며, 수술 전후안압의 변화도 조사하였다. 결과: 총 11명 11안이 포함되었으며, 평균 연령은 67.27 ± 10.55세, 모두 남성이었다. 평균 안축장은 23.64 ± 1.26 mm였다. 평균목표 굴절력은 -0.02 ± 0.46 D, 평균 술 후 굴절력은 -0.80 ± 0.98 D로 유의한 차이가 있었다(p=0.029). 술 후 굴절력은 목표굴절력보다 평균 -0.78 ± 1.11 D 정도 근시화되는 경향을 보였다. 굴절력의 예측 정확도는 ± 0.5 D 이내인 경우가 36.4%, ± 1.0 D 이내인 경우가 72.7%였다. 평균 안압은 술 전 13.18 ± 4.56 mmHg, 술 후 일주일과 3개월에 각각 12.82 ± 5.88 mmHg, 12.73 ± 4.58 mmHg로 유의한 변화는 없었다. 결론: 섬유주절제술이 시행된 녹내장 환자에서 인공수정체 공막고정술을 시행하더라도 안압에는 영향이 없었으나, 굴절력이 예측보다근시화되므로 이를 고려하여 인공수정체 목표 도수를 결정하여야 하겠다.
Abstract
Purpose: To investigate the predictive accuracy of refraction and any change in intraocular pressure (IOP) after transscleral fixation of intraocular lenses (IOLs) in trabeculectomized eyes with glaucoma. Methods: We retrospectively reviewed the medical records of glaucoma patients who underwent trabeculectomy, followed by transscleral fixation of dislocated IOLs combined with vitrectomy. The refraction predicted by the SRK/T formula and the postoperative refraction were converted into spherical equivalents. Predictive refraction accuracies were analyzed when the differences between the two values were within ± 0.5 diopters (D) and ± 1.0 D. The IOP was measured before and after surgery. Results: Eleven eyes of 11 men (mean age, 67.27 ± 10.55 years) were included. The mean axial length was 23.64 ± 1.26 mm; the mean predicted and postoperative refractions were -0.02 ± 0.46 D and -0.80 ± 0.98 D, respectively (p = 0.029). The refractive outcome was more myopic (by -0.78 ± 1.11 D) than predicted. The predictive accuracies were 36.4% and 72.7% when the differences were ± 0.5 and ± 1.0 D, respectively. The IOP did not change during follow-up (13.18 ± 4.56, 12.82 ± 5.88, and 12.73 ± 4.58 mmHg at baseline, 1 week, and 3 months, respectively). Conclusions: In trabeculectomized eyes, transscleral IOL fixation did not affect the IOP, but the refractive outcome was more myopic than predicted. This difference should be considered when choosing IOL target power.
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