탈구된 인공수정체의 고리모양 지지부를 이용하여 네 개의 플랜지를 만들어 재고정한 공막고정술
Four-flanged Technique for Scleral Fixation of a Dislocated Four-eyelet Intraocular Lens
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목적: 탈구된 인공수정체의 고리모양 지지부를 이용하여 네 개의 플랜지를 만들어 재고정한 공막고정술을 소개하고 단기 임상 결과를분석하고자 한다. 대상과 방법: 탈구된 인공수정체의 고리모양 지지부와 프롤렌 봉합사를 이용하여 네 개의 플랜지를 만들어 재고정한 11안을 대상으로후향적 연구를 하였다. 최대교정시력, 안압, 각막내피세포밀도, 구면렌즈대응치, 난시, 인공수정체 기울어짐과 중심이탈 및 합병증을분석하였다. 결과: 최대교정시력(logarithm of the minimal angle of resolution)은 술 전 0.25 ± 0.11, 술 후 6개월 0.14 ± 0.12로 호전되었고(p<0.001), 각막내피세포밀도(/mm2)는 술 전 2,427 ± 384, 술 후 2,367 ± 298로 유의한 차이가 없었다(p=0.285). 구면렌즈대응치(diopters, D)는 수술 전 6.02 ± 4.90, 수술 후 0.11 ± 0.36으로 호전되었다(p<0.001). 난시는 수술 전후 유의한 차이가 없었다. 인공수정체 기울어짐은 2.44 ± 1.68°이고, 중심이탈은 0.23 ± 0.09 mm였다. 굴절오차(공막고정술 후 구면렌즈대응치-인공수정체 탈구전 구면렌즈대응치, D)는 0.11 ± 0.24였다. 플랜지 노출이 1안이 발생하였다. 결론: 고리모양 지지부가 있는 인공수정체를 네 개의 플랜지를 만들어 재고정한 결과, 유의한 시력의 호전을 보였고 각막내피세포밀도는 유의한 변화가 없었다. 수술 후 난시 변화가 거의 없으며 인공수정체 기울어짐과 중심이탈의 발생이 적고 수술 후 회복이 빠른장점이 있어 고리모양 지지부가 있는 인공수정체가 탈구된 경우에서 유용한 공막고정술 방법이 되겠다.
Abstract
Purpose: To define and evaluate the short-term clinical outcomes of the four-flanged technique for scleral fixation of a dislocated four-eyelet intraocular lens (IOL). Methods: Eleven eyes of 11 patients who underwent scleral fixation of dislocated four-eyelet intraocular lenses using a four-flanged technique were studied retrospectively. We measured the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, astigmatism, IOL tilt and decentration, and postoperative complications. Results: The BCVA was 0.25 ± 0.11 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.14 ± 0.12 logMAR 6 months later (p < 0.001). The corneal endothelial cell count was 2,427 ± 384 and 2,367 ± 298/mm2 before and after surgery, respectively (p = 0.285). The spherical equivalent was 6.02 ± 4.90 and 0.11 ± 0.36 before and after surgery, respectively. There was no significant difference in astigmatism before and after surgery. The mean IOL tilt and decentration were 2.44 ± 1.68° and 0.23 ± 0.09 mm, respectively. The refractive difference was 0.11 ± 0.24 diopters (D). Postoperative complications occurred in one eye; one flange lay outside the scleral tunnel, triggering hyperemia and conjunctival inflammation. Conclusions: The four-flanged scleral fixation technique for a dislocated four-eyelet IOL improved the BCVA but did not significantly affect corneal endothelial cell loss. The procedure significantly reduced postoperative IOL tilt, decentration, and astigmatism, and may be a useful alternative to scleral fixation of a dislocated four-eyelet IOL.
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