제2형 과립각막이상증 이형접합자에서 다초점인공수정체 삽입 후의 시기능 고찰 1예
Visual Function after Multifocal Intraocular Lens Insertion in a Heterozygous Granular Corneal Dystrophy Type 2 Patient: Case Report
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목적: 다초점인공수정체를 삽입한 제2형 과립각막이상증(granular corneal dystrophy type 2, GCD2) 환자가 백내장수술 후 심한 불편감을 호소하여, 그 원인을 시기능적인 면에서 조사하였다. 증례요약: GCD2 각막혼탁을 지닌 59세 여자 환자로 5년 전 세극등현미경으로 각막을 촬영하고, 3년 전 양안 다초점인공수정체 삽입백내장수술(AT Lisa tri toric 839MP®, Carl Zeiss Meditec AG, Inc., Jena, Germany)을 시행받았으나, 수술 후 시력저하를 호소하며본원에 내원하였다. 세극등 사진 비교 시 5년 전에 비하여 각막혼탁의 정도는 변화가 거의 없었다. 하지만 백내장수술 직전 교정시력(우안 0.5, 좌안 0.6)에 비해 수술 후 교정시력(우안 0.3, 좌안 0.4)이 저하되었으며, 대비감도가 저하되었고 총 고위수차는 증가(우안1.590 μm, 좌안 1.194 μm)되어 있었다. 결론: 각막혼탁이 심한 GCD2 환자에서 다초점인공수정체를 삽입한 후, 대비감도의 저하와 시력 감소, 고위수차의 증가가 관찰되었다. 각막혼탁이 심한 GCD2에서 다초점인공수정체 사용은 지양되어야 할 것으로 판단된다.
Abstract
Purpose: A patient with heterozygous granular corneal dystrophy type 2 (GCD2) underwent phacoemulsification with multifocal intraocular lens insertion, and complained of visual discomfort. We investigated the cause of the discomfort and visual function in this case. Case summary: A 59-year-old woman with granular opacity had slit lamp photographs taken 5 years earlier. Two years later, she underwent phacoemulsification with multifocal intraocular lens (Trifocal AT Lisa tri toric 839MP ® , Carl Zeiss Meditec AG, Inc., Jena, Germany) insertion in both eyes at a local clinic. She felt very uncomfortable after the surgery, but the granular and lattice opacities due to GCD2 of her corneas remained stationary for 5 years. Her visual acuity decreased from preoperatively (preoperative: right 0.5, left 0.6; last visit: right 0.3, left 0.4). Her contrast sensitivity was also decreased and the total higher order aberration was increased (right 1.590 μm, left 1.194 μm), compared to normal range. Conclusions: Multifocal intraocular lens insertion in cataract surgery can lead to severe declines in contrast sensitivity and visual acuity and increased higher-order aberration in a GCD2 patient. It may not be advisable to use multifocal intraocular lenses in a GCD2 patient.
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