위눈꺼풀수술 후 각막 고위수차와 각막난시의 변화
Changes in Corneal Higher-order Aberrations and Astigmatism after Upper Eyelid Surgery
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목적: 위눈꺼풀수술이 각막 고위수차와 각막난시에 미치는 영향을 알아보고자 하였다. 대상과 방법: 위눈꺼풀성형술을 받은 38명(66안)과 눈꺼풀올림근절제술을 시행받은 48명(81안)을 대상으로 수술 전과 수술 6개월 후의 위눈꺼풀각막반사간거리, 각막 고위수차 및 각막난시를 측정하여 수술 전후의 차이를 비교 분석하였다. 결과: 수술 후 눈꺼풀올림근절제술군에서 각막난시가 유의하게 감소하였으나(p<0.001) 난시축의 변화는 없었다. 각막 고위수차 중3차 수차와 코마유사수차는 수술 전 눈꺼풀올림근절제술군에서 유의하게 컸으며(p=0.027, p=0.044), 눈꺼풀올림근절제술군에서 수술 후 3차 수차와 코마유사수차가 유의하게 감소하였다(p=0.030, p=0.006). 눈꺼풀올림근절제술군에서 수술 후 위눈꺼풀각막반사간거리와 3차 수차의 변화량과 코마유사수차의 변화량은 유의한 음의 상관관계를 보였다(b=-0.186, p<0.001; b=-0.159, p<0.001). 결론: 눈꺼풀올림근절제술 후 각막 고위수차와 각막난시가 감소하므로, 백내장과 눈꺼풀처짐이 동반된 환자의 경우 백내장수술에 앞서 눈꺼풀올림근절제술을 먼저 시행하는 것이 술 후 굴절 오차를 줄이고 시력의 질을 향상시키는 데 유리하다.
Abstract
Purpose: We investigated the effects of upper eyelid surgery on corneal higher-order aberrations and astigmatism. Methods: We enrolled 38 patients (66 eyes) who underwent blepharoplasty and 48 (81 eyes) who underwent levator resection. The marginal reflex distance1 (MRD1), corneal astigmatism, and corneal higher-order aberrations were measured preoperatively, and at 6 months postoperatively, and the two groups were compared. Results: Corneal astigmatism decreased significantly in the ptosis repair group (p < 0.001) but there was no significant change in the axis of astigmatism. Preoperative third-order and coma-like aberrations were significantly more common in the ptosis repair group than in the other group (p = 0.027 and p = 0.044, respectively); both decreased significantly after the operation (p = 0.030 and p = 0.006, respectively). The decrease in MRD1 and changes in the two aberrations showed a significantly stronger negative correlation in the ptosis repair group than in the other group (b = -0.186; p < 0.001 and b = -0.159; p < 0.001, respectively). Conclusions: For patients with both cataract and ptosis, it is best to perform levator resection surgery before cataract surgery, because corneal higher-order aberrations and astigmatism are improved by levator resection. In turn, this reduces postoperative refractive error and improve vision quality.
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