원추각막이 있는 눈에서 미니공막콘택트렌즈 착용의 임상 결과
Clinical Outcomes of Mini-scleral Contact Lenses in Eyes with Keratoconus
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목적: 원추각막이 있는 눈에서 시력 교정 목적으로 처방한 미니공막렌즈의 임상 결과와 처방된 렌즈와 관련된 눈의 형태학적 인자를 분석하였다. 대상과 방법: 2016년 1월부터 2021년 3월까지 원추각막으로 미니공막렌즈를 처방 받은 환자 중 3개월 이상 경과관찰이 된 24명(44안)을 대상으로 하였다. 처방 전 원추각막의 병기, 렌즈 착용 후 교정시력 개선 정도, 추적 관찰 기간, 렌즈 합병증과 착용 유지 실패 원인에 대하여 분석하였다. 렌즈의 기본만곡반경과 렌즈 처방 전 눈의 형태학적 인자들 사이의 상관 관계를 분석하였다. 결과: 렌즈 처방 전 Amsler-Krumeich 원추각막 병기는 평균 2.2 ± 0.8이었고, 90.9%에서 2줄 이상의 교정시력 호전을 보였다. 중도에 렌즈 착용을 포기한 4안(2명, 9.9%)을 제외한 평균 렌즈 착용 기간은 23.6 ± 17.8개월이었고, 일일 평균 착용 시간은 8.79 ± 3.14 시간이었다. 합병증으로는 1안에서 무균성 각막염, 5안(3명)에서 결막 충혈, 1안에서 점상각막염이 보고되었으며 심각한 합병증은 없었다. 렌즈 유지 실패의 원인은 충혈 및 이물감 2안(1명), 관리의 번거로움 2안(1명)이었으며 평균 6개월에 포기하였다. 렌즈 처방 전각막지형도의 각막 전면 및 후면의 최적구면(best fit sphere) 직경이 최종 처방 받은 렌즈의 기본만곡반경과 양의 상관관계가 있었다(p<0.001). 결론: 미니공막렌즈는 다양한 병기의 원추각막 환자에서 심각한 합병증 없이 우수한 시력 교정 효과를 보였고, 렌즈의 기본만곡반경은 각막의 최적구면직경과 상관관계를 보였다.
Abstract
Purpose: To analyze the clinical results of fitting mini-scleral contact lenses prescribed for vision correction in eyes with keratoconus, and the parameters of eyes related to the base curve radius (BCR) of the final prescribed lenses. Methods: From January 2016 to March 2021, 24 patients (44 eyes) who used mini-scleral lenses for more than 3 months due to keratoconus were enrolled. The keratoconus stage before prescription, degree of corrected visual acuity improvement, follow-up period, and complications and causes of failure to maintain the lenses were analyzed. The correlations between the BCR of the final prescribed lenses and the morphological factors of the eyes were analyzed. Results: The average Amsler–Krumeich keratoconus stage before wearing a lens was 2.2 ± 0.8 and 90.9% of patients had a corrected visual acuity improvement exceeding 2 lines. Excluding four eyes in two patients (9.9%) who gave up wearing mini-scleral lenses, the average duration of wearing lenses was 23.6 ± 17.8 months, and the average daily wearing time was 8.79 ± 3.14 hours. Complications were conjunctival injection in five eyes (three patients) and sterile keratitis and superficial punctate keratitis in one eye, respectively. The causes of failure to maintain the mini-scleral lens were injection in two eyes (one patient) and handling difficulty in two eyes (one patient), and they gave up after an average of 6 months. Only the radii of the anterior and posterior corneal best fit sphere before wearing the lens were found to have a significant positive correlation with the BCR of the finally prescribed lenses (p < 0.001). Conclusions: Mini-scleral lenses provide relatively good vision improvement without serious complications in patients at various stages of keratoconus, and the BCR of the finally prescribed lens had a good correlation with the anterior and posterior corneal best fit sphere.
참고문헌 (21)
- Rabinowitz YS, "Keratoconus", Surv Ophthalmol, 42, pp.297~319 (1998)
- Krachmer JH, "Keratoconus and related noninflammatory corneal thinning disorders", Surv Ophthalmol, 28, pp.293~322 (1984)
- Wollensak G, "Riboflavin", ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus, 2003, pp.135, 620~627
- Henein C, "Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus", Cont Lens Anterior Eye, 40, pp.3~14 (2017)
- Chan E, "Current status of corneal collagen cross-linking for keratoconus : a review", Clin Exp Optom, 96, pp.155~164 (2013)
- Fuller DG, "Safety and efficacy of scleral lenses for keratoconus", Optom Vis Sci, 97, pp.741~748 (2020)
- Koppen C, "Scleral lenses reduce the need for corneal transplants in severe keratoconus", Am J Ophthalmol, 185, pp.43~47 (2018)
- Van der Worp E, "Modern scleral contact lenses : a review", Cont Lens Anterior Eye, 37, pp.240~250 (2014)
- Lee SM, "Long-term effect of corneoscleral contact lenses on refractory ocular surface diseases", Cont Lens Anterior Eye, 42, pp.399~405 (2019)
- Rathi VM, "Scleral lens for keratoconus : technology update", Clin Ophthalmol, 9, pp.2013~2018 (2015)
- Akkaya Turhan S, "Use of a Mini-scleral lens in patients with keratoconus", Turk J Ophthalmol, 50, pp.339~342 (2020)
- 서수연, "다양한 각막질환에서 미니공막콘택트렌즈의 임상결과", 대한안과학회지, 57(11), pp.1699~1705 (2016), 대한안과학회
- Amsler M, "Classic keratocene and crude keratocene; unitary arguments", Ophthalmologica, 111, pp.96~101 (1946)
- Moon J, "Large diameter scleral lens benefits for Asians with intractable ocular surface diseases : a prospective, single-arm clinical trial", Sci Rep, 11, pp.2288~ (2021)
- Rathi VM, "Contact lens in keratoconus", Indian J Ophthalmol, 61, pp.410~415 (2013)
- Downie LE, "Contact lens management of keratoconus", Clin Exp Optom, 98, pp.299~311 (2015)
- Lee SM, "Estimation of axial curvature of anterior sclera : correlation between axial length and anterior scleral curvature as affected by angle kappa", BMC Ophthalmol, 16, pp.176~ (2016)
- Choi HJ, "Measurement of anterior scleral curvature using anterior segment OCT", Optom Vis Sci, 91, pp.793~802 (2014)
- Gemoules G, "A novel method of fitting scleral lenses using high resolution optical coherence tomography", Eye Contact Lens, 34, pp.80~83 (2008)
- Pecego M, "Jupiter scleral lenses : the UC Davis Eye Center experience", Eye Contact Lens, 38, pp.179~182 (2012)
- Severinsky B, "Scleral contact lenses for visual rehabilitation after penetrating keratoplasty : long term outcomes", Cont Lens Anterior Eye, 37, pp.196~202 (2014)