조명차퍼를 이용한 백내장수술에서 최소-에너지 수정체유화술
Illuminated Chop Using an Illuminated Chopper in Cataract Surgery: on the Way to Minimal-energy Phacoemulsification
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목적: 백내장수술에서 조명차퍼를 이용한 변형된 수정체 핵 쪼개기로 수술 중 발생하는 초음파 에너지와 수술 시간을 최소화하고자 하였다. 대상과 방법: 단일 술자에 의해 전방내 조명기를 사용한 Stop & Chop 방식으로 노인성 백내장수술 받은 34명 45안과 조명차퍼를 사용한 Illuminated chop (I-Chop) 방식으로 수술 받은 49명 71안에서 수술 중 사용된 유효 초음파 에너지양을 나타내는 수술 기구의 고유 상수(EFX), 수정체유화술 시간, 각막내피세포수 변화 등을 비교하고, I-Chop군에서 제로-에너지 수정체유화술 비율을 조사하였다. 결과: 두 그룹에서 수술 중 사용된 유효 초음파 에너지양은 각각 0.82 ± 3.53, 18.08 ± 16.15 (p=0.001), 수정체유화술 시간은 162.04 ± 49.65초, 185.08 ± 41.42초(p=0.01)로 유의한 차이를 보였다. 하지만 각막내피세포 감소량은 7.13 ± 9.47%, 7.03 ± 7.89%로 유의한 차이를 보이지 않았다(p=0.76). I-Chop군에서 제로-에너지 수정체유화술 환자는 56안(86%)이었으며, EFX>1인 환자들에서 핵경화 정도는 더 심한 경향을 보였다(2.90 ± 0.71 vs. 4.5 ± 1.0; p=0.001). 결론: 조명차퍼를 이용한 I-Chop 수정체 핵 쪼개기를 통해 백내장수술에서 초음파 에너지를 최소화할 수 있었다.
Abstract
Purpose: To minimize ultrasound power use and surgical phaco time in illuminated chop cataract surgery. Methods: The charts of patients who underwent senile cataract surgery by a single surgeon were reviewed retrospectively. A conventional intracameral endoilluminator was used in a Stop & Chop group (n = 45), while an illuminated chopper was used in an illuminated chop (I-Chop) group (n = 71). EFX, a unitless value that roughly correlates with ultrasound energy during phacoemulsification, surgical phaco time, and changes in endothelial cell count were compared between the two groups and the ratio of zero phacoemulsification in the I-Chop group was evaluated. Results: EFX of the Stop & Chop and I-Chop groups was 18.08 ± 16.15 and 0.82 ± 3.53, respectively (p = 0.001), while the surgical phaco time was 185.08 ± 41.42 and 162.04 ± 49.65 seconds (p = 0.01). However, the endothelial loss did not differ in the two groups (7.03 ± 7.89 vs. 7.13 ± 9.47%, p = 0.76). In the I-Chop group, 56 (86%) eyes had zero phaco energy and patients with EFX >1 (n = 6) had more severe nuclear sclerosis grading (2.90 ± 0.71 vs. 4.5 ± 1.0; p = 0.001). Conclusions: The I-Chop group had lower EFX and shorter surgical phaco time than the Stop & Chop group. Illuminated chop using an illuminated chopper is one way to attain minimal phacoemulsification.
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