신생혈관녹내장에서 발생한 친수성 아크릴 인공수정체혼탁의 임상양상
Clinical Features of Patients with Opacification of Hydrophilic Acrylic Intraocular Lens in Neovascular Glaucoma
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목적: 신생혈관녹내장안에서 백내장수술 후 발생한 친수성 아크릴 인공수정체혼탁의 임상양상에 대하여 보고하고자 한다. 대상과 방법: 2006년 1월부터 2010년 12월까지 내원한 신생혈관녹내장 환자에서 인공수정체혼탁이 발생했던 11안(10명)의 의무기록을 후향적으로 분석하였다. 인공수정체혼탁안 중 3안에서 인공수정체교환술을 시행하였으며, 제거된 인공수정체는 육안 및 광학현미경으로 검사하였다. 인공수정체 광학부를 시상 절단하여 von Kossa 염색, 주사전자현미경(scanning electron microscope, SEM), 엑스선 에너지 분광분석기(energy dispersive X-ray spectroscope, EDX)를 통하여 분석하였다. 결과: 인공수정체혼탁은 모두 친수성 아크릴 인공수정체에서 발생하였다. 소수성 인공수정체를 삽입했던 증례에서는 혼탁이 발생하지 않았다. 인공수정체혼탁이 발생했던 10명 가운데 9명이 당뇨망막병증, 1명이 중심동맥폐쇄 환자였다. 혼탁 발생은 인공수정체삽입 후 평균 19.45 ± 8.52개월, 신생혈관녹내장이 병발된 이후 평균 14.37 ± 8.51개월 경과 후 발생하였다. 제거한 인공수정체의 von Kossa 염색에서 칼슘침착을 확인할 수 있었다. 인공수정체의 주사전자현미경검사에서 전체 광학부에 앞쪽 표면 걸쳐 과립상 미세침착물을 관찰하였으며 엑스레인 분광분석에서 칼슘을 확인할 수 있었다. 결론: 신생혈관녹내장이 발생할 수 있는 당뇨망막병증, 중심동맥폐쇄, 중심정맥폐쇄 등의 환자에서 백내장수술 후 친수성 아크릴 인공수정체를 사용함에 있어서는 보다 신중한 고려가 필요할 것을 생각한다.
Abstract
Purpose: To report the clinical features of patients with opacification of hydrophilic acrylic intraocular lens (IOL) after cataract surgery in neovascular glaucoma. Methods: This retrospective case series included 11 eyes of 10 patients with IOL opacification and neovascular glaucoma (NVG) between January 2006 and December 2010. We included and analyzed cases with opacification of hydrophilic acrylic IOL. An IOL exchange was performed in three cases, and the explanted IOLs were examined grossly and evaluated by light microscopy. Sagittal sections of the optics of the IOLs were evaluated by Von Kossa staining, scanning electron microscopy (SEM), and energy- dispersive X-ray spectroscopy (EDX). Results: All 11 eyes of 10 patients were implanted with hydrophilic acrylic IOLs. In addition, there were no cases of hydrophobic acrylic IOL opacification. Nine patients of the 10 patients had diabetic retinopathy and one patient had central retinal artery occlusion. The mean period of IOL opacification after IOL implantation was 19.45 ± 8.52 months and the mean period of IOL opacification after the occurrence of NVG was 14.37 ± 8.51 months. The deposits of the explanted IOLs were shown to consist of calcium by von Kossa staining. The explanted IOLs showed fine whitish irregular granular deposits on the entire anterior surface of the optics by SEM and the presence of calcium deposition was confirmed by EDX analysis. Conclusions: Care is required when using hydrophilic acrylic IOLs in patients with risk of neovascular glaucoma, such as those with diabetic retinopathy or central retinal artery occlusion.
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