라식수술과 스마일수술 후 안압의 변화 및 그에 영향을 미치는 인자들
Changes in Intraocular Pressure and Factors that Influence such Changes after FS-LASIK and SMILE
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목적: 라식수술과 스마일수술 후 안압 측정값의 변화 양상과 그에 영향을 미치는 인자들을 비교해보고자 하였다. 대상과 방법: 라식수술을 받은 117명, 234안과 스마일수술을 받은 122명, 244안을 대상으로 후향적으로 조사하였다. 각 군의 수술 전, 수술 후 1개월, 3개월, 6개월에 비접촉안압계로 측정한 안압과 이중샤임플러그 전안부분석기로 측정한 중심각막두께, 평균각막곡률, 편평각막곡률, 가파른각막곡률 등의 변화의 차이를 비교하였고, 단순선형회귀분석을 통해 수술 전후 안압 변화와 관련된 인자들의 관련성을 분석하였다. 결과: 술 후 6개월째 안압감소는 라식군에서 5.41 ± 2.28 mmHg, 스마일군에서 4.77 ± 2.38 mmHg로 스마일군에서 유의하게 적었고(p=0.004), 안압이 라식군에서 수술 후 1개월부터 6개월간 유의미한 변화가 없었던 반면 스마일군에서 안압은 술 후 3개월째 12.07 ± 1.77 mmHg에서 6개월째 12.77 ± 1.89 mmHg로 유의미하게 상승하였다(p=0.002). 두 군 모두에서 안압감소량은 수술 전 구면렌즈 대응치, 수술 전 안압, 평균각막곡률 변화, 편평각막곡률 변화, 가파른각막곡률 변화, 중심각막두께 변화와 유의미한 연관성을 보였고, 두 군 모두에서 수술 전 안압이 술 후 안압감소량과 가장 높은 상관관계를 보였다(라식군 R2=0.414, 스마일군 R2=0.292). 결론: 라식수술과 스마일수술 후 안압은 술 전에 비하여 유의미하게 감소하였는데 그 정도는 라식군에서 더 높았으며, 두 수술 모두에서 술 전 안압이 술 후 안압감소에 가장 중요한 예측 인자였다.
Abstract
Purpose: We compared the intraocular pressure (IOP) changes and the relationships thereof with corneal biomechanics after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Methods: A total of 234 eyes of 117 patients who underwent FS-LASIK surgery and 244 eyes of 122 patients who underwent SMILE surgery were included in this retrospective study. Data were collected preoperatively, and at 1, 3, and 6 months postoperatively, including IOP measured via non-contract tonometry, central corneal thickness (CCT), and mean keratometry (Km), flat keratometry (Kf), and steep keratometry (Ks) data obtained using a dual Scheimpflug analyzer. Between-group differences were compared. Simple linear regression analysis was used to determine the relationship between changes in the IOP and the various parameters. Results: The IOP changes were 5.41 ± 2.28 mmHg in the FS-LASIK group and 4.77 ± 2.38 mmHg in the SMILE group, thus significantly different (p = 0.004). The IOP did not change significantly from 1 to 6 months after FS-LASIK but increased significantly from 12.07 ± 1.77 mmHg at 3 months postoperatively to 12.77 ± 1.89 mmHg at 6 months postoperatively after SMILE (p = 0.002). All of the preoperative spherical equivalent and IOP, and changes in the Km, Kf, Ks, and CCT, were significantly associated with the IOP changes in both groups. The preoperative IOP evidenced the strongest relationship with the IOP changes in both groups (R2 = 0.414 in the FS-LASIK group, R2 = 0.292 in the SMILE group). Conclusions: The IOP fell significantly after FS-LASIK and SMILE surgery, significantly more so after FS-LASIK than SMILE. The preoperative IOP exhibited the greatest influence on the IOP decreases after both FS-LASIK and SMILE.
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