탈구된 인공수정체 재고정술과 공막내고정술을 이용한 인공수정체 교환술 임상결과 비교
Comparison of Clinical Outcomes between Refixation of Dislocated Intraocular Lenses and Exchange with Intrascleral Fixation
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목적: 탈구된 인공수정체 재고정술과 공막내고정술을 이용한 인공수정체교환술에 대한 임상결과를 알아보고자 하였다. 대상과 방법: 2014년 1월부터 2019년 4월까지 탈구된 인공수정체 재고정술 또는 인공수정체교환술을 시행한 환자 90명(91안)을 대상으로 후향적 연구를 진행하였다. 기존 인공수정체로 외부 공막고정술을 시행한 군(1군), 기존 인공수정체로 공막내고정술을 시행한 군(2군), 공막내고정술을 이용한 인공수정체교환술을 시행한 군(3군)으로 나누어 최대교정시력, 구면렌즈 대응치, 난시값, 안압 및 합병증을 관찰하였다. 결과: 최대교정시력(logMAR)은 수술 6개월 후 1군에서 0.10 ± 0.17, 2군에서 0.15 ± 0.29, 3군에서 0.31 ± 0.52로 향상되었다. 최대교정시력의 변화는 1, 2군보다 3군에서 유의하게 높았으나(p=0.018, p=0.046), 최종 최대교정시력은 유의한 차이가 없었다(p=0.422). 구면렌즈 대응치는 수술 6개월 후 1군에서 -1.26 ± 1.72 diopters (D), 2군에서 -1.32 ± 2.09 D, 3군에서 -0.17 ± 1.58 D로 근시화되었고, 3군보다 1, 2군에서 유의하게 더 큰 근시값을 보였다(p=0.004, p=0.001). 합병증 중 지지부 미끄러짐이 가장 많았다. 결론: 탈구된 인공수정체 재고정술은 인공수정체교환술과 비교하여 최종 최대교정시력에서 유의한 차이가 없었다. 인공수정체교환술보다 재고정술에서 더욱 근시화되는 경향이 있었고, 인공수정체 탈구 또는 지지부 미끄러짐의 위험이 높았다.
Abstract
Purpose: To investigate the clinical outcomes of refixation of a dislocated intraocular lens (IOL) and IOL exchange with intrascleral fixation. Methods: We performed a retrospective study of 90 patients (91 eyes) who underwent refixation or exchange of IOLs from January 2014 to April 2019. The patients were divided into an ab externo scleral refixation group (group 1), an intrascleral refixation group (group 2), and an exchange with intrascleral fixation group (group 3). We evaluated the best-corrected visual acuity (BCVA), spherical equivalent, cylindrical power, intraocular pressure, and postoperative complications. Results: The BCVA was 0.10 ± 0.17 (group 1), 0.15 ± 0.29 (group 2), and 0.31 ± 0.52 (group 3) at 6 months after surgery. The BCVA change in group 3 was significantly greater than that in groups 1 and 2 (p = 0.018 and p = 0.046, respectively). The final BCVA was not significantly different among the groups (p = 0.422). The spherical equivalent was -1.26 ± 1.72 diopters (D) (group 1), -1.32 ± 2.09 D (group 2), and -0.17 ± 1.58 D (group 3) at 6 months after surgery, showing that group 1 and group 2 were more myopic than group 3 (p = 0.004 and p = 0.001, respectively). Haptic slippage was the most common complication. Conclusions: Refixation of dislocated IOLs and IOL exchange with intrascleral fixation did not differ significantly in terms of the final visual outcomes. Refixation was associated with more myopia and a higher risk of IOL dislocation or haptic slippage than exchange.
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