안저검사상 망막이 관찰되지 않는 진행 백내장의 시력예후와 술 후 만족도
Visual Prognosis and Satisfaction of Advanced Cataract Patients Unable to be Evaluated by Fundus Imaging
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목적: 망막이 관찰되지 않는 진행 백내장환자의 수술 예후와 만족도에 대해 조사하였다. 대상과 방법: 2015년부터 2017년까지 백내장수술을 받은 480명 748안을 후향적으로 분석하였다. 술 전 요인과 백내장의 진행 정도, 수술 방법, 수술 1개월 및 6개월 후 최대교정시력에 대해 조사하였다. 이 중 망막이 관찰되지 않는 진행 백내장환자 78명 91안의 술 후 만족도를 조사하였다. 결과: 고혈압은 수술 6개월 후 시력과 양의 상관관계를 보였다(p=0.004). 낮은 각막 내피세포 수, 원발개방각녹내장, 섬유주절제술, 각막이상증 혹은 각막혼탁, 안저검사상 망막이 관찰되지 않는 진행 백내장, 과숙백내장, 백내장 낭외적출술 및 낭내적출술, 수술 1개월 후 시력이 0.5 미만인 경우는 수술 6개월 후 시력과 음의 상관관계를 보였다(각각 p=0.019, p=0.002, p=0.037, p=0.001, p=0.004, p=0.012, p=0.00, p=0.00). 망막이 관찰되지 않는 진행 백내장은 수술 후 6개월 후 시력 0.5 미만의 위험도가 3.18배(p=0.003) 높았다. 망막이 관찰되지 않는 진행 백내장환자 중, 예후가 좋지 않을 것으로 기대되어 수술을 미룬 환자 10명 10안 중 6안(60%)의 최종시력은 0.5 미만이었다. 하지만, 6명(60%)이 수술 후 만족한다고 답하였으며 수술 후 만족도가 상대적으로 높았다. 결론: 망막이 관찰되지 않는 진행 백내장환자의 수술 후 최종 시력은 낮다. 그러나 진행 백내장환자 중 좋지 않은 예후가 기대되었던 환자의 술 후 만족도는 시력예후에 비해 높다.
Abstract
Purpose: We evaluated the surgical prognoses of patients with advanced cataract who were unable to be evaluated by fundus imaging and their satisfaction with daily life. Methods: We retrospectively reviewed 748 eyes of 480 patients who underwent cataract surgery from January 2015 to December 2017. Preoperative factors, surgical technique, degree of cataract, and the best-corrected visual acuity for 1 and 6 months after surgery were analyzed. Among 91 eyes of 78 patients with advanced cataract who were unable to be evaluated by fundus imaging, the degree of discomfort before surgery and postoperative satisfaction were evaluated. Results: Hypertension was positively correlated with visual acuity after cataract surgery (p = 0.004). Low corneal endothelial cell count, primary open-angle glaucoma, a history of trabeculectomy due to glaucoma, corneal dystrophy or corneal opacity, advanced cataract unable to be evaluated by fundus imaging, hypermature cataract, extracapsular cataract extraction, and intracapsular cataract extraction and visual acuity <0.5 after 1 month showed negative correlations with the visual outcomes after 6 months (p = 0.019, p = 0.002, p = 0.037, p = 0.001, p = 0.004, p = 0.012, p = 0.00, and p = 0.00, respectively). The risk of a final visual acuity <0.5 after cataract surgery was 3.18-fold higher in cases of advanced cataract, unable to be evaluated by fundus imaging (p = 0.003). Ten patients with 10 eyes postponed surgery due to poor prognoses, which was expected, and six patients (60%) had a best-corrected visual acuity <0.5 after 6 months. Six patients (60%), expected to have a poor prognosis were satisfied after surgery and the postoperative satisfaction was high when compared with a poor visual outcome. Conclusions: Poor surgical prognoses were expected in advanced cataract patients unable to be evaluated by fundus imaging. However, advanced cataract patients, who postponed surgery due to an unfavorable visual prognosis, showed a higher subjective satisfaction when compared with the postoperative visual acuity.
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