안내 후방인공수정체삽입술 렌즈 직경에 따른 중심 볼트 결과
Result of Central Vault Depending on Lens Diameters in Patients with Implantable Collamer Lens Implantation
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목적: 후방유수정체안내렌즈삽입술 시행 후, 삽입된 렌즈의 크기에 따른 중심 vaulting과 임상 결과를 비교하고자 하였다. 대상과 방법: 후방유수정체안내렌즈(V4C, V5) 삽입술을 시행받은 35안(19명)을 각막윤부직경에 따라 11.3-11.7 mm인 경우 12.6 mm 크기의 렌즈를 삽입한 그룹 1 (22안)과 11.8-12.2 mm인 경우 13.2 mm 크기의 렌즈를 삽입한 그룹 2 (13안)로 나누어 시간에 따른 vaulting의 변화, 굴절력, 시력, 내피세포의 변화, 합병증 발생을 비교하였다. 결과: 수술 후 1, 3, 6개월째 평균 중심 vaulting은 모든 기간 동안 그룹 2에서 유의하게 높았으며(p<0.05), 중심 vaulting이 750 mm 이상인 비율은 그룹 1에서 각각 27% (6안), 27% (6안), 18% (4안)였으며 그룹 2에서는 각각 69% (9안), 61% (8안), 53% (7안)로 1, 6개월에서 유의하게 높은 비율을 보였다(p<0.05). 수술 6개월 후 두 그룹 간의 나안시력(logMAR)과 구면렌즈대응치는 유의한 차이를 보이지 않았으며 각막내피세포 수는 수술 전과 수술 후 6개월에서 유의한 감소가 없었다. 결론: 각막윤부직경을 측정하여 삽입할 후방유수정체안내렌즈의 직경을 결정하는 경우 V4C와 V5 모델 중 13.2 mm 직경의 렌즈가 12.6 mm의 렌즈에 비해 높은 평균 중심 vaulting과 높은 비율의 high vaulting를 보여 이 렌즈를 사용하여 수술을 시행할 계획이 있는 환자에서 이에 대한 고려와 술자에 따른 렌즈 직경 조정이 필요할 것으로 생각된다.
Abstract
Purpose: To compare vaulting height and clinical results in patients who underwent anterior chamber phakic intraocular lens implantation with different lens diameters. Methods: Thirty-five eyes (19 patients) who underwent anterior chamber phakic intraocular lens (V4C or V5) implantation were divided into two groups according to lens diameters, which were based on the patient C or V5) implantation were dividdiameters. Group 1 was implanted with a 12.6 mm diameter lens (WTW, 11.3-11.7 mm; 22 eyes) and group 2 was implanted with a 13.2 mm diameter lens (WTW, 11.8-12.2 mm; 13 eyes). Changes in the central vault over time, refractive error, visual acuity, endothelial cell count, and complications were evaluated as clinical outcomes. Results: The post operative mean central vaulting heights at 1, 3, and 6 months Group 2 showed significantly higher vaulting at each visit (all, p < 0.05). High vaulting (greater than 750 mm) at 1, 3, and 6 months after surgery involved 27% (6 eyes), 27% (6 eyes), and 18% (4 eyes) in group 1 and 69% (9 eyes), 61% (8 eyes), and 53% (7 eyes) in group 2 (p < 0.05), respectively. Uncorrected distance visual acuity (logMAR) and spherical equivalent were not significantly different between two groups (p > 0.05). Conclusions: The results of optimal vaulting shows the lens diameter should be adjusted according to the surgeon’s experience or nomogram when the horizontal corneal WTW diameter was used to determine lens diameter. Especially in cases using a V4C or V5 model anterior chamber phakic intraocular lens, 13.2 mm in diameter (V5) shows higher central vaulting than 12.6 mm in diameter (V4C).
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