무수정체안에서 인공수정체공막고정술 및 홍채 후방고정 안내렌즈삽입술 비교
Scleral Fixation of Intraocular Lens and Retropupillary Fixation of Iris Claw Lens for Aphakic Eyes
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목적: 본 연구는 탈구된 인공수정체안이나 무수정체안의 치료로서 인공수정체공막고정술과 홍채 후방고정 안내렌즈삽입술 사이의 임상 결과를 비교 분석하고자 한다. 대상과 방법: 본 후향적 연구는 2013년 8월에서 2018년 6월까지 인공수정체공막고정술을 시행받은 16명 17안과 홍채 후방고정 안내렌즈삽입술을 시행받은 13명 14안에 대하여 진행하였다. 수술 전과 수술 1일, 1주일, 1개월, 2개월, 6개월 후의 나안시력, 최대교정시력, 안압 등을 세극등현미경, 각막형태검사, 자동굴절검사 및 각막내피세포검사로 확인하여 그 결과 및 합병증을 비교하였다. 결과: 수술 6개월 후 나안시력과 최대교정시력은 두 군 모두 호전되었으나, 두 군 간에 유의한 차이를 보이지 않았으며(나안시력, p=0.162; 최대교정시력, p=0.418), 수술 1일 후 안압은 공막고정군에서 일시적으로 더 높았다(p=0.023). 수술 6개월 후 평균 절대예측오차는 홍채고정군에서 더 작았다(p=0.034). 수술 후 전체난시와 각막난시, 각막내피세포 밀도는 두 군에서 유의한 차이가 없었다. 결론: 홍채 후방고정 안내렌즈삽입술은 인공수정체공막고정술에 비해 유의한 시력 호전은 없었으나, 평균 절대예측오차가 더 작아서 수술 후 구면렌즈 대응치에 대한 예측도가 더 좋은 것으로 생각되며, 수술 후 안압상승을 덜 유발한다. 홍채 후방고정 안내렌즈삽입술은 탈구된 인공수정체안이나 무수정체안의 치료로서 공막고정술의 유효한 대안이 될 수 있다.
Abstract
Purpose: To compare the efficacy and complications of scleral fixation of posterior chamber intraocular lens (IOL) and retropupillary fixation of iris claw IOL for dislocated IOL or aphakia without sufficient capsular support. Methods: This retrospective study was comprised of 17 eyes of 16 patients undergoing scleral fixation and 14 eyes of 13 patients undergoing retropupillary fixation from August 2013 to June 2018. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp examination, corneal topography, refractive indices, corneal curvatures, corneal endothelial cell density, and complications of both groups were examined preoperatively and 1 day, 1 week, 1 month, 2 months, and 6 months postoperatively. Results: Six months after the operation, UCVA and BCVA improved in both groups; however, there were no significant differences between the two groups (UCVA, p = 0.162; BCVA, p = 0.418). IOP was temporarily higher in the scleral fixation group at one day postoperatively (p = 0.023). The mean absolute prediction error was smaller in the retropupillary iris fixation group at 6 months postoperatively (p = 0.034). Postoperative total astigmatism, corneal astigmatism, and corneal endothelial cell density were not significantly different between the two groups. Conclusions: The retropupillary iris fixation group did not show significant improvement in visual acuity compared with the scleral fixation group. However, the retropupillary iris fixation group provided better mean absolute prediction error and a low risk of postoperative increase in IOP compared with the scleral fixation group. Retropupillary fixation of iris claw IOL is a promising option for scleral fixation of posterior chamber IOL for dislocated IOL or aphakia without sufficient capsular support.
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