유리체절제술과 백내장병합수술 중 유리체절제기로 시행한 수정체후낭절제술
Pars Plana Posterior Capsulectomy during Phacovitrectomy
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목적: 유리체절제술과 백내장병합수술 중 유리체절제기로 시행한 수정체후낭절제술의 안정성과 효과, 굴절력 변화를 알아보고자 하였다. 대상과 방법: 유리체절제술과 백내장병합수술을 시행받은 환자 76안을 대상으로 술 중 후낭절제술을 시행한 A군과 시행하지 않은 B군으로 나누어 두 군의 술 후 시력, 목표 굴절력과 술 후 실제 굴절력, 술 후 합병증, 후낭혼탁 등의 결과를 후향적으로 조사하였다. 결과: A군(37안)과 B군(39안)의 나이, 성별, 술 전 및 술 후 시력의 통계학적 차이는 없었으며 술 중 합병증은 없었다. 술 후 2개월째 A군의 실제 굴절력은 -0.44 ± 0.88D로 목표 굴절력(-0.56 ± 0.40D)과 비교하여 경한 원시 이행을 보였고 B군의 실제 굴절력은 -0.70 ± 0.72D로 목표 굴절력(-0.60 ± 0.81D)과 비교하여 경한 근시 이행을 보였다. 두 군 간의 목표 굴절력과 실제 굴절력값의 차이는 통계학적 유의수준에 매우 근사하였다(p=0.050). 술 후 A군에서는 후낭혼탁이나 섬유조직의 증식은 없었으나 B군의 10안에서 중등도 이상의 후낭혼탁이 발생하여 6안은 야그레이저후낭절개술을 시행하였으며 수술일로부터 평균 9.83 ± 5.2개월 후였다. 두 군 모두에서 인공수정체 아탈구 및 중심이탈의 합병증은 없었다. 결론: 유리체절제술과 백내장병합수술에서 유리체절제기로 시행한 수정체후낭절제술은 약간의 원시 이행을 나타내는 경향을 보였고 술 후 후낭혼탁을 예방하는 안전하고 효과적인 방법이다.
Abstract
Purpose: To evaluate the efficacy and safety of pars plana posterior capsulectomy (PPPC) during phacovitrectomy. Methods: In this retrospective study, 76 patients (76 eyes) who underwent phacovitrectomy were enrolled. The patients were divided into two groups according to whether PPPC was performed during phacovitrectomy. In group A, PPPC using a vitreous cutter was combined with phacovitrectomy; in group B, only phacovitrectomy was performed. The best-corrected visual acuity (BCVA), predicted and actual refractive errors, adverse events, and posterior capsular opacity (PCO) were analyzed and compared between the two groups. Results: Age, sex, and pre- and postoperative BCVA were not significantly different between group A (n = 37) and group B (n = 39). No intraoperative complications were identified in either group. In group A, the actual refraction (postoperative 2 months) was -0.44 ± 0.88 diopters (D) and a mild hyperopic shift was found compared to the preoperative predicted refraction (-0.56 ± 0.40 D). In group B, the actual refraction was -0.70 ± 0.72 D and a mild myopic shift was found compared to the preoperative predicted refraction (-0.60 ± 0.81 D). The difference in refraction shifts between the two groups was not significant but very close to it (p = 0.050). In group A, yttrium-aluminum-garnet (YAG) laser posterior capsulotomy was not required. However, PCO was observed in 10 eyes in group B, 6 of which subsequently underwent YAG laser posterior capsulotomy at the last follow-up. Lens instability such as dislocation or subluxations was not observed during the follow-up period. Conclusions: PPPC combined with phacovitrectomy may lead to hyperopic refractive changes. However, this was a safe and effective approach to prevent PCO and additional YAG laser posterior capsulotomy.
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