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인공수정체 낭내 탈구에서 시행된 유리체절제술 및 새로운 인공수정체 공막내고정술의 임상 결과

Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

전혜민|방찬우|윤희성|채수혜|이민수
대한안과학회 (The Korean Ophthalmological Society)|2018.07|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제59권 제7호|pp. 657-664

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Pars plana vitrectomyIntraocular lens dislocationIntrascleral fixationPosterior chamber intraocular lens
주제분류안과학

초록

목적: 인공수정체 낭내(in-the-bag) 탈구에서 시행된 유리체절제술 및 새로운 인공수정체 공막내고정술의 임상 결과를 알아보고자 한다. 대상과 방법: 2015년 1월부터 2017년 1월까지 인공수정체 낭내 탈구로 본원에서 유리체절제술 및 인공수정체 공막내고정술을 시행받고 6개월 이상 경과관찰이 가능했던 증례를 후향적으로 연구하였다. 수술 방법은 유리체절제술을 먼저 시행하고 탈구된 인공수정체를 제거하였다. 공막내고정술은 각막 윤부로부터 1.5 mm 떨어진 6, 12시 부위에 공막터널을 만들고, 새로운 인공수정체 지지부(haptic)를 공막터널에 삽입하여 고정하였다. 수술 전 상태, 수술 전후 시력 및 굴절력, 수술 후 합병증을 관찰하였다. 결과: 49명 50안이 연구 대상에 포함되었으며, 평균 경과관찰 기간은 12.8 ± 6.6개월이었다. 수술 후 결과에서 최종 관찰의 최대교정시력이 6/12 또는 그 이상을 보인 환자가 43안(86%)이었으며, 최대교정시력(logMAR)은 수술 전 0.32에서 수술 후 최종 0.18로 유의한 시력 호전을 보였다(p=0.03). 수술 후 굴절 오차는 +1.09 ± 1.28의 원시화를 보였다. 수술 후 부작용으로 유리체 출혈이 6안, 낭포황반부종이 2안에서 발생하였고 보존적 치료로 모두 회복되었다. 2안에서 탈구가 재발하여 재수술하였고, 고정실 합병증, 망막 박리, 각막 부전, 안내염 등과 같은 심각한 부작용은 없었다. 결론: 인공수정체 낭내 탈구를 치료함에 있어서 유리체절제술 및 인공수정체 공막내고정술은 안전하고 효과적인 방법이며, 고정실과 관련된 부작용이 없는 좋은 수술법이라 하겠다.

Abstract

Purpose: To investigate the clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation. Methods: We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o’clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications. Results: Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-corrected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients. Conclusions: Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.

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