회절 이중초점 인공수정체와 회절 삼중초점 인공수정체의 임상 결과 비교
Clinical Outcomes of Patients Fitted with Bifocal and Trifocal Diffractive Intraocular Lenses
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목적: 최근 소개된 회절 삼중초점 인공수정체의 단기간의 안전성과 유효성을 평가하기 위하여 회절 이중초점 인공수정체와 수술 후 3개월까지의 임상 결과를 비교해 보고자 하였다. 대상과 방법: 회절 이중초점 인공수정체(TECNISⓇ 1 ZLB00, Abbott Medical Optics Inc., Santa Ana, CA, USA) 및 회절 삼중초점 인공수정체(FineVisionⓇ POD F, PhysIOL SA, Liège, Belgium) 삽입술을 시행받은 각 21안, 17안을 대상으로 수술 후 1주, 1개월, 3개월간의 원거리, 중간거리, 근거리(4 m, 50 cm, 33 cm) 나안시력, 원거리 교정시력, 구면렌즈대응치를 측정하였다. 수술 후 1개월 뒤 Optec 6500Ⓡ (Stereo Optical Co. Inc., Chicago, IL, USA)를 이용한 대비감도를 비교하였으며, 수술 후 3개월 뒤 iTraceⓇ (Tracey Technologies, Houston, TX, USA)를 이용한 내부 수차를 비교하였다. 수술 후 눈부심과 달무리 증상에 대하여 설문하였으며, 안경의 필요 유무에 대하여 조사하였다. 결과: 수술 후 1주 뒤, 이중초점 인공수정체군보다 삼중초점 인공수정체군에서 근거리 나안시력(33 cm)이 유의하게 높았으며, 수술 후 1개월, 3개월 뒤에는 중간거리 나안시력(50 cm)이 유의하게 높았다. 두 군 간 구면렌즈대응치, 대비감도, 내부수차의 유의한 차이는 없었다. 수술 후 눈부심 및 달무리 증상은 삼중초점 인공수정체군에서 조금 더 적게 나타났으나 유의한 차이를 보이지는 않았으며, 안경 착용의 필요성도 두 군 간 유의한 차이가 없었다. 결론: 회절 삼중초점 인공수정체는 회절 이중초점 인공수정체보다 우수한 중간거리 시력을 보여, 백내장수술 후 환자의 다양한 거리에서의 시력 호전에 효과적일 것으로 기대된다.
Abstract
Purpose: We compared the short-term visual outcomes of patients fitted with trifocal diffractive intraocular lenses (IOLs) and bifocal IOLs 3 months after IOL implantation. Methods: We included 38 eyes undergoing IOL implantation at a single tertiary hospital. In all, 21 eyes received bifocal IOLs (TECNISⓇ 1 ZLB00; Abbott Medical Optics Inc., Santa Ana, CA, USA) and 17 received trifocal diffractive IOLs (FineVisionⓇ POD F; PhysIOL SA, Liège, Belgium). The primary outcomes were corrected and uncorrected visual acuities at 4 m, 50 cm, and 33 cm on postoperative weeks 1, 4, and 12, and the spherical equivalence values at those times. The secondary outcomes included contrast sensitivity measured using an Optec 6500Ⓡ instrument (Stereo Optical Co. Inc., Chicago, IL, USA) 4 weeks after surgery, the numbers of total and internal optical aberrations assessed using the iTraceⓇ (Tracey Technologies, Houston, TX, USA) instrument at 12 weeks, symptoms including glare or halo, and the need for spectacles when engaging in daily activity. Results: One week after surgery, eyes implanted with trifocal IOLs exhibited significantly better uncorrected near vision compared to eyes that had received bifocal IOLs, and at weeks 4 and 12, uncorrected intermediate vision was also better in the former eyes. The mean spherical equivalence did not significantly differ between the two groups, nor did the contrast sensitivity measured on postoperative week 4 or the numbers of optical aberrations evident at postoperative week 12. Eyes fitted with trifocal IOLs appeared to suffer less from glare or halo, but the between-group difference was not significant. The two groups did not significantly differ in terms of the need to wear supplementary spectacles. Conclusions: Trifocal diffractive IOLs seem to afford superior intermediate vision compared to traditional bifocal IOLs, and may therefore improve visual outcomes at varying distances in patients undergoing cataract surgery.
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