백내장수술에서 윤부 이완절개법과 난시교정인공수정체의 난시교정효과 비교
Comparison of Efficacies in Treating Astigmatism between Toric Intraocular Lens Implantation and Limbal Relaxing Incision
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목적: 한국인 백내장 환자에서 난시교정인공수정체와 윤부이완절개술의 효과를 비교하고자 하였다. 대상과 방법: 1.25D 이상의 각막난시를 보인 79명 100안에 대하여 후향적으로 고찰하였다. 난시교정인공수정체군(54안)과 윤부이완절개술군(24안), 일반인공수정체 삽입군(대조군, 22안)으로 나누어 수술 후 2, 6개월 경과 후 나안과 교정시력, 각막난시, 굴절난시를 비교분석하였다. 또한 대상자 중 2.5D 이하의 각막난시군을 따로 중등도 난시군으로 분류하여 추가 분석을 실시하였다. 결과: 수술 2개월 후 난시교정인공수정체군의 64.8%, 윤부이완절개술군의 41.7%, 대조군의 27.3%에서 0.1 logMAR 이상 나안시력을 보였다. 각막난시의 경우 술 전후 난시교정인공수정체군은 2.40 ± 1.33D에서 2.23 ± 1.42D, 윤부이완절개술군은 1.86 ± 0.44D에서 1.29 ± 0.55D, 대조군은 1.60 ± 0.39D에서 1.35 ± 0.60D로 윤부이완절개술군에서 가장 유의한 호전을 보였다(p=0.025). 굴절난시에서 난시교정인공수정체군은 -2.48 ± 1.84D에서 -0.98 ± 0.92D, 윤부이완절개술군은 -2.02 ± 1.03D에서 -1.65 ± 0.86D, 대조군은 -1.69 ± 0.88D에서 -1.49 ± 0.60D의 변화를 보였으며, 변화량은 난시교정인공수정체군에서만 유의하였다(p<0.001). 2.5D 이하의 각막난시를 보인 85안 중 굴절난시는 난시교정인공수정체군에서 0.97 ± 0.66D (55.1%)의 가장 높은 호전을 보였고(p<0.001), 윤부이완절개술군에서도 0.53 ± 0.87D의 유의한 변화를 보였다(p=0.046). 결론: 두 군 모두 대조군에 비하여 월등한 시력호전 및 난시 교정 결과를 보였으나 술 전 난시의 양에 관계없이 난시교정인공수정체삽입술에서 가장 큰 호전을 나타냈다. 중등도 난시를 가진 환자에서는 윤부이완절개법을 통하여도 유의한 양의 난시 및 시력 교정효과를 얻을 수 있어 경제적인 문제로 난시교정인공수정체 삽입을 꺼려하는 환자에게 유용한 수술이라고 사료된다.
Abstract
Purpose: To compare the effectiveness of toric intraocular lens (IOL) implantation and monofocal IOL implantation with a limbal relaxing incision (LRI) for correcting astigmatism in the Korean population. Methods: The medical records of 79 patients (100 eyes) with corneal astigmatism over 1.25 diopters (D) who underwent toric IOL implantation (toric group; 54 eyes), monofocal IOL implantation with a concurrent LRI (LRI group; 24 eyes), or monofocal IOL implantation without correcting astigmatism (control group; 22 eyes), were retrospectively reviewed. For subgroup analyses, the three groups were subdivided according to preoperative astigmatic severity under 2.5 D. Visual, refractive, and keratometric outcomes were compared 2 and 6 months postoperatively. Results: The uncorrected distance visual acuity was at least 20/25 (0.1 logMAR) in 64.8%, 41.7%, and 27.3% of the toric, LRI, and control group eyes, respectively at 2 months after surgery. The toric group had the greatest refractive cylindrical error change (toric group, -2.48 ± 1.84 D to -0.98 ± 0.92 D; LRI group, -2.02 ± 1.03 D to -1.65 ± 0.86 D; control group, -1.69 ± 0.88 D to -1.49 ± 0.60 D; p < 0.001) and the LRI group showed the greatest mean corneal cylindrical error change (toric group, 2.40 ± 1.33 D to 2.23 ± 1.42 D; LRI group, 1.86 ± 0.44 D to 1.29 ± 0.55 D; control group, 1.60 ± 0.39 D to 1.35 ± 0.60 D; p = 0.025). The 85 eyes with moderate corneal astigmatism (between 1.25 D and 2.5 D) were under evaluation. The toric group showed the highest mean refractive cylindrical change (0.97 ± 0.66 D; p < 0.001), followed by the LRI group (0.53 ± 0.87 D; p = 0.046). Conclusions: Both surgical techniques significantly reduced astigmatism and had comparable visual outcomes. Toric IOL implantation was more reliable for correcting astigmatism than monofocal IOL implantation with a concurrent LRI regardless of the preoperative astigmatic severity. Both procedures were effective in reducing astigmatism in eyes with moderate corneal astigmatism.
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