공막터널을 통한 백내장수술 후의 각막 상피 및 기질의 두께 변화
Change of Corneal Epithelial and Stromal Thickness after Cataract Surgery through Scleral Tunnel Incision
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목적: 공막터널을 통한 백내장수술 전후 각막상피와 기질의 두께를 비교하고 각막상피와 기질의 변화 양상의 차이를 알아보고자 하였다. 대상과 방법: 상부 공막터널 절개 후 초음파 백내장수술을 시행 받은 40세 이상의 성인 40명의 40안을 대상으로 하였다. RTVue (Optovue Inc., Fremont, CA, USA) 기기를 이용하여 대상자들의 각막상피 및 각막기질의 두께를 술 전과 술 후 3일, 1주, 1달에 측정하였다. 측정된 각막상피 및 기질두께는 정점에서 직경 2 mm 부위를 중심부, 2-5 mm 부위를 중심주변부, 5-6 mm 부위를 주변부로 나누어 분석하였다. 결과: 중심부의 평균 기질두께는 술 전 486.68 ± 25.15 μm에서 술 후 3일에 535.16 ± 48.13 μm, 술 후 7일에 515.98 ± 44.07 μm, 술 후 30일에 502.28 ± 34.87 μm였으며(모두 p<0.001), 직경 6 mm 이내 모든 부위에서 술 후 3일부터 술 전보다 유의하게 증가하여 술 후 30일까지 증가된 상태를 유지하였다(모두 p<0.001). 중심부, 중심주변부, 주변부의 평균 각막상피두께는 술 전에 52.13 ± 3.41 μm, 50.42 ± 2.97 μm, 49.12 ± 3.05 μm였고, 술 후 3일과 7일에는 모든 영역에서 의미있는 상피두께 변화가 없었으나, 술 후 30일에는 51.03 ± 3.63 μm, 48.96 ± 3.62 μm, 47.67 ± 3.81 μm로 변하였다(각각 p=0.061, 0.006, 0.001). 각막기질 및 상피의 두께 변화는 절개창이 위치한 상이측 부위에서 두드러졌다. 결론: 백내장수술 후 각막두께의 변화는 수술 직후부터 기질부위에서 나타나며, 상피부위에서는 수술 초기에는 유의한 변화가 없다가 술 후 1달에 주변부에서 감소가 나타났다. 술 후 각막 상피의 두께변화는 기질 부종에 대한 보상성 변화로 생각되며 술 후 1주에서 1달 사이에 나타났다.
Abstract
Purpose: To compare preoperative and postoperative thickness and to investigate the difference in the thickness change of corneal epithelium and stroma after cataract surgery through scleral tunnel incision. Methods: Forty eyes of forty patients who were 40 years old or older and underwent small-incision superior scleral tunnel cataract surgery with phacoemulsification were included. Using the RTVue instrument (Optovue Inc., Fremont, CA, USA), corneal epithelial (ET) and stromal thicknesses (ST) of all subjects were measured preoperatively and at 3 days, 1 week, and 1 month postoperatively. Thicknesses were classified into 3 zones according to the distance from the vertex: central zone (within 2 mm), paracentral zone (2-5 mm diameter) and midperipheral zone (5-6 mm diameter). Results: Mean central ST was 486.68 ± 25.15 μm, 535.16 ± 48.13 μm, 515.98 ± 44.07 μm, and 502.28 ± 34.87 μm preoperatively, and at 3 days, 1 week, and 1 month postoperatively, respectively (p < 0.001 for all). ST showed significant thickening in all three zones from 3 days to 1 month postoperatively (p < 0.001 for all). Mean central, paracentral, and midperipheral ET was 52.13 ± 3.41 μm, 50.42 ± 2.97 μm, 49.12 ± 3.05 μm at preoperatively and 51.03 ± 3.63 μm, 48.96 ± 3.62 μm, 47.67 ± 3.81 μm at 1 month postoperatively, respectively (p = 0.061, 0.006, 0.001, respectively), while there were no signficant changes in all three zones at 3 and 7 days postoperatively. Changes in ET and ST were prominent at the superotemporal incision site. Conclusions: After scleral tunnel cataract surgery, corneal edema was observed in the stroma immediately after surgery. There was no significant change at early times after surgery in the epithelium, and there was a decrease in the peripheral cornea at 1 month postoperatively. The change in ET was considered a compensatory change due to stromal edema and appeared between 1 week to 1 month postoperatively.
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