섬유주절제술 병합 백내장수술 후 고위수차 변화
Changes in High-order Aberrations after Phacotrabeculectomy Surgery
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목적: 섬유주 절제술 병합 백내장수술(삼중수술)을 받은 환자에서 수술 전후의 고위수차의 변화를 알아보고, 대조군으로 백내장수술만 받은 환자의 고위수차의 변화를 비교, 분석하고자 하였다. 대상과 방법: 2013년 4월부터 2015년 12월까지 섬유주 절제술 병합 백내장수술을 받은 총 38명 38안을 대상으로 수술 전과 수술 후 2주, 4주, 3달 후의 시력, 안압, 고위수차를 측정하였으며, 이들의 변화를 비교하였다. 그리고 대조군으로 같은 기간에 백내장수술을 단독으로 받은 총 34명 34안을 대상으로 수술 전과 수술 후 2주의 고위수차의 변화를 비교하였다. 결과: 섬유주 절제술 병합 백내장수술을 받은 환자군에서, 안압은 유의하게 하강하였으며(p<0.001), 수술 후 안구전체, 각막 및 수정체고위수차 각각에서 수술 후 2주째 전체고위수차, 코마수차, 구면수차 모두 증가한 이후 3개월까지는 감소하는 경향을 보였으나 통계적 유의성이 없었다. 백내장수술군에서는 수술 후 안구전체 및 수정체 고위수차에서 전체고위수차(각각 p=0.006, p=0.005), 코마수차(각각 p=0.006, p=0.008), 구면수차(각각 p=0.006, p=0.005) 모두 감소하였다. 결론: 백내장 단독 수술일 경우에는 고위수차가 유의하게 감소하였으나, 섬유주 절제술 병합 백내장수술로 의미있는 고위수차의 변화는 관찰되지 않았다. 이러한 결과는 백내장 단독군의 고위수차가 다소 높았다는 점과 섬유주절제술의 영향과 관련된 것으로 생각된다.
Abstract
Purpose: To investigate changes in ocular high-order aberrations (HOAs) resulting from phacotrabeculectomy and phacoemulsification. Methods: We retrospectively reviewed 38 eyes of 38 glaucoma and cataract patients who underwent mitomycin C (MMC) augmented trabeculectomy with phacoemulsification and 34 eyes of 34 cataract patients who underwent phacoemulsifiction. For all patients, we measured the best corrected visual acuity (BCVA), intraocular pressure (IOP), keratometry, and HOAs (iTrace, Tracey Technologies, Houston, TX, USA) both preoperatively and postoperatively. Results: IOP was significantly decreased after surgery in the combined group (p < 0.001). Entire eye, coma-like, and spherical- like high-order aberrations from each entire eye, corneal aberrations, and internal-optics aberration were increased until after 2 weeks, which then decreased until 3 months after phacotrabeculectomy. In the phacoemulsification group, entire eye (each p = 0.006, p =0.006), coma-like (each p = 0.006 and p = 0.005), and spherical-like high-order aberrations (each p = 0.008, p = 0.005) from entire eye and internal-optics aberrations were decreased. Conclusions: After cataract surgery, entire eye, coma-like, and spherical-like high-order aberrations were significantly decreased while aberrations did not change after combined operation. These results suggest that a change in high-order aberrations of internal optics results in a decrease in postoperative HOAs. In addition, the baseline HOAs of the cataract group were higher than those of the combined surgery group, and the effect of trabeculectomy on HOAs may offset the impact of cataract surgery in the combined surgery group.
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