굴절교정수술 전후의 망막 이상과 술 전 시행한 망막 레이저 치료 빈도
Incidence of Retinal Lesions before and after Refractive Surgery and Preoperative Prophylactic Laser Treatment
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목적: 근시교정을 위해 다양한 각막굴절교정수술 혹은 유수정체 안내렌즈 삽입술을 시행한 환자에서 수술 전 발견한 망막 이상과술 전 시행한 예방적 레이저 광응고술 여부, 그리고 수술 후 발생한 망막 질환의 빈도를 알아보고자 하였다. 대상과 방법: 본원에서 2005년 1월부터 2013년 6월까지 시행한 굴절교정수술 환자를 대상으로 술 전 검사에서 발견한 망막 이상의종류와 빈도 및 이에 대해 예방적 레이저 광응고술을 시행한 비율을 조사하였으며, 수술 이후 새로이 발생한 망막 질환의 종류와빈도를 후향적 의무기록 조사를 통해 분석하였다. 결과: 총 466명 894안(라식군 117명 225안, 라섹 및 엑시머군 231명 450안, 유수정체 안내렌즈 삽입술군 121명 219안) 중 268안(29.98%)에서 술 전 망막 이상이 발견되었고, 이 중 144안(16.11%)에서 예방적 레이저 광응고술을 시행하였으며, 추적 관찰 기간 중8안(라섹 및 엑시머 군 5안, 유수정체 안내렌즈 삽입술군 3안)에서 술 전에 관찰되지 않았던 망막 이상이 새로 발견되었다. 수술 전구면렌즈 대응치와 망막 이상의 유무 간의 유의한 상관관계가 관찰되었다. 결론: 굴절교정술 환자의 대부분을 차지하는 근시 환자에서 망막 이상의 빈도는 정상안보다 높으며 수술 전 망막 레이저 치료가 필요한 경우가 많았다. 뿐만 아니라 수술 후 추적기간 중에도 망막 이상이 발생하는 경우가 있어 이에 대한 술자와 환자 모두의 주의가 요구된다.
Abstract
Purpose: We investigated the incidence of retinal lesions before and after surgery and the percentage of preoperative prophylactic laser treatment in patients who underwent corneal refractive surgery or phakic intraocular lens implantation (pIOLi). Methods: The medical records of patients who underwent refractive surgery from January 2005 to June 2013 were reviewed retrospectively. We investigated the incidence and type of retinal lesions identified during the preoperative examination. Additionally, the percentage of preoperative prophylactic laser treatment and the incidence of postoperative newly developed retinal lesions were analyzed. Results: A total of 894 eyes of 466 subjects (laser in situ keratomileusis [LASIK] 225 eyes, 117 subjects; laser-assisted subepithelial keratectomy [LASEK] or photorefractive keratectomy [PRK] 450 eyes, 231 subjects; pIOLi 219 eyes, 121 subjects) were enrolled in the present study. Retinal lesions were found in 268 eyes (29.98%) and of those, 144 eyes (16.11%) received prophylactic laser treatment. Postoperative newly developed retinal lesions were detected in 8 cases (LASEK or PRK, 5 cases; pIOLi, 3 cases) during the follow-up period. There was a significant correlation between preoperative spherical equivalent and the presence of retinal lesions. Conclusions: The patient population of refractive surgery is largely myopic and thus particularly vulnerable to retinal lesions. Additionally, a considerable number of patients required preoperative prophylactic laser treatment. Therefore, both surgeons and patients should be aware of the risks of developing postoperative retinal lesions.
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