유리체절제술과 수정체유화술 동시수술 시 접촉식초음파와 부분결합간섭계의 술 후 굴절력 예측 비교
Comparison of the Postoperative Refractive Errors Measured by Ultrasound and Partial Coherence Interferometers after Phacovitrectomy
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목적: 유리체절제술과 수정체유화술을 동시에 시행한 경우 접촉식초음파와 부분결합간섭계를 이용한 생체계측 및 수술 후 굴절력예측 정확도를 비교하고자 하였다. 대상과 방법: 유리체절제술과 수정체유화술 및 인공수정체삽입술을 시행한 74명 74안을 대상으로 하였다. 술 전 굴절력 예측을 위한안구생체계측은 접촉식초음파방식인 UltrascanⓇ (Alcon, Fort Worth, TX, USA)과 부분결합간섭방식인 IOL masterⓇ (Carl Zeiss, Jena, Germany)를 이용하였다. 예상 굴절력은 각각의 기계에 내장된 SRK-T 공식을 이용하였으며, UltrascanⓇ에서는 각막굴절률을입력하기 위해 Auto Refractor-Keratometer를 이용하였다. 굴절력 예측 정확도 측정은 수술 후 검영검사를 시행하여 예상 굴절력과의 차를 구하였다. 결과: 평균 안축장은 UltrascanⓇ IOL masterⓇ로 측정하였을 때 각각 23.56 ± 0.15 mm, 23.85 ± 0.15 mm로 IOL masterⓇ가 통계적으로 유의하게 길었으며(p＜0.001), 각막굴절력은 44.03 ± 1.35 D, 44.05 ± 1.33 D로 유의한 차이는 없었다. 전체 환자의 굴절력예측 정확도는 0.47 ± 0.69, 0.08 ± 0.74로 IOL masterⓇ가 더 정확한 결과를 보였으며(p＜0.001), 매체혼탁이 존재하는 유리체출혈(n=9)만 비교하였을 경우에는 0.07 ± 0.54, 0.42 ± 0.49로 UltrascanⓇ이 더 정확하였다(p=0.007). 결론: 유리체절제술과 수정체유화술을 동시에 시행한 경우 굴절력 예측은 부분결합간섭계가 접촉식초음파보다 더 정확하지만, 매체혼탁이 존재하는 유리체출혈의 경우만을 고려한다면 접촉식초음파가 더 유용한 측정 방법이 될 수 있다.
Abstract
Purpose: To compare the accuracy of refractive outcome measured by Ultrascan® (Alcon, Fort Worth, TX, USA) and partial coherence interferometers after phacovitrectomy. Methods: We performed a retrospective study in 74 eyes of 74 patients who underwent phacovitrectomy. SRK-T formula was used to predict intraocular lens (IOL) power. The difference between the predicted and postoperative refractive outcomes for the 2 methodologies (Ultrascan® and IOL Master® [Zeiss, Carl Zeiss, Jena, Germany]) were compared. The predicted refractive outcome was defined as the estimated refractive error when the selected IOL was inserted. Results: The axial length measured using IOL Master® was statistically longer than when measured using Ultrascan® (23.85 ± 0.15 mm, 23.56 ± 0.15 mm, p < 0.001). Based on keratometry, statistically significant difference between the 2 groups was not observed. The postoperative refractive error was more accurate when using the IOL Master® than Ultrascan® (0.08 ± 0.74, 0.47 ± 0.69, p < 0.001). However, in cases of vitreous hemorrhage, the postoperative refractive error was 0.42 ± 0.49 with the IOL Master® and 0.07 ± 0.54 with the Ultrascan®. Conclusions: Generally, IOL Master® is a more accurate method for calculating the IOL power prior to phacovitrectomy. However, in cases of vitreous hemorrhage, Ultrascan® appears superior to IOL Master® when calculating the IOL power.
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