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굴절교정술 후 재수술의 임상성적

Clinical Outcome of Retreatment after Refractive Surgery

정태영|유자영|정의상|임동희|이은정
대한안과학회 (The Korean Ophthalmological Society)|2015.02|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제56권 제2호|pp. 180-189

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RetreatmentLASIKRefractive surgeryMyopic regressionLASEK
주제분류안과학

초록

목적: 굴절교정술 후 재수술을 시행한 경우의 임상결과를 알아보고자 하였다. 대상과 방법: 2008년 8월부터 2013년 5월까지 본원에서 펨토초레이져 및 MEL80 엑시머레이저를 이용한 굴절교정술 후 재수술 받은24명 38안을 대상으로 후향적 분석을 하였다. 재수술 군의 최초 수술 전 특성과 재수술 시행 원인에 대해 알아보고 재수술 전후의나안시력, 최대교정시력, 구면렌즈대응치, 안전성, 효율성, 예측성, 수술 후 합병증 유무를 조사하였다. 결과: 초기 수술과 재수술 시행 시의 나이는 28.50 ± 7.29세(17‐49세), 31.21 ± 6.49세(21‐49세)였다. 재수술 시행 원인으로는 근시재발이 36안(94.7%), 그리고 과교정이 2안(5.3%)이었다. 재수술 방법으로는 라섹이 31안(81.6%)이고 라식 7안(18.4%)이었다. 재수술 후1개월, 3개월 그리고 마지막 방문 시 안전성 지표는 모두 1.0 이상이었고, 효율성 지표는 각각 0.92, 0.93, 그리고 0.95이었다. 최대교정시력의 감소를 보인 안은 없었다. 재수술 후 일시적인 원시를 보인 1안과 각막 혼탁이 발생한 1명 2안이 있었으나 시력 예후에 영향을 끼치지는 않았다. 결론: 본원에서 시행한 굴절교정수술 후 재수술은 효과적이고 안전한 임상경과를 나타내었다. 장기적으로 호전되지 않은 합병증은없었으며 재수술 전에 비하여 나안시력과 굴절력이 유의하게 호전되었다. 특히 라섹의 경우 각막확장증의 위험 없이 효과적이고 안전한 재수술 방법으로 고려할 수 있다.

Abstract

Purpose: To evaluate the clinical outcome of retreatment after refractive surgery. Methods: Retrospective analysis of 38 eyes of 24 patients who received retreatment surgery after refractive surgery from August 2008 to May 2013 was performed. Pre-initial surgery characteristics and the reason for retreatment were investigated, and preand post-retreatment uncorrected visual acuity, best corrected visual acuity, safety index, efficacy index, predictability, and postoperative complication were also investigated. Results: Age at initial refractive surgery and retreatment were 28.50 ± 7.29 years (17-49 years) and 31.21 ± 6.49 years (21-49 years). Reasons for retreatment were myopic regression in 36 eyes (94.7%) and overcorrection in two eyes (5.3%). Methods of retreatment were laser subepithelial keratomileusis (LASEK) in 31 eyes (81.6%) and laser-assisted in situ keratomileusis (LASIK) in seven eyes (18.4%). Safety index values for all were above 1.0 and efficacy index values were 0.92, 0.93, and 0.95 in postoperative examination at 1 month, 3 months, and 6 months, respectively. No eye showed a decrease in best corrected visual acuity. One eye had transient hyperopia after retreatment, and two eyes had postoperative corneal opacity, but no eye experienced significant alteration in visual prognosis. Conclusions: Retreatment after refractive surgery was an efficient and safe clinical course in our clinic. No long-term complications were observed, and uncorrected visual acuity and refractive errors significantly improved after retreatment. In particular, LASEK can be considered as a safe and efficient retreatment modality without risk of keratectasia.

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