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특발성망막앞막과 황반원공 환자의 유리체절제술과 백내장동시수술에서 굴절값의 예측정확도

Accuracy of Predictive Refraction in Combined Vitrectomy-Cataract Surgery for Epiretinal Membrane and Macular Hole

이지은|김경호|변익수|신민규|박성후|임효철
대한안과학회 (The Korean Ophthalmological Society)|2015.02|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제56권 제2호|pp. 219-227

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참고문헌

키워드

Refractive errorAccuracy of predictive refractionCombined vitrectomy and cataract surgeryPredictive refraction error
주제분류안과학

초록

목적: 유리체절제술과 백내장 동시수술에서 목표굴절값의 예측정확도와 이에 영향을 주는 요소에 대해 알아보고자 한다. 대상과 방법: 유리체절제술과 백내장 동시수술 후 6개월 이상 경과관찰한 특발성 망막앞막과 황반원공환자를 대상으로 술 전굴절값,목표굴절값, 술 후 굴절값, 굴절값오차(술후측정된 굴절값에서 목표굴절값을 뺀 값), 예측정확도(굴절값오차가 ±0.5 diopter 이내인경우), 안압, 안구길이, 중심망막두께, 인공수정체 도수결정에 사용된 장비(A-scan과 IOL master) 등을 의무기록을 이용하여 후향적으로 조사하였다. 결과: 대상환자는 총 176안으로 망막앞막 132안, 황반원공 44안이었다. 전체환자에서 목표굴절값의 예측정확도는 6개월에 60.8%이었으며, 망막앞막군은 59.8%, 황반원공군은 63.6%으로 두 군 사이에 차이는 없었다. 안구길이, 사용된 장비(A-scan과 IOL master)에따른 굴절값예측정확도의 차이는 없었다. 굴절값 오차는 술 전 굴절값과 양의 상관관계를 나타냈다(r=0.227; p=0.002). 망막앞막군에서는 굴절값 오차는 술 전 중심망막두께 및 술 후 중심망막두께 변화량 모두와 음의상관관계(r=-0.211; p=0.015 and r=-0.241;p=0.005)를 나타내었다. 결론: 유리체절제술과 백내장 동시수술에서 굴절값의 예측정확도는 약 60%였으며, 술 후 굴절값은 술 전 근시가 심할수록, 술 전중심망막두께가 두꺼울수록 목표 굴절값보다 근시로 나타나므로, 이를 고려하여 인공수정체도수를 결정하는 것이 좋겠다.

Abstract

Purpose: To evaluate the accuracy of predictive refraction and the factors influencing the predictability in combined vitrectomyand cataract surgery. Methods: We retrospectively investigated patients who received combined vitrectomy and cataract surgery for idiopathic epiretinalmembrane (ERM) and macular hole (MH), followed up for a minimum of 6 months. Preoperative refraction, target refraction, postoperativerefraction, predictive refraction error (target refraction - postoperative refraction), accuracy of predictive refraction error(predictive refraction error was within ±0.5 diopter), intraocular pressure, axial length, central macular thickness, and tools thatwere used for intraocular lens power calculation (A-scan and IOL master) were assessed by analyzing medical records. Results: A total of 176 eyes (including 132 idiopathic ERM cases and 44 MH cases) were included in this study. The accuracy ofpredictive refraction error was 60.8% at 6 months and there was no difference between the idiopathic epiretinal membrane group(59.8%) and the macular hole group (63.6%). There was no significant difference in predictive refraction error according to axiallength and tools (IOL master vs A-scan). Predictive refraction error correlated positively with preoperative refraction (r = 0.227; p =0.002). In the ERM group, predictive refraction error correlated negatively with both preoperative central macular thickness and thechange in central macular thickness between, before, and 6 months after surgery (r = -0.211; p = 0.015 and r = -0.241; p = 0.005). Conclusions: The accuracy of predictive refraction error was approximately 60% in combined vitrectomy and cataract surgery. Postoperative refraction appeared to be myopia relative to target refraction with higher preoperative myopia and thicker preoperativecentral macular thickness. Hence, the intraocular lens power should be determined considering the above factors.

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