공여편 삽입 방법에 따른 데스메막박리 각막내피층판이식술의 임상결과 비교
Comparing Clinical Outcomes of Descemet’s Membrane Stripping Automated Endothelial Keratoplasty Between Graft Insertion Methods
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목적: 국내에서 데스메막박리 각막내피층판 이식술(Descemet’s Membrane Stripping Automated Endothelial Keratoplasty, DSAEK)을받은 환자들을 공여편 삽입 방법에 따른 임상결과를 비교하고자 하였다. 대상과 방법: 한 명의 술자에게 DSAEK을 받은 30명(32안)을 대상으로, 공여편 삽입법에 따라 A군(Taco-folding법 사용) 10안과 B군(Tan-endoglide 사용) 22안으로 분류하여 수술 전, 후의 최대 교정시력, 안압, 난시, 각막 내피세포수, 각막두께, 합병증 등을 후향적으로 분석하였다. 결과: 평균 경과 관찰 기간은 19개월(범위 1-67)이었으며, 각 군별 logMAR 최대교정시력은 술 전 각각 1.63, 1.63에서 술 후 12개월에0.69, 0.53으로 향상되었다(p=0.035, p=0.000). 술 후 1개월째 각막내피세포 생존율은 각각 75.8% (범위 62.7-88.6), 87.7% (범위70.2-97.9)였다(p=0.012). 12개월째 최종시력 및 각막내피세포 생존율의 두 군간 차이는 없었다(p=0.393, p=0.544). 결론: 두 방법 모두 술 후 빠른 시력 회복을 보였으며, Tan-endoglide를 사용하는 방법이 Taco-folding을 사용하는 방법에 비해 술후 초기 각막내피세포 감소가 적었으며, 합병증 발생 및 이식 실패가 적었다.
Abstract
Purpose: To compare clinical outcomes of Descemet’s stripping automated endothelial keratoplasty (DSAEK) between different graft insertion methods Methods: The clinical records of 32 eyes of 30 DSAEK patients were retrospectively analyzed. Patients were divided into 2 groups according to graft insertion method. Group A: Taco-folding, group B: Tan-endoglide. The best corrected visual acuities (BCVA), intraocular pressures, astigmatism, endothelial cell count, central corneal thickness and complications were evaluated pre and post-operatively. Results: The average follow-up period was 19 months (range 1-67). Postoperative log MAR visual acuity had significantly improved both from 1.63 (log MAR) to 0.69 and 0.53 at 12 months in each group (p = 0.035, p = 0.000). Mean endothelial cell survival of each group at 1 month postoperative were 75.8% (range 62.7-88.6) and 87.7% (range 70.2-97.9), respectively (p = 0.012). The differences of BCVA improvement and endothelial cell survival between the groups at 12months were not significant (p = 0.393, p = 0.544). Conclusions: Both methods showed fast visual recovery. Using Tan-endoglide insertion resulted less endothelial cell loss at early post-operative period and showed less post-operative complication and graft failure.
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