안외상으로 유리체절제술을 시행한 무수정체안에서이차인공수정체삽입술의 임상 성적
Clinical Outcomes of Secondary Intraocular Lens Implantation in Vitrectomized Aphakic Eyes Due to Ocular Trauma
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목적: 안외상으로 유리체절제술과 수정체제거술을 받은 무수정체안에서 시행한 이차적인 인공수정체삽입술의 임상 성적과 수술 후시력 예후에 영향을 미치는 인자들에 대하여 알아보고자 하였다. 대상과 방법: 안외상으로 인하여 유리체절제술과 수정체제거술을 받은 뒤 이차인공수정체삽입술을 시행 받은 환자 39명 40안을 대상으로 수술 전후 시력과 굴절이상 등을 후향적으로 조사하였다. 결과: 남자가 35명(89.7%)이었으며 연령분포는 50대가 13명(33.3%)으로 가장 많았다. 수술 전 평균 굴절이상은 구면렌즈 대응치로+9.99 ± 2.80D, 평균 난시는 1.80 ± 1.73D였으며, 평균 최대교정시력은 0.53 ± 0.51 (logMAR)이었다. 수술 후 6개월에 평균 최대교정시력은 0.54 ± 0.46, 굴절이상은 -1.28 ± 1.40D, 난시는 2.54 ± 1.52D로 목표굴절이상과 -0.63 ± 1.44D의 차이로 더 근시였다. 수술 전과 후의 교정 시력은 통계학적으로 유의한 관계를 보였으며(p＜0.001), 다른 수술 전 인자들과는 상관관계가 없었다. 수술 후합병증은 고안압증이 4안, 저안압증에 의한 맥락막박리, 망막박리의 재발, 수포각막병증, 낭포성황반부종이 각 1안에서 발생했으며, 인공수정체 탈구에 의한 재수술이 2안에서 시행되었다. 결론: 안외상으로 유리체절제술을 시행 받은 무수정체안에서 이차인공수정체삽입술은 안전하게 시행될 수 있었으며, 수술 전 교정 시력이 양호하다면 적극적으로 이차인공수정체삽입술을 고려해 볼 수 있다. 계산된 목표굴절이상보다 수술 후 근시의 경향이 있으므로인공수정체 도수 결정에 이를 고려하여야 할 것이다.
Abstract
Purpose: To evaluate the clinical outcomes of secondary intraocular lens (IOL) implantation in eyes that underwent pars plana vitrectomy and lens removal due to ocular trauma. Methods: We retrospectively investigated 40 vitrectomized aphakic eyes that had received secondary IOL from March 2005 to January 2012. Various parameters including pre- and postoperative best corrected visual acuity (BCVA) were reviewed. Results: Incidence was higher in males (n = 35, 89.7%) and highest in the 6th decade of life (n = 13, 33.3%). Mean preoperative refractive error was +9.99 ± 2.80 D in spherical equivalent, and astigmatism was 1.80 ± 1.73 D. Mean BCVA (log MAR) was 0.53 ± 0.51 preoperatively and 0.54 ± 0.46 at 6 months postoperatively. Postoperative refractive error was -1.28± 1.40 D and the astigmatism was 2.54 ± 1.52 D. The difference between the target and postoperative refractive error was a myopic shift of -0.63 ± 1.44 D. Postoperative BCVA had no significant correlation with preoperative factors other than preoperative BCVA (p < 0.001). The most common complication was temporarily increased IOP in 4 eyes. Choroidal detachment, recurrence of retinal detachment, bullous keratopathy, and cystoid macular edema were each found in 1 eye. IOL dislocation was corrected with reoperation in 2 eyes. Conclusions: Secondary IOL implantation can be performed safely in vitrectomized aphakic eyes due to ocular trauma and can be recommended in patients with good preoperative BCVA. Myopic shift of the postoperative refractive error should be considered when calculating IOL power.
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