술 전 Crystalline Lens Rise가 안내후방인공수정체 삽입술 후 Vaulting에 미치는 영향
Effect of Preoperative Crystalline Lens Rise on Vaulting after Implantable Collamer Lens Implantation
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목적: 안내후방인공수정체(Implantable contact lens :ICL) 삽입술 후 Vaulting에 영향을 미치는 인자들을 확인하고 특히 수술 전 계측한 Crystalline lens rise (CLR)과 ICL 삽입 후 Vaulting과의 상관성에 대해 연구하고자 하였다. 대상과 방법: 고도근시로 ICL 삽입술을 받은 29명, 53안을 대상으로 후향적 연구를 진행하였다. 수술 전 각막지형도를 통해 각막윤부직경(White-to-White:WTW), 전방깊이(Anterior chamber depth, ACD)를 측정하고 전안부 빛간섭단층촬영(Anterior segment OCT)으로수술 전 Crystalline lens rise (CLR) 값과 수술 후 6개월에 중심 vaulting을 측정하여, 상관관계 분석, 다중 회귀 분석을 통해 수술후 vaulting에 영향을 주는 계측 값들을 확인하였다. 결과: 수술 전 평균 구면렌즈 대응치(Spherical equivalent:SE)는 -8.84 ± 1.81D, WTW는 11.81 ± 0.30 mm, ACD는 3.32 ± 0.30mm, CLR 값은 -120 ± 219 μm였다. 수술 후 6개월째 중심 vaulting 평균 값은 544 ± 175 μm였으며 수술 전 SE (p˂0.05), WTW (p<0.01), ACD (p<0.05), CLR (p=0.001)이 수술 후 6개월의 vaulting 값과 통계적으로 유의한 상관관계를 보였다. 상관관계가 입증된변수들을 이용하여 다중선형회귀분석을 시행한 결과 CLR, WTW, ACD, SE의 순으로 수술 6개월 후 vaulting에 큰 영향력을 미치는인자임을 확인할 수 있었으며(adjusted R2=0.559), vaulting을 예측할 수 있는 다음과 같은 선형회귀식을 얻었다. Vaulting (μm)=(160.913 × ACD (mm))+(170.134 × WTW (mm))+(-0.338 × CLR (μm))+(-23.783 × SE (D))-2250.184. 결론: 본 연구를 통해 기존 연구에서 vaulting에 영향을 주는 것으로 알려진 WTW, ACD, SE 보다 Crystalline lens rise (CLR) 값이통계적으로 더욱 유의하게 vaulting에 영향을 주는 것으로 확인하였다. 따라서 수술 전 ICL vaulitng을 예측 시 새로운 변수인 CLR 또한 고려해야 할 것으로 생각한다.
Abstract
Purpose: To evaluate the parameters affecting vaulting and correlation between preoperative crystalline lens rise and vaulting after implantable collamer lense (ICL) implantation. Methods: A total of 53 eyes of 34 patients who underwent ICL implantation were examined retrospectively. White-to-white (WTW) and anterior chamber depth (ACD) were obtained from scanning topography (ORB scan) before surgery. Preoperative crystalline lens rise (CLR) and vaulting at 6 months after ICL implantation were measured using anterior segment optic coherence tomography (AS-OCT). Multiple regression analysis was performed to evaluate the factors affecting central vaulting. Results: The mean preoperative crystalline lens rise was -120 ± 219 μm, and mean central vaulting 6 months after surgery was 544 ± 175 μm. Preoperative SE, WTW, ACD, and CLR were significantly correlated with vaulting at 6 months after surgery. With the use of meaningful variables, multiple regression analysis showed that CLR, WTW, ACD and SE, in that order of influence, had significant effects on vaulting and the multiple regression equation was obtained as follows:Vaulting (μm) = (160.913 × ACD (mm)) + (170.134 × WTW (mm)) + (-0.338 × CLR (μm)) + (-23.783 × SE (D)) - 2250.184. Conclusions: CLR had a stronger influence on vaulting after ICL implantation than the previously proven parameters:WTW, ACD, and SE. In addition to WTW, ACD and SE, CLR should also be considered a new criterion for estimating vaulting after ICL implantation.
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