백내장 수술에서 후낭 파열로 인한 섬모체고랑 삽입 후 일체형 인공수정체 도수 결정 및 전방 변화
Choice of One‐Piece Intraocular Lens Power and Changes of Anterior Chamber in Sulcus Implantation due to Posterior Capsular Rupture during Cataract Surgery
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목적: 후낭 파열로 인해 섬모체고랑에 일체형 인공수정체를 삽입했을 때 예측된 도수와의 차이를 알아보고, 섬모체고랑 삽입 후 전방각을 낭내 삽입한 경우의 전방각과 비교한다. 대상과 방법: 후낭파열로 인해 경험적으로 0.5디옵터 낮은 도수의 인공수정체를 섬모체고랑에 삽입한 52명 52안을 대상으로 수술 전과술 후 3개월 시점에서 굴절력 차이를 측정하였다. 그중 대상안 반대쪽 눈에 낭내 삽입 받은 16명을 대상으로 하여 Visante OCT로양안의 전방각을 비교하였다. 결과: 술 전 SRK-T를 이용한 예측치와 비교했을 때, 섬모체고랑에 삽입한 경우 -0.597 ± 0.879디옵터의 근시 편위 소견을 보였다. Visante OCT로 전방각에 대한 항목(ACD500, ACD750, TISA500, TISA750)을 비교했을 때, 섬모체고랑에 삽입한 경우 낭내 삽입한경우보다 통계학적으로 유의하게 낮게 측정되었다. 결론: 후낭파열로 인해 섬모체고랑에 일체형 인공수정체를 삽입할 때, 0.5디옵터 낮은 도수의 인공수정체를 삽입하더라도 근시 편위현상을 보이므로, 좀 더 낮은 디옵터의 인공 수정체 삽입을 고려해 볼 수 있겠다. 백내장 수술 후 전방각은 섬모체고랑에 삽입한 경우에서 낭내 삽입한 경우보다 유의하게 좁았다.
Abstract
Purpose: To evaluate the appropriate correction of predicted intraocular lens (IOL) power when sulcus implantation due to posterior capsular rupture was performed and to compare the anterior chamber angle of sulcus-implanted eyes with in-the-bag implanted eyes using anterior segment optical coherence tomography (Visante OCT). Methods: Fifty-two eyes of 52 patients who had IOL implantation in the sulcus due to posterior capsular rupture during cataract surgery were retrospectively reviewed. A 0.5 lower diopter IOL than predicted IOL power using SRK-T formula was chosen. The difference between the predicted refractive error and the spherical equivalence at the 3-month time-point after sulcus implantation were evaluated. Among 52 patients, 16 patients whose fellow eye had an in-the-bag IOL implantation underwent Visante OCT and the anterior angle of affected eyes and normal fellow eyes were compared. Results: The difference between the predicted refractive error using SRK-T formula and the spherical equivalence after sulcus implantation was a myopic shift of 0.597 ± 0.879 diopter. The mean iridocorneal angles, angle opening distance (AOD), trabecular iris surface area (TISA) at 500 um and 750 um for both nasal and temporal sides in sulcus implantation were all significantly lower than in-the-bag implantation. Conclusions: A choice of a 0.5 lower diopter power IOL than the power for in-the-bag implantation may be considered because of greater myopic shift than predicted refractive error when sulcus implantation due to posterior rupture is performed. Anterior chamber angle in sulcus IOL implantation was shallower than in-the-bag IOL implantation.
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