전층 각막이식술 후 잔여 고도난시에 대해 각막윤부 이완절개 및 추가 봉합술의 단기 교정효과
The Short-Term Effect of Limbal Relaxing Incision and Compression Suture on Post-Penetrating Keratoplasty Astigmatism
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목적: 전층 각막이식술 후 고도난시가 잔여된 환자에서 각막윤부이완절개 및 추가봉합술의 난시교정 단기 효과를 알고자 하였다. 대상과 방법: 전층 각막이식술 후 적어도 1년 6개월 이후 잔여 각막난시가 4.0D 이상이 되는 12명 12안에 대해 가파른 축에 한 쌍의각막윤부이완절개를, 편평한 축에는 추가봉합술을 시행한 환자의 의무기록을 후향적으로 분석하였다. 평균 1개월 및 6개월 후 시력변화, 각막 지형도상 난시변화 및 합병증을 분석하였다. 결과: 수술 후 평균 1개월 후 경과관찰 시 교정시력(logMAR)은 0.840에서 0.674로 호전되었고(p=0.037), 각막지형도검사상 평균 각막난시는 9.118 ± 3.158D에서 4.982 ± 3.063D로 감소하였다(p=0.021). 6개월까지 관찰 시 평균 각막난시는 5.489 ± 2.670D로 증가하였고(p=0.008), 수술 전 난시와 비교해 유의한 차이를 보이지 않았다(p=0.477). 결론: 전층 각막이식술 후 1년 6개월이 경과한 후에도 각막윤부이완절개 및 추가봉합술은 잔여된 고도 각막난시를 감소시키고, 시력을개선시키는 단기 효과가 있었으나 6개월 후에는 그 효과가 감소되었다.
Abstract
Purpose: To investigate the short-term effect of limbal relaxing incisions accompanied by compression sutures on postoperative astigmatism in penetrating keratoplasty. Methods: The medical records of patients who underwent penetrating keratoplasty, were followed-up for at least 18months and had residual astigmatism greater than 4.0 diopters (D), were retrospectively analyzed. The patients had paired limbal relaxing incisions on the steep axis and compression sutures on the flat axis. The paired limbal relaxing incision was done for 2 clock hours each with a depth of 85% of the corneal thickness, and the compression sutures with an average of 3.2 bites were added with a Troutman operating keratometer guide. The visual acuities, corneal astigmatism and complications were evaluated at 1 month and 6 months. Results: At 1 month after the surgery, the best corrected visual acuities (log MAR) improved from 0.840 to 0.674 (p =0.037) except for 1 patient with immediate postoperative rejection and another patient with a pre-existing cataract. The mean corneal astigmatism was reduced from 9.118 ± 3.158 D to 4.982 ± 3.063 D (p = 0.021). At 6 months after the surgery,the mean corneal astigmatism increased to 5.489 ± 2.670 D (p = 0.008), and the effect of surgery became statistically insignificant (p = 0.477). Conclusions: Paired limbal relaxing incisions and compression sutures were effective short-term on reducing residual corneal astigmatism and improving visual acuities in keratoplasty patients with high astigmatism, but became less effective on corneal astigmatism at 6 months.
참고문헌 (21)
- Murta JN, "Astigmatism after penetrating keratoplasty. Role of the suture technique", Doc Ophthalmol, 87, pp.331~336 (1994)
- Williams KA, "Factors predictive of corneal graft survival. Report from the Australian Corneal Graft Registry", Ophthalmology, 99, pp.403~414 (1992)
- Busin M, "Different suturing techniques variously affect the regularity of postkeratoplasty astigmatism", Ophthalmology, 105, pp.1200~1205 (1998)
- Eggink FA, "A new technique for rigid gas permeablecontact lens fitting following penetrating keratoplasty", Acta Ophthalmol Scand, 79, pp.245~250 (2001)
- Kuryan J, "Refractive surgery after corneal transplant", Curr Opin Ophthalmol, 21, pp.259~264 (2010)
- Wilkins MR, "Standardized arcuate keratotomy for postkeratoplasty astigmatism", J Cataract Refract Surg, 31, pp.297~301 (2005)
- Koay PY, "Effect of a standard paired arcuate incision and augmentation sutures on postkeratoplasty astigmatism", J Cataract Refract Surg, 26, pp.553~561 (2000)
- Javadi MA, "Outcomes of augmented relaxing incisions for postpenetrating keratoplasty astigmatism in keratoconus", Cornea, 28, pp.280~284 (2009)
- Claesson M, "Astigmatism and the impact of relaxing incisions after penetrating keratoplasty", J Refract Surg, 23, pp.284~289 (2007)
- Bochmann F, "Correction of post-keratoplasty astigmatism with keratotomies in the host cornea", J Cataract Refract Surg, 32, pp.923~928 (2006)
- Alessio G, "Corneal interactive programmed topographic ablation customized photorefractive keratectomy for correction of postkeratoplasty astigmatism", Ophthalmology, 108, pp.2029~2037 (2001)
- Lazzaro DR, "Excimer laser keratectomy for astigmatism occurring after penetrating keratoplasty", Ophthalmology, 103, pp.458~464 (1996)
- Kwitko S, "Laser in situ keratomileusis after penetrating keratoplasty", J Cataract Refract Surg, 27, pp.374~379 (2001)
- Webber SK, "LASIK for post penetrating keratoplasty astigmatism and myopia", Br J Ophthalmol, 83, pp.1013~1018 (1999)
- Lee HS, "Factors related to the correction of astigmatism by LASIK after penetrating keratoplasty", J Refract Surg, 26, pp.960~965 (2010)
- Kaye SB, "A method for assessing the accuracy of surgical technique in the correction of astigmatism", Br J Ophthalmol, 76, pp.738~740 (1992)
- Chang DH, "Refractive surgery after corneal transplantation", Curr Opin Ophthalmol, 16, pp.251~255 (2005)
- Nubile M, "Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty", Ophthalmology, 116, pp.1083~1092 (2009)
- Vajpayee RB, "Laser in-situ keratomileusis after penetrating keratoplasty", Surv Ophthalmol, 48, pp.503~514 (2003)
- Nassaralla BR, "Laser in situ keratomileusis after penetrating keratoplasty", J Refract Surg, 16, pp.431~437 (2000)
- Ranchod TM, "Wound dehiscence in a patient with keratoconus after penetrating keratoplasty and LASIK", Arch Ophthalmol, 122, pp.920~921 (2004)