저밀도내피세포 환자에서 회전진동방식의 초음파유화술을 이용한 백내장 수술 시 단기 임상결과
Short-Term Outcome of Cataract Surgery Using Torsional-Mode Phacoemulsification for Patients with Low Endothelial Cell Counts
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목적: 내피세포밀도가 낮은 백내장 환자에서 회전진동방식의 초음파유화술을 이용한 백내장 수술시 단기 임상결과를 알아보고자 하였다. 대상과 방법: 회전진동방식의 초음파유화술 및 인공수정체 후방삽입술을 시행 받은 환자 52명 57안을 대상으로 하였다. 술 전 내피세 포밀도에 따라 2,500/mm^2 이상인 대조군, 1,600/mm^2 미만인 저밀도 세포군을 비교하였고, 저밀도 세포군을 다시 1,000/mm^2 미만인 극저밀도 세포군과, 1,000/mm^2 미만이면서 이전에 전층각막이식술을 시행 받은 군으로 세분하여 술 전과 술 후 평균 1달에 각막내피 세포의 밀도, 변이계수, 육각세포비율, 중심각막두께를 측정하였다. 결과: 핵경화 정도가 4였던 저밀도 세포군의 1안에서만 각막내피세포부전이 발생하였다. 저밀도 세포군과 대조군 간, 극저밀도 세포군 과 전층각막이식술 후 극저밀도세포군 간에 각막내피세포의 특성 및 중심각막두께의 술 전후 변화에 통계학적으로 의미 있는 차이는 없었다. 결론: 저밀도내피세포 환자에서도 중등도 이하의 핵경화 시에 회전진동방식의 초음파유화술을 이용하여 백내장 수술을 시행하면, 단기 적으로는 각막내피세포의 변화가 정상군과 비슷하여 단계식 접근수술이 가능함을 시사하였다.
Abstract
Purpose: To evaluate the short-term clinical outcome of cataract surgery using torsional mode phacoemulsification for patients with low endothelial cell density. Methods: Fifty-seven eyes of 52 patients who underwent torsional phacoemulsification and intraocular lens insertion were included in the present study. Patients were divided into groups according to endothelial cell density (ECD). The control group was comprised of patients with more than 2500/mm^2 of ECD and was compared with the low ECD group (LECD) comprised of patients with less than 1600/mm^2 of ECD. The LECD group was further divided into a very low ECD group (VLECD) comprised of patients with less than 1000/mm^2 of ECD, and a PK-VLECD group comprised of patients with less than 1000/mm^2 of ECD after penetrating keratoplasty. Measurement of ECD, cell-size variation coefficient, hexagonality, and central corneal thickness were performed preoperatively and 1 month after surgery. Results: The only one patient who had undergone penetrating keratoplasty with remaining low endothelial density and grade 4 nuclear sclerosis developed overt corneal edema after cataract surgery. No statistically significant differences in the change of endothelial cell characteristics and central corneal thickness before and after surgery were observed between the control and LECD group and between the VLECD and PK-VLECD group. Conclusions: Even in patients with low ECD, torsional phacoemulsification appears to have a similar effect on the short-term change of endothelial cells, suggesting cataract surgery can be conducted with a staged approach when the density of nucleus is moderate or less dense.
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