전방깊이에 따른 백내장수술 전후의 각막내피세포수의 변화
Effect of Anterior Chamber Depth on Corneal Endothelial Change After Phacoemulsification
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 동일한 술자와 수술방법으로 시행된 백내장수술에서 수술 전 전방깊이가 수술 전후의 각막내피세포수의 변화에 미치는 영향을 분석하고자 하였다. 대상과 방법: 단일 술자 및 동일한 수술방법에 의해 백내장수술이 시행된 82명 82안에 대하여 환자의 연령, 핵경화도, 전방깊이, 수술 중 초음파 시간, 초음파 강도, 초음파 에너지, 술 전 각막내피세포밀도, 다양성, 다형성, 수술 후 각막내피세포감소율을 측정하였다. 비접촉식 경면현미경으로 수술 전 및 수술 후의 각막내피세포밀도를 측정하였다. 결과: 초음파유화술을 이용한 백내장수술에서 전방깊이가 깊을수록 각막내피수의 손실이 적음을 확인하였다. 백내장 초음파유화술시 연령이 높을수록, 백내장 핵성숙도가 높을수록, 전방깊이가 얕을수록 각막내피세포 밀도 감소가 증가하였다. 결론: 초음파유화술 시간 및 에너지가 클수록 각막내피수의 감소가 증가였으며 전방깊이가 깊을수록 각막내피세포의 감소가 줄었다. 이는 전방이 깊을수록 초음파 에너지를 더 흡수하여 이에 의한 손상이 줄었기 때문으로 보인다.
Abstract
Purpose: To evaluate the effects of preoperative and postoperative parameters, particularly anterior chamber depth, on corneal endothelial cell loss during cataract surgery. Methods: Eighty-two eyes of 82 patients who underwent cataract surgery by the same surgeon using the same technique were selected for the present study. Various preoperative and postoperative parameters including age, anterior chamber depth, duration and power of phacoemulsification, preoperative endothelial cell density, coefficient of variation, hexagonality, and grade of nucleosclerosis were evaluated. Endothelial cell densities were recorded preoperatively and at two months postoperatively using a noncontact specular microscope. Results: After two months, the mean central endothelial cell loss in all eyes was 8.77%. Among the pre- and post-operative parameters, patient’ age, anterior chamber depth, duration, power, and energy of phacoemulsification and grade of nucleosclerosis showed significant correlation with endothelial cell loss. Stepwise multiple linear regression analysis identified age, nucleosclerosis, anterior chamber depth, and phacoemulsification time as independent predictors for endothelial cell loss. Conclusions: The risk of endothelial cell loss increased with increases in patient’ age, nucleosclerosis, and phacoemulsification time. However, eyes with a deep anterior chamber showed a significantly lower risk of endothelial cell loss.
참고문헌 (14)
- Bourne RR, "Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery", Ophthalmology, 111, pp.679~685 (2004)
- Jacobs PM, "Endothelial cell loss after cataract surgery--the problem of interpretation", Trans Ophthalmol Soc U K, 102, pp.291~293 (1982)
- Long-term corneal endothelial cell loss after cataract surgery, "Results of a randomized controlled trial. Oxford Cataract Treatment and Evaluation Team (OCTET)", Arch Ophthalmol, 104, pp.1170~1175 (1986)
- Walkow T, "Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters", J Cataract Refract Surg, 26, pp.727~732 (2000)
- Hayashi K, "Risk factors for corneal endothelial injury during phacoemulsification", J Cataract Refract Surg, 22, pp.1079~1084 (1996)
- Doughty MJ, "Assessment of the reliability of calculations of the coefficient of variation for normal and polymegethous human corneal endothelium", Optom Vis Sci, 70, pp.759~770 (1993)
- Wirbelauer C, "Influence of cataract surgery on corneal endothelial cell density estimation", Cornea, 24, pp.135~140 (2005)
- Davison JA, "Clinical application of the lens opacities classification system III in the performance of phacoemulsification", J Cataract Refract Surg, 29, pp.138~145 (2003)
- Kelman CD, "Phaco-emulsification and aspiration. A new technique of cataract removal. A preliminary report", Am J Ophthalmol, 64, pp.23~35 (1967)
- Minassian DC, "Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial", Br J Ophthalmol, 85, pp.822~829 (2001)
- McCarey BE, "The phacoemulsification procedure. I. The effect of intraocular irrigating solutions on the corneal endothelium", Invest Ophthalmol, 15, pp.449~457 (1976)
- O’Brien PD, "Risk factors for endothelial cell loss after phacoemulsification surgery by a junior resident", J Cataract Refract Surg, 30, pp.839~843 (2004)
- Storr-Paulsen A, "Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique", J Cataract Refract Surg, 34, pp.996~1000 (2008)
- Yang Kyeung Cho, "Risk Factors for Endothelial Cell Loss after Phacoemulsification: Comparison in Different Anterior Chamber Depth Groups", Korean Journal of Ophthalmology, 24(1), pp.10~15 (2010), 대한안과학회