소안구증 환자에서 piggyback 방법을 이용한 백내장 수술
Cataract Surgery Using Piggyback Method in Patient With Nanophthalmos
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목적: 안축장이 16.00 mm 이하로 매우 짧은 순수 소안구증 환자에게 piggyback 방법을 이용한 백내장 수술을 시행하여 이를 보고하는 바이다. 증례요약: 44세 남자로 안축장이 우안 15.36 mm, 좌안 15.59 mm인 소안구증 환자의 백내장 수술 시 2개의 인공수정체를 삽입하는piggyback 방법을 사용하였다. 우안에는 SRK/T 공식을 이용하여 계산한 +53.0D (diopter)를, 좌안에는 Hoffer Q 공식을 이용하여계산한 +60.0D의 인공수정체를 삽입하였다. 술 후 양안 모두에서 원시성 굴절오차가 발생하였으며, 술 전 목표 구면렌즈대응치와술 후 1년 4개월째 측정한 구면렌즈대응치 차이는 우안 9.68D, 좌안 1.63D였다. 결론: 안축장이 16.00 mm 이하로 매우 짧은 소안구증 환자의 백내장 수술은 높은 도수의 인공수정체 삽입이 필요하므로 piggyback 방법을 사용해 굴절오차를 교정할 수 있었다. 본 증례의 경우 인공수정체 계산에서 Hoffer Q 공식이 SRK/T, Holladay 공식보다 수술전후 구면렌즈대응치의 오차가 적어 유용하였으나 향후 더 많은 증례를 통한 연구가 필요할 것으로 사료된다.
Abstract
Purpose: To report a case of cataract surgery using a piggyback method in a patient with pure nanophthalmos with an axial length under 16.00 mm in both eyes. Case summary: The authors performed cataract surgery using a piggyback method inserting two intraocular lenses (IOLs) in a 44-year-old male with nanophthalmos with axial lengths of OD 15.36 mm, and OS 15.59 mm. Primary implantation of two IOLs of +53.0D as calculated by the SRK/T and Holladay formula was performed in the right eye using a piggyback method. In the left eye, two IOLs of +60.0D calculated by the Hoffer Q formula were implanted. Postoperative hyperopic refractive errors occurred in both eyes. The differences between the preoperative target spherical equivalent (SE) and the postoperative one year four month SE were 9.68D in the right eye and 1.63D in the left eye. Conclusions: Due to high diopter IOL requirements in nanophthalmic patients (less than 16.00 mm) during cataract surgery, the refractive errors were well corrected, without complications, by using a piggyback method. In the present case study, the Hoffer Q formula produced better results than did the SRK/T or Holladay formula in reducing the difference in preoperative and postoperative SEs, but more surgical cases and research are required to establish the most appropriate formula for cataract surgery in nanophthalmos.
참고문헌 (28)
- Weiss AH, "Simple microphthalmos", Arch Ophthalmol, 107, pp.1625~1630 (1989)
- Auffarth GU, "Relative anterior microphthalmos:morphometric analysis and its implications for cataract surgery", Ophthalmology, 107, pp.1555~1560 (2000)
- Khairallah M, "Posterior segment changes associated with posterior microphthalmos", Ophthalmology, 109, pp.569~574 (2002)
- Wladis EJ, "Cataract surgery in the small adult eye", Survey Ophthalmol, 51, pp.153~161 (2006)
- Lee JH, "Microphthalmos with large cyst and colobomatous microphthalmos in the other eye", J Korean Ophthalmol Soc, 34, pp.1203~1207 (1993)
- Weiss AH, "Complex microphthalmols", Arch Ophthalmol, 107, pp.1619~1624 (1989)
- Wu W, "Cataract surgery in patients with nanophthalmos: results and complications", J Cataract Refract Surg, 30, pp.584~590 (2004)
- Brockhurst RJ, "Cataract surgery in nanophthalmic eyes", Arch Ophthalmol, 108, pp.965~967 (1990)
- Gayton JL, "Implanting two posterior chamber intraocular lenses in a case of microphthalmos", J Cataract Refract Surg, 19, pp.776~777 (1993)
- Shugar JK, "Implantation of multiple foldable acrylic posterior chamber lenses in the capsular bag for high hyperopia", J Cataract Refract Surg, 22, pp.1368~1372 (1996)
- Masket S, "Piggyback intraocular lens implantation", J Cataract Refract Surg, 24, pp.569~570 (1998)
- Cao KY, "Primary piggyback implantation of 3 intraocular lenses in nanophthalmos", J Cataract Refract Surg, 33, pp.727~730 (2007)
- Chylack LT, "The lens opacities classification system III. The longitudinal study of cataract study group", Arch Ophthalmol, 111, pp.831~836 (1993)
- Retzlaff JA, "Development of the SRK", T intraocular lens implant power calculation formula, 1990, pp.16, 333~340
- Holladay JT, "A three-part system for refining intraocular lens power calculations", J Cataract Refract Surg, 14, pp.17~24 (1988)
- Hoffer KJ, "The Hoffer Q formula : a comparison of theoretic and regression formulas", J Cataract Refract Surg, 19, pp.700~712 (1993)
- Oshika T, "Piggyback foldable intraocular lens implantation in patients with microphthalmos", J Cataract Refract Surg, 27, pp.841~844 (2001)
- Drews RC, "Reliability of lens implant power formulas in hyperopes and myopes", Ophthalmic Surg, 19, pp.11~15 (1988)
- Holladay JT, "Achieving emmetropia in extremely short eyes with two piggyback posterior chamber intraocular lenses", Ophthalmology, 103, pp.1118~1123 (1996)
- Inatomi M, "Intraocular lens power calculation for microphthalmos", J Cataract Refract Surg, 23, pp.1208~1212 (1997)
- 박종운, "Piggy-back 방법을 이용한 백내장 수술의 임상적 결과", 대한안과학회지, 42(10), pp.1500~1503 (2001), 대한안과학회
- Findl O, "Contact zone of piggyback acrylic intraocular lenses", J Cataract Refract Surg, 25, pp.860~862 (1999)
- Jin JC, "Laser and unsutured sclerotomy in nanophthal-mos", Am J Ophthalmol, 109, pp.575~580 (1990)
- Shugar JK, "Interpseudophakos Elschnig pearls associated with hyperopic shift: a complication of piggyback posterior chamber intraocular lens implantation", J Cataract Refract Surg, 25, pp.863~867 (1999)
- Gayton JL, "Interlenticular opacification:clinicopathological correlation of a complication of posterior chamber piggyback intraocular lenses", J Cataract Refract Surg, 26, pp.330~336 (2000)
- Shugar JK, "Interpseudophakos intraocular lens surface opacification as a late complication of piggyback acrylic posterior chamber lens implantation", J Cataract Refract Surg, 26, pp.448~455 (2000)
- Fenzl RE, "Refractive and visual outcome of hyperopic cataract cases operated on before and after implementation of the Holiday II formula", Ophthalmology, 105, pp.1759~1764 (1998)
- 최성호, "영아기에 시행한 단일 또는 임시 이중인공수정체삽입술 후 굴절력 변화 및 합병증 비교 연구", 대한안과학회지, 46(4), pp.636~642 (2005), 대한안과학회