백내장 수술 중 투명각막절개창 크기를 이용한 각막난시교정
The Effect of Manipulation of Corneal Incision on Astigmatism During the Cataract Surgery
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목적: 백내장 수술 시 투명각막절개창 크기를 이용한 각막난시교정의 임상적 효과에 대해서 알아보고자 한다. 대상과 방법: 백내장 수술 시행예정 환자 중 각막난시가 도난시 1.0 Diopter (D) 이상인 78명, 108안을 대상으로 수술 전 난시량, 수술후 1주, 1,2,6개월 째 난시를 각막지형도 및 자동굴절검사를 통하여 조사하였다. 수술 시 2.8 mm 절개창에 주사 방식으로 인공수정체를삽입한 군을 1군으로, 절개창을 4.0 mm로 넓혀 인공수정체 겸자를 이용하여 인공수정체를 삽입한 군을 2군으로 하였다. 결과: 술 후 나안시력은 1주일째 0.59±0.35, 0.71±0.34 (p=0.04), 1개월 째 0.60±0.23, 0.79±0.24 (p=0.04) 로 2군에서 통계학적으로 유의하게 좋았으나 2,6개월에는 유의한 차이를 보이지 않았다(p=.135,.087). 난시는 각막지형도검사에서 2개월에 1.62±0.44D,0.94±0.30D (P=.045), 6개월에 1.73±0.45D, 0.92±0.34D (P=.042)로 2군에서 통계학적으로 유의하게 작은 잔여난시를 보였으며이는 자동굴절검사에서도 같은 양상을 보였다. 술 후 경과관찰기간 중 창상누출 등 절개창 크기와 관련된 합병증은 관찰되지 않았다. 결론: 도난시를 보이는 환자에서 술 중 이측 절개창을 넓히는 술기를 통하여 별다른 합병증 없이 각막난시를 줄일 수 있을 것으로사료된다.
Abstract
Purpose: To evaluate the effect of clear corneal incisional size on astigmatism during cataract surgery. Methods: Randomized prospective study of 78 patients (108 eyes) who had received cataract surgery for a corneal astigmatism over against-the-rule (ATR) 1.0 Diopter (D) was performed. The eyes were checked by corneal topography and autorefractor preoperatively and one week, one month, two months, and six months postoperative. Group 1 included patients who received an inserted foldable intraocular lens (IOL) through a 2.8 mm incision, and Group 2 included patients who underwent IOL implantation through a corneal incision enlarged to 4 mm. Results: Postoperative visual acuity showed a better visual acuity in Group 2 at both one week postoperatively (0.598±0.352 vs.,0.713±0.345, for Groups 1 and 2, respectively, p=0.046) and one month postoperatively (0.604±0.237 vs., 0.791±0.242, respectively,p=.043). There were no statistically significant differences between the groups after two and six months (p=.135, .087). Postoperative astigmatism measured by corneal topopgraphy showed 1.62±0.44D and, 0.94±0.30D for groups 1 and 2 respectively,(P=.045) at 2 months, and 1.73±0.45 D and, 0.92±0.34 D (P=.042) at six months. These results showed a statistically significant amount of residual astigmatism in Group 2. Autorefractor measurements showed similar results. There were no complications, such as wound leakage, resulting from the increased incision size. Conclusions: Widening of the incision during cataract surgery can reduce corneal astigmatism without significant complications.
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