각막확장증 환자에서 펨토초레이저를 이용한 기질내 각막고리 삽입술의 단기 임상 성적
The Clinical Results of Intrastromal Corneal Ring Segment Implantation Using a Femtosecond Laser in Keratectasia
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목적: 각막확장증 환자에서 펨토초레이저를 이용한 기질내 각막고리(케라링, KeraringⓇ) 삽입술 후 임상결과에 대해 알아보고자 하였다. 대상과 방법: 수술 후 3개월 이상 경과 관찰한 각막확장증 환자 19명 20안(원추각막 15안, 라식 후 각막확장증 5안)을 대상으로 수술전후로 나안시력, 안경최대교정시력, 구면렌즈대응치, 각막 곡률 값, 각막난시, 각막고위수차 및 각막내피세포검사를 시행하였으며,술 중 및 술 후 합병증 발생유무를 조사하였다. 결과: 20안 중 13안(65%)에서 나안시력 상승을 보였고, 16안(80%)에서 안경최대교정시력 상승을 보였다. 술 전에 비해 술 후 구면렌즈대응치는 통계적으로 유의하지 않은 감소를 보였으며, 반면에 각막지형도상 평균 K값 및 Sim K 난시와 각막 전체 및 코마 고위수차에서는 모두 통계적으로 유의한 감소 결과를 나타내었다(p<0.05). 수술 전후 각막내피세포밀도에서는 유의한 차이가 없었다. 합병증으로부분 데스메막 박리 1예와 미세천공 1예가 있었으나 별 다른 치료 없이 회복되었다. 결론: 케라링 삽입술은 각막확장증 환자에서 시력을 교정하고, 각막굴절력을 안정화 시키는데 효과적이고 안전적이라 생각된다.
Abstract
Purpose: To evaluate the clinical results of intrastromal ring segment (KeraringⓇ) implantation using a femtosecond laser in patients with keratectasia. Methods: Twenty eyes of 19 keratectatic patients (15 eyes of keratoconus and five eyes of post-LASIK keratectasia) who completed at least three months of postoperative follow-up were included in this study. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent, keratometric value, corneal astigmatism, corneal higher order aberrations (HOA) and specular microscopy were determined or performed before and after surgery. In addition, intraoperative and postoperative adverse complications were recorded. Results: UCVA improved in 13 out of 20 eyes (65%), and BSCVA improved in 16 out of 20 eyes (80%). At the postoperative examination there was no statistically significant reduction in the spherical equivalent with that observed at the examination before implantation. Conversely, there were statistically significant reductions in topographic mean K value and Sim K astigmatism, corneal total and coma-like HOA (p<0.05). On specular microscopy, there was no statistically significant difference between preoperative and postoperative endothelial cell density. There was one case of partial Descemet membrane detachment and one case of microperforation as a complication during surgery, which recovered over time without any treatment. Conclusion: KeraringⓇ implantation appears to be an effective and safe procedure for improving visual acuity and stabilizing corneal refractive power in keratectactic patients.
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