미세각막절개도를 이용한 데스메막박리 각막내피층판이식술의 국내 장기 임상 결과
Long-Term Results of Descemet’s Stripping Automated Endothelial Keratoplasty in Korea
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목적: 국내에서 데스메막박리 각막내피층판이식술을 시행받은 환자들의 장기 임상 결과를 알아보고자 하였다. 대상과 방법: 본원에서 수포각막병증으로 데스메막박리 각막내피층판이식술을 시행받은 환자 중 18개월 이상 경과 관찰하였던 7명(7안) 을 대상으로 수술 전, 후의 최대교정시력, 굴절이상 및 난시값, 각막내피세포수, 각막두께 등을 후향적으로 분석하였다. 결과: 평균 관찰 기간은 19.9 ± 2.9 (18~24)개월이었으며 평균 연령은 61.42 ± 10.13 (46~76)세였다. 전체 7안 중 6안(85.7%)에서 성 공적인 상태를 보였고 최대교정시력(logMAR)은 수술 전 1.62 (중앙값)에서 수술 후 1개월째 1.15 (중앙값) (p = 0.027)로 유의한 호전을 보였으며 최종 경과 관찰 시까지 유지되었다. 수술 후 18개월의 굴절이상 및 난시값은 수술 전과 비교하여 유의한 차이를 보이지 않았 다. 1안에서 이식실패를 보여 수술 후 12개월째 전층각막이식술을 시행하였다. 결론: 장기 경과 관찰 결과 데스메막박리 각막내피층판이식술은 빠른 시력 회복을 보였고 굴절 및 난시값의 변화가 적었으며, 각막내피 부전증 환자에 있어 선택할 수 있는 좋은 수술법이라 생각된다.
Abstract
Purpose: To evaluate the long-term results of Descemet’s stripping automated endothelial keratoplasty in Korea (DSAEK). Methods: Seven patients with bullous keratopathy who underwent DSAEK and who were followed-up for more than 18 months were reviewed retrospectively. Best corrected visual acuity, refraction, corneal thickness, and endothelial cell count were examined before and after surgery. Results: The mean follow-up period was 19.9 ± 2.9 months (18 to 24 months), and the mean age was 61.42 ± 10.13 years (46 to 76 years). Six patients (85.7%) showed successful results after surgery. Best corrected visual acuity (logMAR) was significantly improved from 1.62 (median) to 1.15 (median) (p = 0.027) at one month after surgery and was maintained until the final follow-up period. There were no statistical differences in spherical ametropia or astigmatism before or 18 months after the operation. Graft failure was observed in one case, in which penetrating keratoplasty was performed 12 months after DSAEK. Conclusions: Long term results of DSAEK showed fast visual recovery, low ametropia and astigmatism. DSAEK may be a good option for the surgical management of corneal endothelial disease.
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