가속 각막 교차결합술과 라섹 병합 수술의 장기간 효용성과 안정성
Long-term Outcome of Combined Laser-assisted Subepithelial Keratomileusis and Accelerated Corneal Crosslinking for Myopia
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목적: 가속 각막 콜라겐 교차결합술을 함께 시행한 라섹(아베드로라섹) 환자군과 라섹수술을 단독으로 시행한 환자들을 2년간 경과 관찰하여 효용성과 안정성을 비교 평가하였다. 대상과 방법: 후향적 연구로 아베드로라섹 19명 38안, 대조군인 라섹 17명 34안을 대상으로 2년간 추적 관찰하여 나안시력의 변화, 구면렌즈대응치의 변화, 각막곡률도의 변화, 술 후 각막 염증의 유무 등을 비교, 분석하였다. 결과: 수술 전 두 군 간의 구면렌즈대응치(p<0.05)와 중심각막두께(p<0.05)는 유의한 차이를 보였다. 아베드로라섹군과 라섹 환자군의 나안시력은 수술 후 2년간 통계적으로 유의한 차이는 없었다. 구면렌즈대응치와 각막곡률도의 변화에도 술 후 2년간의 경과 관찰에서 유의한 차이를 보이지 않았다. 2년째 구면렌즈대응치는 아베드로라섹군 92%에서 ±0.25디옵터, 라섹수술을 받은 환자 90.2%에서 ±0.5디옵터 이내에 있었으며 두 군 모두 높은 시력 예측도를 보였다. 아베드로라섹군과 라섹 환자군 간 시간의 영향을 보정한 상태에서 수술 방법 차이에 따른 수평각막곡률값(p=0.38)과 수직각막곡률값(p=0.56)은 유의한 차이가 없었다. 아베드로라섹 환자군 중 21%에서 주변부 각막 염증이 관찰되었으나 시력저하나 각막확장증은 관찰되지 않았다. 결론: 2년간의 장기 경과 관찰 기간 동안 아베드로라섹과 라섹을 시행한 두 환자군 간의 유의한 차이는 보이지 않았고, 두 시술 모두 안정성과 효용성이 있어 효과적인 근시교정수술 방법으로 생각된다.
Abstract
Purpose: We compared clinical outcomes between combined laser-assisted subepithelial keratomileusis and accelerated collagencross-linking (Avedro-LASEK), and LASEK alone. Methods: This retrospective study analyzed 38 eyes of 19 patients who had undergone Avedro-LASEK, and 34 eyes of 17 patientswho received LASEK alone. Uncorrected distance visual acuity (UDVA), spherical equivalent (SE), keratometry, and cornealinflammation were evaluated preoperatively, and at 1 week, 1, 3, and 6 months, and 1 and 2 years after surgery. Results: The Avedro-LASEK group had a higher preoperative SE (p < 0.05) and thinner central cornea compared with the controlgroup (p < 0.05). There was no significant difference in UDVA, SE stability or keratometry between the two groups during the2-year follow-up period. At the 2-year follow-up, the SE was ± 0.25 diopter (D) in 92% of the Avedro-LASEK patients and ± 0.5D in 90.2% of the LASEK patients. Both groups showed high levels of refractive predictability. There was no significant differencebetween the flat K (p = 0.38) and steep K (p = 0.56) rates over time between the two groups. Corneal haze was observed in 21%of eyes in the Avedro-LASEK group, but neither decreased vision nor ectasia was observed during the follow-up period. Conclusions: During the 2-year follow-up period, there were no significant differences in any parameters between theAvedro-LASEK and LASEK patients, and both procedures are considered effective for myopia correction because of their stabilityand effectiveness.
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