접이식 홍채고정안내렌즈삽입술 후 각막내피세포 밀도의 5년간 변화
Five-year Change in Corneal Endothelial Cell Density after Foldable Iris-fixed Lens Insertion
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목적: 접이식 홍채고정안내렌즈(Artiflex; Ophtec BV, Groningen, The Netherlands) 삽입 수술 후 5년간 각막내피세포 밀도의 변화를 보고하고, 전방부피와 전방깊이의 영향을 분석하였다. 대상과 방법: 본 연구는 2009년 3월부터 2014년 3월까지 근시교정을 위한 접이식 유수정체 홍채고정렌즈(Artiflex) 수술을 받은 88명, 146안이 포함되었다. 정상인 20세, 25세, 30세 각각 100명의 각막내피세포 밀도를 측정 후 연령에 따른 각막내피세포 변화를 추정한 모방대조군으로 설정하여 수술 후 변화와 비교하였다. 렌즈와 각막내피까지의 거리 및 전방부피, 전방깊이를 4군으로 나눈 후 각막내피세포 밀도의 변화를 비교하였다. 결과: 각막내피세포 밀도의 평균값은 수술 전, 수술 후 1년, 3년, 5년이 각각 3,038.8 ± 223.2, 2,985.3 ± 235.5, 2,905.1 ± 231.3, 2,814.9 ± 250.5 cells/mm2로 나타났다(각각 1.73%, 4.36%, 7.31% 감소, p<0.001). 이는 수술을 받지 않은 20세와 25세군의 2.2%의 차이, 25세와 30세군의 1.2% 차이와 비교하여 통계적으로 유의한 감소였다(p<0.001). 귀쪽의 렌즈와 각막내피 거리와 전방부피가작은 군에서 각막내피세포 밀도의 감소가 다른 군에 비해 유의하게 컸다. 결론: 접이식 홍채고정렌즈 삽입 수술 후 5년간 각막내피세포 밀도의 유의한 감소가 있으며, 렌즈와 각막내피까지의 거리와 전방부피가 적을수록 각막내피감소가 크게 나타났다.
Abstract
Purpose: To investigate changes in corneal endothelial cell density over 5 years after implantation of Artiflex lenses (Ophtec BV,Groningen, The Netherlands) and to explore the influence of anterior chamber depth and volume on changes in endothelial celldensity. Methods: This study included 146 eyes of 88 patients implanted with foldable phakic iris-fixation intraocular (Artiflex) lenses formyopia correction from March 2009 to March 2014. To simulate chronological changes in endothelial cell density with age, wecollected normal endothelial cell density data from 100 healthy subjects aged 20, 25, or 30 years, and compared the changesamong these groups at 5 years after surgery. Changes in corneal endothelial cell density were compared among four groups towhich subjects were assigned based on the distance from the intraocular lens to the corneal endothelium, and the volume anddepth of the preoperative anterior chamber. Results: The mean endothelial cell density, pre-operatively and at 1, 3, and 5 years post-operatively, was 3,038.8 ± 223.2,2,985.3 ± 235.5, 2,905.1 ± 231.3, and 2,814.9 ± 250.5 cells/mm2, respectively (1.73%, 4.36%, and 7.31% reduction, respectively,vs. pre-operatively, p < 0.001). These differences were greater than those observed among different age groups(2.2% difference between 20- and 25-year-olds, and 1.2% difference between 25- and 30-year-olds, p < 0.001). A shorter distancefrom the lens to the endothelium and smaller anterior chamber volume were associated with greater decreases in endothelialcell density following surgery. Conclusions: Corneal endothelial cell density significantly decreased during a 5-year follow-up after Artiflex lens implantation. The distance from the intraocular lens to the corneal endothelium, and the anterior chamber volume, were negatively correlatedwith the rate at which endothelial cell density decreased over time.
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