라식수술 후 백내장수술 시에 Shammas-PL 공식을 이용한 인공수정체도수계산
Intraocular Lens Power Calculation Using Shammas-PL Formula after Laser In-situ Keratomileusis
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목적: 라식수술 과거력이 있는 환자의 백내장수술 시에 Shammas-PL 공식을 이용했을 때 인공수정체도수계산 방법을 알아보고자 한다. 대상과 방법: 2018년 9월부터 2019년 9월까지 본원에서 백내장수술을 시행한 환자 중 라식수술의 과거력이 있는 환자 29명 41안을 대상으로 하였다. 수술 전 안축장, 전방깊이, 각막곡률을 측정하였고, 인공수정체도수계산은 가장 많이 사용되고 있는 Shammas-PL (post laser in-situ keratomileusis, post LASIK) 공식을 이용하였다. 수술 전 굴절예측치와 수술 후 현성굴절검사값을 이용하여 평균절대오차와 평균산술오차를 구하여 정확도를 파악하였다. 결과: 전체 41안 중 15안(36.6%)에서 수술 전의 굴절예측치와 비교해서 수술 후 상대적으로 원시로 이행되었고, 25안(61%)에서 상대적으로 근시 이행을 보였으며, 1안(2.4%)은 수술 전 굴절예측치와 동일하였다. 백내장수술 전 굴절이상치는 수술 후 근시, 정시, 원시의 이행과는 관련성이 없었다(p>0.05). 평균절대오차는 0.63 ± 0.57 diopter (D)였고, 원시로 이행한 경우의 평균절대오차는 0.41 ± 0.35 D, 근시로 이행한 경우의 평균절대오차는 0.78 ± 0.63 D였다. 결론: 라식수술 후 백내장수술 시에 Shammas-PL 공식을 이용하여 인공수정체도수계산을 했을 때 술 후 근시로 이행하는 경우가 더 많았고, 원시로 이행한 경우보다 근시로 이행한 경우의 평균절대오차가 더 컸으므로 목표 굴절예측치보다 더 원시쪽으로 인공수정체도수를 결정하는 것이 좋을 것이다.
Abstract
Purpose: To calculate the intraocular lens (IOL) power using the Shammas-PL formula after laser in-situ keratomileusis (LASIK). Methods: Forty-one eyes of 29 patients that had undergone cataract surgery from September 2018 to September 2019 after LASIK were enrolled in this study. A preoperative AL-Scan® (Nidek Co., Gamagori, Japan) was used to measure the axial length, anterior chamber depth, and corneal curvature. An IOL power calculation was performed using the Shammas-PL (post LASIK) formula. Mean absolute error (MAE) and mean arithmetic error (MARE) were calculated using preoperative manifest refraction and postoperative manifest refraction. Results: Of the 41 eyes, 15 eyes (36.6%) were relatively hyperopic-shifted after surgery compared to the predicted refractive error before surgery, 25 eyes (61%) showed a relative myopic shift, and one eye (2.4%) showed no change with respect to the previous refractive predicted error. Refractive errors before cataract surgery were not related to myopic, emmetropic, or hyperopic shifting after surgery (p > 0.05). Conclusions: When cataract surgery using the Shammas-PL formula was performed after LASIK, myopic shifting was more common than hyperopic shifting. The MAE was greater in myopic-shifted cases than that of hyperopic-shifted cases. Thus, it is better to determine IOL power toward the hyperopic side than the target refractive prediction.
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