능동적 수정체유화 역동학과 하방경사 첨단부를 이용한 백내장수술의 각막내피세포에 대한 안정성
Safety of Active Phacoemulsification Fluidics with Bevel-down Phaco-tip on Corneal Endothelial Cells
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목적: 다양한 각막내피세포밀도를 보이는 백내장 환자들에서 능동적 수정체유화 역동학을 이용한 Centurion® Vision System (Alcon, Fort Worth, TX, USA)을 사용하여 하방경사 첨단부 방식으로 백내장수술을 시행한 후 각막내피세포의 안정성을 평가하고자 하였다. 대상과 방법: 백내장수술을 시행한 111명 173안에서 수술 전과 후의 각막내피세포밀도와 형태 지표들을 비교하였으며, 수술 후 각막내피세포밀도의 감소율과 연관된 인자들을 분석하였다. 결과: 수술 전 각막내피세포밀도는 평균 2,511.02 ± 463.14 cells/mm2 (range, 540-3,390 cells/mm2)였다. 각막내피세포밀도는 수술 후 유의한 감소를 보였으며(-50.70 cells/mm2, p<0.017) 육각형성과 세포면적변이계수, 그리고 중심각막두께에는 유의한 변화를 보이지 않았다. 수술 전 각막내피세포밀도가 높을수록(regression coefficient, B=-0.010, p<0.001), 백내장의 핵경화도가 높을수록(B=-3.002, p<0.001), 나이가 적을수록(B=0.167, p=0.040) 각막내피세포밀도의 감소율(%)은 커졌다. 결론: Centurion®을 사용한 하방경사 첨단부 방식은 매우 낮은 각막내피세포밀도의 감소율을 보였으며, 수술 전 각막내피세포밀도가 낮은 것은 술 후 각막내피세포밀도 감소의 위험요인이 아니었다. 따라서, 술 전 각막내피세포밀도가 낮은 환자에서도 핵경화도가 심하지 않은 경우에는 비교적 안전하게 시행할 수 있는 수술 방법이 될 수 있을 것으로 보인다.
Abstract
Purpose: To evaluate the safety of active phacoemulsification fluidics with a bevel-down phaco-tip on corneal endothelial cells in patients with various corneal endothelial cell densities (ECDs). Methods: One hundred and seventy-three eyes of 111 patients who underwent cataract surgery using active phacoemulsification fluidics with a bevel-down phaco-tip technique were consecutively enrolled. We analyzed the postoperative changes in corneal parameters including ECD and clinical factors associated with percent change in ECD. Results: Preoperative mean ECD was 2,511.02 ± 463.14 cells/mm2 (range, 540-3,390 cells/mm2 ). There was a significant change in postoperative ECD (-50.70 cells/mm2 , p < 0.017), and no significant change in hexagonality or coefficients of variation. A higher preoperative mean ECD (B = -0.010, p < 0.001), a higher grade of nucleus sclerosis (B = -3.002, p < 0.001), and a younger age (B = 0.167, p = 0.040) were associated with a larger percent change in ECD. Conclusions: There was very low ECD loss after active phacoemulsification fluidics with a bevel-down phaco-tip. The lower preoperative ECD was not a risk factor for postoperative ECD loss. Therefore, we suggest that active phacoemulsification fluidics with a bevel-down phaco-tip technique can be performed safely in patients with low ECD when nuclear sclerosis is not severe.
참고문헌 (38)
- Hodson S, "Evidence for a bicarbonate-dependent sodium pump in corneal endothelium", Exp Eye Res, 11, pp.20~29 (1971)
- Maurice DM, "The location of the fluid pump in the cornea", J Physiol, 221, pp.43~54 (1972)
- Dikstein S, "The metabolic basis to the fluid pump in the cornea", J Physiol, 221, pp.29~41 (1972)
- Fischbarg J, "Role of cations, anions and carbonic anhydrase in fluid transport across rabbit corneal endothelium", J Physiol, 241, pp.647~675 (1974)
- Geroski DH, "Pump function of the human corneal endothelium. Effects of age and cornea guttata", Ophthalmology, 92, pp.759~763 (1985)
- American Academy of Ophthalmology, "Corneal endothelial photography. Three-year revision", Ophthalmology, 104, pp.1360~1365 (1997)
- Waring GO 3rd, "The corneal endothelium. Normal and pathologic structure and function", Ophthalmology, 89, pp.531~590 (1982)
- Bourne WM, "Specular microscopy of human corneal endothelium in vivo", Am J Ophthalmol, 81, pp.319~323 (1976)
- Bourne WM, "Endothelial cell loss during penetrating keratoplasty", Am J Ophthalmol, 85, pp.760~766 (1978)
- Bourne RR, "Effect of cataract surgery on the corneal endothelium : modern phacoemulsification compared with extracapsular cataract surgery", Ophthalmology, 111, pp.679~685 (2004)
- Smith DL, "The effect of glaucoma filtering surgery on corneal endothelial cell density", Ophthalmic Surg, 22, pp.251~255 (1991)
- Eom Y, "Comparison of cornea endothelial cell counts after combined phacovitrectomy versus pars plana vitrectomy with fragmentation", Graefes Arch Clin Exp Ophthalmol, 251, pp.2187~2193 (2013)
- Smith J, "Corneal endothelial changes after argon laser iridotomy", Am J Ophthalmol, 98, pp.153~156 (1984)
- Kim MS, "Clinical corneal endothelium, Vol. 1", pp.224~225 (2014), Naewaehaksool
- Krachmer J, "Cornea, Vol. 1", pp.188~ (2010), Mosby
- Van den Bruel A, "The protective effect of ophthalmic viscoelastic devices on endothelial cell loss during cataract surgery : a meta-analysis using mixed treatment comparisons", Br J Ophthalmol, 95, pp.5~10 (2011)
- 이은경, "저밀도내피세포 환자에서 회전진동방식의 초음파유화술을 이용한 백내장 수술 시 단기 임상결과", 대한안과학회지, 52(4), pp.434~441 (2011), 대한안과학회
- Kim EC, "Microincision versus small-incision coaxial cataract surgery using different power modes for hard nuclear cataract", J Cataract Refract Surg, 37, pp.1799~1805 (2011)
- Faramarzi A, "Corneal endothelial cell loss during phacoemulsification : Bevel-up versus bevel-down phaco tip", J Cataract Refract Surg, 37, pp.1971~1976 (2011)
- "Ophthalmology", 2008, 2315~
- Nicoli CM, "Experimental anterior chamber maintenance in active versus passive phacoemulsification fluidics systems", J Cataract Refract Surg, 42, pp.157~162 (2016)
- 공석준, "능동적 및 중력 기반의 수정체유화 역동학을 이용한 양안 백내장 동시수술 후 임상결과 비교", 대한안과학회지, 58(1), pp.27~33 (2017), 대한안과학회
- Dick HB, "Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision", J Cataract Refract Surg, 22, pp.63~71 (1996)
- Minassian DC, "Extracapsular cataract extraction compared with small incision surgery by phacoemulsification : a randomised trial", Br J Ophthalmol, 85, pp.822~829 (2001)
- Steinert RF, "Cataract surgery: technique, complications & management, Vol. 1", pp.185~191 (1995), W.B. Saunders
- Boulter T, "Comparison of a torsional and a standard tip with a monitored forced infusion phacoemulsification system", J Cataract Refract Surg, 42, pp.613~617 (2016)
- Raskin E, "Effect of bevel position on the corneal endothelium after phacoemulsification", Arq Bras Oftalmol, 73, pp.508~510 (2010)
- Walkow T, "Endothelial cell loss after phacoemulsification : relation to preoperative and intraoperative parameters", J Cataract Refract Surg, 26, pp.727~732 (2000)
- Hayashi K, "Risk factors for corneal endothelial injury during phacoemulsification", J Cataract Refract Surg, 22, pp.1079~1084 (1996)
- Rekas M, "Comparison of torsional and longitudinal modes using phacoemulsification parameters", J Cataract Refract Surg, 35, pp.1719~1724 (2009)
- Vasavada AR, "Impact of high and low aspiration parameters on postoperative outcomes of phacoemulsification : randomized clinical trial", J Cataract Refract Surg, 36, pp.588~593 (2010)
- Sharif-Kashani P, "Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems", BMC Ophthalmol, 14, pp.96~ (2014)
- 허원재, "초음파유화술의 높고 낮은 유체 역동학 지표들에 따른 수술 결과 비교", 대한안과학회지, 56(12), pp.1860~1866 (2015), 대한안과학회
- 양재니, "유수정체용 전방각지지렌즈 삽입 후 각막내피세포의 장기 변화", 대한안과학회지, 53(2), pp.208~214 (2012), 대한안과학회
- 최정한, "저밀도 내피세포 환자의 백내장 수술 후 장기 임상결과", 대한안과학회지, 54(4), pp.602~609 (2013), 대한안과학회
- Yamazoe K, "Outcomes of cataract surgery in eyes with a low corneal endothelial cell density", J Cataract Refract Surg, 37, pp.2130~2136 (2011)
- Hayashi K, "Cataract surgery in eyes with low corneal endothelial cell density", J Cataract Refract Surg, 37, pp.1419~1425 (2011)
- KIM PATRICK ALFRED, "백내장수술 전 각막내피세포의 상태가 수술 후 각막내피세포의 감소에 미치는 영향", 대한안과학회지, 58(2), pp.131~139 (2017), 대한안과학회