이미지 유도 시스템을 이용한 각막 절개 방향에 따른 난시의 감소 효과
Effect of the Corneal Incision Direction Using an Image-guided System on Residual Astigmatism
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목적: 백내장수술 시 이미지 유도 시스템을 이용해 각막 절개를 시행할 경우 잔여난시의 감소 효과를 알아보고자 한다. 대상과 방법: 가톨릭대학교 여의도성모병원에서 백내장수술을 시행한 환자들을 대상으로 후향적으로 연구를 진행하였다. 1군(20안)은VERION 이미지 유도 시스템(VERION, Alcon, Fort Worth, TX, USA)을 이용하여 환자의 각막난시 축에 따라서 다른 각도의 절개를시행하였고 2군(대조군, 20안)은 직난시 및 도난시에 따른 동축 절개를 시행하여 두 그룹 간의 수술 전후 각막곡률계(RK-F1Ⓡ, Canon, Tokyo, Japan)와 Pentacam (Oculus, Wetzlar, Germany)으로 측정한 전면 각막의 난시와 난시의 감소량을 비교하였다. 결과: 1군은 백내장수술 2개월째 각막곡률계로 측정한 잔여난시는 0.89 ± 0.58 D, pentacam으로 측정 시 0.84 ± 0.51 D, 2군의각막곡률계로 측정한 잔여난시는 1.38 ± 0.62 D, pentacam으로 측정 시 1.24 ± 0.62 D로 VERION을 이용했을 때 유의하게 잔여난시가 적은 것으로 나타났다(p=0.049, p=0.043). 난시 감소량 역시 1군은 각막곡률계로 측정 시 0.71 ± 0.81 D, pentacam으로 측정시 0.61 ± 0.69 D로 측정되었고 2군에서는 각막곡률계로 측정 시 0.61 ± 0.69 D, pentacam으로 측정 시 0.43 ± 0.61 D로 VERION 을 이용하였을 때 유의하게 난시를 더 많이 줄일 수 있었다(p=0.034, p=0.048). 결론: 수술 후 발생하는 난시를 최소화하기 위해서는 이미지 유도 시스템을 이용하여 환자의 각막난시 축에 따라서 절개 방향을 고려하는 것이 바람직하다.
Abstract
Purpose: We evaluated the effect of corneal incision direction using an image-guided system on cataract surgery. Methods: We retrospectively reviewed patients who underwent cataract surgery at The Catholic University of Korea Yeouido St.Mary’s Hospital. The patients were divided into two groups. In group 1 (20 eyes), the corneal incision was made along the steepest axis using the VERION image-guided system (Alcon, Fort Worth, TX, USA). In the control group, group 2 (20 eyes), the incision was made at the vertical or horizontal axis closest to the patient’s steepest axis. We compared residual astigmatism and the mean difference in astigmatism before and after cataract surgery between the two groups using an autorefractor keratometer (RK-F1®; Canon, Tokyo, Japan) and a Pentacam system (Oculus, Wetzlar, Germany). Results: Group 1’s residual astigmatism was significantly lower than that of group 2 ([VERION group 1; before, 0.89 ± 0.58 D; after, 0.84 ± 0.51 D; p = 0.049] and [control group 2; before, 1.38 ± 0.62 D; after, 1.24 ± 0.62 D; p = 0.043]). The mean difference in astigmatism before and after cataract surgery for group 1 was also larger than group 2 ([VERION group 1; before, 0.71 ± 0.81 D; after, 0.61 ± 0.69 D; p = 0.034] and [control group 2; before, 0.61 ± 0.69 D; after, 0.43 ± 0.61 D; p = 0.048]). Conclusions: Using an image-guided system, postoperative residual astigmatism from cataract surgery can be minimized using an incision direction that is aligned with the corneal astigmatic axis.
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