유수정체용 안내렌즈삽입술 후 측정된 생체계측값의 변화
Changes in Ocular Biometrics Measured after Implantation of a Phakic Intraocular Lens
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목적: 고도근시 환자의 근시교정을 위해 Implantable collamer lens (AQUA ICL, STAAR surgical company, Monrovia, CA, USA) 및 ArtiflexⓇ lens (Artiflex, Ophtec BV, Netherlands) 삽입술을 시행받은 눈에서 백내장수술 시 안내렌즈 도수 계산에 있어 필요한 생체계측값의 변화를 알아보고자 한다. 대상과 방법: -7D 이상의 근시 환자의 교정을 위해 후방유수정체 및 홍채고정 안내렌즈삽입술(ICL 또는 ArtiflexⓇ lens)을 시행받은 환자 23명의 45안구를 대상으로 안내렌즈삽입술 전에 IOL masterⓇ (IOL master 500, Carl Zeiss Meditec AG, Jena, Germany)의 유수정체안 설정(euphakic mode)으로 안축장과 전방깊이를 측정한 후, 술 후 한 달째 유수정체안 설정과 인공수정체안 설정(pseudophakic mode)으로 안축장과 전방깊이를 측정하여 수술 전후와 측정 설정 간의 차이를 비교분석하였다. Sanders-Retzlaff-Kraff/Theoretical (SRK/T) 공식과 Haigis 공식을 사용하여 측정한 인공수정체 도수 예측치의 차이를 비교 분석하였다. 결과: 45안구 중 17안(37.8%)이 ICL 삽입술을 받았고 28안(62.2%)이 ArtiflexⓇ lens 삽입술을 받았다. 유수정체 안내렌즈삽입술 후 유수정체안과 인공수정체안 설정 모두 안축장이 술 전에 비해 통계적으로 유의하게 길게 측정되었고(p=0.03, p＜0.0001), 전방깊이의 측정에서도 두 가지 설정 모두에서 유의하게 짧은 것으로 나타났다(p＜0.0001, p＜0.0001). 안축장과 전방깊이의 측정값의 변화는 유수정체안 설정이 인공수정체안 설정에 비해 차이가 적었다. 인공수정체 도수의 예측값(predicted IOL power)은 SRK/T 공식과(-0.03D, p=0.023), Haigis 공식(-0.06D, p=0.001) 모두 술 전에 비해 유의하게 작게 계산되었으나, 인공수정체 도수 선택에 영향을 주지 않을 정도로 작은 차이를 보였다. 결론: 유수정체 안내렌즈삽입술 후 생체계측치 측정에 있어 IOL masterⓇ의 유수정체안 설정이 인공수정체안 설정보다 수술 전과 비슷하게 측정되며 통계적으로 유의미한 차이를 보이나 임상적으로 안내렌즈 도수계산에 영향을 미칠 정도는 아니었다. 전방깊이 측정은 안축장 측정에 비해 안내렌즈삽입술 후 보다 많은 차이를 보였다. 유수정체 안내렌즈삽인안에서 백내장수술 시 생체계측치의 차이가 있을 수 있음을 유념해야 할 것으로 생각된다.
Abstract
Purpose: To measure changes in ocular biometrics required for calculating intraocular lens powers during cataract surgery on phakic eyes undergoing implantation of a collamer lens (AQUA ICL [STAAR Surgical Company, Monrovia, CA, USA] or an Artiflex® lens [Ophtec BV, Groningen, Netherlands]) to correct myopia. Methods: A total of 45 eyes of 23 patients who underwent implantation of iris-fixated or posterior chamber phakic intraocular lenses (pIOLs) for correction of myopia >−7D were evaluated using the euphakic mode of the IOL Master® 500 (Carl Zeiss Meditec AG, Jena, Germany) prior to pIOL implantation. After implantation, the axial length (AL) and anterior chamber depth (ACD) were measured 1 month postoperatively using both the euphakic and pseudophakic modes of the instrument. We compared differences between predicted IOL powers calculated using the Sanders-Retzlaff-Kraff/Theoretical (SRK/T) and Haigis formulae. Results: Seventeen eyes (37.8%) receiving ICL and 28 (62.2%) Artiflex® pIOL implants were included in the study. After pIOL implantation, ALs measured by the euphakic and pseudophakic modes of the IOL Master were significantly longer (p = 0.03, p < 0.0001) and ACDs significantly shorter (p < 0.0001, p < 0.0001, respectively) than preoperatively. The changes after surgery were less when the euphakic rather than the pseudophakic measurement mode was employed. The postoperative IOL powers predicted by the SRK/T (−0.03D, p = 0.023) and Haigis formulae (−0.06D, p = 0.001) were significantly lower that the preoperative values. However, the differences were small and did not influence IOL power selection. Conclusions: After pIOL implantation, AL changes were less when measured using the euphakic rather than the pseudophakic mode of the IOL Master. Although the ACDs differed significantly after pIOL implantation, the changes were too small to influence IOL power calculations. ACD measurements differed significantly from those of AL after IOL implantation. Thus, a pIOL implantation history may affect biometric findings during cataract surgery.
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