군날개절제술 전후의 각막 고위수차 비교
Comparison of Corneal Higher-order Aberration before and after Excision of Pterygium
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목적: 군날개 환자에서 군날개로 유발되는 고위수차와 술 후 잔류고위수차의 종류를 확인하고 군날개의 길이와 연관이 있는 고위수차를 알아보고자 하였다. 대상과 방법: 군날개절제술과 자가 결막 이식술을 시행받은 53안을 대상으로 술 전과 술 후 3개월에 PentacamⓇ HR (Oculus Inc., Wetzlar, Germany)을 이용하여 광학부 6 mm에서 고위수차를 측정하였다. 대상안의 술 전 고위수차와 정상안의 고위수차를 비교하여 군날개로 유발된 고위수차를, 대상안의 술 후 고위수차와 정상안의 고위수차를 비교하여 수술 후 잔류 고위수차를 구하였다. 군날개로 유발된 고위수차와 술 후 잔류고위수차가 군날개의 길이와 어떠한 상관관계가 있는지 알아보기 위해 편상관분석을 시행하였다. 그리고 술 후 고위수차를 0.35 μm 이하로 감소시킬 수 있는 경우를 효과적 수술결과로 정의하고, receiver operator characteristic (ROC) 커브를 이용하여 적절한 수술 시기를 추정하였다. 결과: 대상안과 정상안을 비교하였을 때 술 전에는 대상안에서 수평코마, 전체코마, 경사트레포일, 수평트레포일, 전체트레포일, 전체고위수차가 유의하게 컸다. 군날개절제술 후에는 전체코마와 전체고위수차만이 정상안에 비하여 크게 나타났다. 편상관분석에서 군날개의 길이와 유의한 상관관계가 있는 고위수차는 수평코마, 수직코마, 전체코마, 경사테트라포일이 있었다. ROC 커브를 이용하여 술 전 군날개의 길이와 술 후 고위수차를 분석한 결과, 군날개가 1.6 mm 이하일 때 수술을 시행하는 것이 좋은 수술결과를 보였다. 결론: 군날개에 의하여 3차 이상의 고위수차 대부분이 발생하며, 군날개절제술 후 고위수차를 크게 줄일 수 있었다. 군날개의 길이가 길수록 전체코마가 크게 유발되었고, 술 후 잔류코마수차도 컸다. 술 후 고위수차를 효과적으로 줄이기 위해서는 군날개가 1.6 mm 이하일 때 수술하는 것이 권장된다.
Abstract
Purpose: To investigate the types of corneal higher-order aberration (HOA) induced by pterygium, residual corneal HOA after pterygium surgery, and correlations between corneal HOA and the length of the pterygium. Methods: Fifty-three patients who underwent pterygium excision with conjunctival autograft were enrolled. Corneal HOA was measured by Pentacam® (Oculus Inc., Wetzlar, Germany) preoperatively and 3 months postoperatively in the 6-mm optical zone. Preoperative and postoperative HOAs of eyes with pterygium were compared with HOAs of the fellow eye to evaluate HOAs induced by pterygium and residual HOAs after pterygium surgery. Partial correlation analysis was performed to investigate the relationship between HOAs and the length of pterygium. A postoperative HOA less than 0.35 μm in size was defined as a favorable surgical outcome and the surgical indications were estimated using receiver operator characteristic (ROC) curve. Results: Horizontal coma, root mean square (RMS) of coma, oblique trefoil, horizontal trefoil, RMS of trefoil, and total HOA were significantly greater in the eye with preoperative pterygium. Three months after pterygium excision, only RMS of coma and total HOA remained significantly greater in eyes with pterygium. Vertical coma, horizontal coma, RMS of coma, and oblique tetrafoil were correlated with pterygium length. Pterygium excision when pterygium length was less than 1.6 mm led to favorable surgical outcomes. Conclusion: Pterygium induced greater than third-order corneal HOAs and these HOAs were corrected via pterygium surgery. Longer pterygium length was associated with larger RMS of coma and larger coma RMS persisted after pterygium surgery. A pterygium length of 1.6 mm should be considered the cutoff for pterygium excision for reducing postoperative corneal HOA.
참고문헌 (26)
- Dushku N, "Pterygia pathogenesis:corneal invasion by matrix metalloproteinase expressing altered limbal epithelial basal cells", Arch Ophthalmol, 119, pp.695~706 (2001)
- Threlfall TJ, "Sun exposure and pterygium of the eye:a dose-response curve", Am J Ophthalmol, 128, pp.280~287 (1999)
- Hansen A, "Astigmatism and surface phenomena in pterygium", Acta Ophthalmol (Copenh), 58, pp.174~181 (1980)
- Yasar T, "Effects of fibrovascular traction and pooling of tears on corneal topographic changes induced by pterygium", Eye (Lond), 17, pp.492~496 (2003)
- Cinal A, "The effect of pterygium surgery on corneal topography", Ophthalmic Surg Lasers, 32, pp.35~40 (2001)
- Ozdemir M, "Early and late effects of pterygium surgery on corneal topography", Ophthalmic Surg Lasers Imaging, 36, pp.451~456 (2005)
- Lin A, "Correlation between pterygium size and induced corneal astigmatism", Cornea, 17, pp.28~30 (1998)
- Stern GA, "Effect of pterygium excision on induced corneal topographic abnormalities", Cornea, 17, pp.23~27 (1998)
- Fong KS, "Refractive change following pterygium surgery", CLAO J, 24, pp.115~117 (1998)
- Tomidokoro A, "Effects of pterygium on corneal spherical power and astigmatism", Ophthalmology, 107, pp.1568~1571 (2000)
- Tomidokoro A, "Quantitative analysis of regular and irregular astigmatism induced by pterygium", Cornea, 18, pp.412~415 (1999)
- Lindsay RG, "Pterygium-induced corneal astigmatism", Clin Exp Optom, 84, pp.200~203 (2001)
- Mohammad-Salih PA, "Analysis of pterygium size and induced corneal astigmatism", Cornea, 27, pp.434~438 (2008)
- Oner FH, "Analysis of the pterygium size inducing marked refractive astigmatism", Eur J Ophthalmol, 10, pp.212~214 (2000)
- Villegas EA, "Optical quality of the eye in subjects with normal and excellent visual acuity", Invest Ophthalmol Vis Sci, 49, pp.4688~4696 (2008)
- Pesudovs K, "Corneal first surface wavefront aberrations before and after pterygium surgery", J Refract Surg, 22, pp.921~925 (2006)
- Gumus K, "Effect of pterygia on refractive indices, corneal topography, and ocular aberrations", Cornea, 30, pp.24~29 (2011)
- Zare M, "Effects of pterygium on ocular aberrations", Cornea, 29, pp.1232~1235 (2010)
- 권상민, "군날개 수술 전후의 각막형태검사기와 파면수차계를 이용한 난시벡터분석 및 고위수차의 변화", 대한안과학회지, 49(11), pp.1737~1745 (2008), 대한안과학회
- Gumus K, "The change in ocular higher-order aberrations after pterygium excision with conjunctival autograft:a 1-year prospective clinical trial", Cornea, 31, pp.1428~1431 (2012)
- Miranda MA, "Repeatability of oculus pentacam metrics derived from corneal topography", Cornea, 28, pp.657~666 (2009)
- Swartz T, "Measuring the cornea: the latest developments in corneal topography", Curr Opin Ophthalmol, 18, pp.325~333 (2007)
- Levy Y, "Ocular higher-order aberrations in eyes with supernormal vision", Am J Ophthalmol, 139, pp.225~228 (2005)
- 한현철, "군날개의 크기에 따른 수술 전후의 각막 고위수차의 변화", 대한안과학회지, 55(1), pp.32~39 (2014), 대한안과학회
- Oie Y, "Characteristics of ocular higher-order aberrations in patients with pellucid marginal corneal degeneration", J Cataract Refract Surg, 34, pp.1928~1934 (2008)
- Smolek MK, "Zernike polynomial fitting fails to represent all visually significant corneal aberrations", Invest Ophthalmol Vis Sci, 44, pp.4676~4681 (2003)