백내장수술 전 각막내피세포의 상태가 수술 후 각막내피세포의 감소에 미치는 영향
Influence of Preoperative Corneal Endothelial Status on Postoperative Corneal Endothelium Density after Cataract Surgery
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목적: 수술 전 각막내피의 상태가 백내장수술 후 각막내피의 감소에 미치는 영향을 알아보고자 한다. 대상과 방법: 백내장수술을 받은 158명 228안을 대상으로, 수술 전, 술 후 1일, 1개월, 3개월, 6개월에 각막내피의 상태를 평가하고, 중심각막두께를 측정하였다. 수술 전 단위면적당 각막내피의 개수에 따라 세 군으로, 세포면적변이계수 및 육각형성에 따라 두 군으로 나누었다. 각 대상 군의 술 전과 술 후 1일, 1개월, 3개월, 6개월에 시력, 안압, 구면렌즈대응치, 중심각막두께, 각막내피의 밀도를 비교하였다. 결과: 수술 전 각막내피의 밀도에 따라 나눈 세 군의 시력, 안압, 구면렌즈대응치, 각막내피감소율은 수술 후 6개월까지 군 간 유의한 차이를 보이지 않았다. 중심각막두께는 수술 후 1일과 1개월에 저밀도 각막내피환자군이 각막내피 2,000-2,500개/mm2 군에 비해 증가된 상태였으나(p<0.05), 3개월 이후에는 차이를 보이지 않았다. 수술 전 세포면적변이계수와 육각형성으로 나눈 군의 여러 임상지표에서 수술 후 6개월까지 유의한 차이를 보이지 않았다. 결론: 각막내피의 밀도가 낮은 경우 일시적인 각막부종을 보였지만, 수술 전 각막내피의 상태에 따른 수술 후 각막내피감소율은 차이가 없었다. 최근 백내장 술기가 발달하면서 비정상적인 각막내피밀도나 다양성, 다형성 지표를 가지고 있더라도, 정상 환자의 백내장수술과 비슷한 결과를 얻을 수 있을 것으로 기대한다.
Abstract
Purpose: To analyze the influence of preoperative corneal endothelial status on postoperative corneal endothelium density after cataract surgery. Methods: We evaluated 228 eyes of 158 patients who underwent cataract surgery. Corneal endothelial status and central corneal thickness were measured before surgery and 1 day, 1 month, 3 months and 6 months after surgery. Patients were classified by preoperative endothelial cell density (three groups) and their coefficients of variation and hexagonality (two groups). Clinical parameters, including corneal endothelial cell losses, visual acuity, intraocular pressure, spherical equivalent refraction and central corneal thickness were measured to compare the intergroup indices. Results: There were no significant differences in corneal endothelial cell losses at 1 day, 1 month, 3 months and 6 months after surgery in any of the groups based on corneal endothelial cell density. There were increases in corneal thickness at 1 day and 1 month after surgery that were significantly higher in the low-endothelial cell density group than the 2,000−2,500 cells/mm2 cell density group (p < 0.05), but there were no differences after the 3-month time point. There were no significant differences in clinical parameters for the coefficient of variation and hexagonality groups until 6 months after surgery. Conclusions: We observed reversible corneal edema in the low endothelial group; however, there were no significant intergroup differences in corneal endothelial cell loss due to preoperative corneal endothelial status. Our results suggest that cataract surgery is relatively safe for patients with morphologically abnormal corneal endothelium and/or low endothelial density; the safety is primarily due to improved equipment and surgery techniques.
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