성인 백내장수술 중 시행한 계획적 후낭원형절개술의 임상결과
Clinical Result of Planned Posterior Continuous Curvilinear Capsulorrhexis in Adult Patients
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목적: 성인에서의 백내장수술 시, 계획적 후낭원형절개술을 시행하고 시력 변화, 후낭 혼탁의 예방 등의 임상 효과를 보았다. 대상과 방법: 백내장수술 시 후낭원형절개술을 받은 실험군 43명 43안과 시행 받지 않은 대조군 31명 46안을 조사하였다. 술 전, 술 후 2개월, 실험군에서 평균 14.6개월, 대조군에서 평균 15.7개월 시의 최대교정시력과 혼탁 여부에 대하여 관찰하였다. 백내장수술 시 일체형 판형 인공수정체가 사용되었다. 결과: 술 전 최대교정시력은 대조군에서 낮게 나타났으나 큰 차이는 보이지 않았다. 술 후 2개월의 최대교정시력은 두 군 모두 뚜렷한 시력의 호전을 보였고 두 군 간의 차이는 없었다. 최종 내원 시 최대교정시력은 두 군 모두 술 후 2개월보다 감소하였으나 유의한 차이는 아니었으며, 두 군 간의 차이도 없었다. 실험군 43안 중 13안(30.2%)에서 앞유리체 혼탁이 관찰되었고 최종 내원 시 최대 교정시력은 술 후 2달째보다 유의하게 저하되었다(p<0.05). 이 중, 후낭 절개창의 완전 폐쇄를 보인 3안에서 neodymium-doped yttrium aluminium garnet (Nd:YAG) 레이저 후낭 절개술이 시행되었다. 결론: 후낭원형절개술을 시행하지 않은 군과 임상 효과에 큰 차이를 보이지 않으며 고난이도 수술임을 고려 시, 백내장수술에서 후낭원형절개술의 유용성은 앞유리체의 혼탁으로 인한 시력저하까지 발생하기에 시행함에 주의가 요구된다.
Abstract
Purpose: Following planned posterior continuous curvilinear capsulorrhexis (PCCC) during cataract surgery in adults, we evaluated the clinical effects of visual acuity and prevention of posterior capsule opacity. Methods: The clinical results were studied retrospectively by comparing 43 eyes of 43 patients who underwent cataract surgery with PCCC (the experimental group) and 46 eyes of 31 patients who underwent cataract surgery without PCCC (the control group). Preoperative and postoperative best corrected visual acuities (BCVAs) of patients were measured. BCVA (using log MAR) and the occurrence of posterior capsule opacity were closely monitored in both groups preoperatively, two months postoperatively, and at each group’s final visit (14.6 months postoperatively for the experimental group and 15.7 months for the control group). One-piece plate intraocular lens was used in cataract surgery. Results: Preoperative BCVA was lower in the control group but not significantly. The 2-month mean postoperative BCVA showed improvement in vision in both the control and experimental groups. In both groups, the BCVA was decreased at the final examination compared with the 2-month postoperative BCVA, and significant differences between the two groups were not observed. Under slit lamp examination, anterior hyaloid opacity was observed in 13 of 43 eyes that underwent PCCC. The decrease in BCVA in 13 eyes with anterior hyaloid opacity was significantly different (p < 0.05) compared with the 2-month postoperative BCVA. Conclusions: Considering the effort and operation skills required for PCCC, the clinical benefits are negligible. Since cataract surgery with PCCC can cause reduced vision due to anterior hyaloid opacity, side effects should be disclosed before PCCC is performed.
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