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이중샤임플러그 전안부분석기를 이용한 백내장 수술 시 인공수정체 도수 계산

Intraocular Lens Power Calculations Using Dual Scheimpflug Analyzer

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목적: 백내장 수술 환자에서 이중샤임플러그 전안부분석기(dual Scheimpflug analyzer, DSA; Galilei G2)로 측정한 생체계측값과 예측굴절력을 기존 방식과 비교하고 DSA의 simulated keratometry (simK)를 이용한 인공수정체 계산공식들의 예측오차를 알아보고자 하였다. 대상과 방법: 백내장 환자 총 39명을 대상으로 초음파계측기, 자동각막굴절계, 부분결합간섭계(IOL master®), DSA로 생체계측을 하였다. 수술 전 자동각막굴절계의 auto-keratometry (Auto-K), 부분결합간섭계의 mean K, DSA의 simK와 총각막굴절력(total corneal power, TCP)을 측정하고 4가지 각막굴절값을 이용하여 예상굴절력을 계산하였다. 또한 DSA의 simK를 Sanders-Retzlaff-Kraff (SRK)-II, SRK-T, Holladay II, Haigis, Hoffer-Q 공식에 대입하여 얻은 예상굴절력을 비교하였다. 수술 후 1, 3, 6개월에 측정한 구면렌즈대응치와 예상굴절력의 차이를 평균예측오차로, 그 절대값을 절대예측오차로 정의하여 그 값을 비교하였다. 결과: DSA의 TCP는 simK, mean K, Auto-K에 비해 유의하게 낮았다(p<0.05). 수술 후 1개월에 평균예측오차는 simK, mean K와 Auto-K 사이에 차이가 없었고, TCP를 사용한 경우에는 다른 각막굴절력을 사용한 경우보다 평균예측오차가 컸다(p<0.05). 수술 후 6개월에 simK와 TCP를 사용하여 계산된 평균예측오차는 유의한 차이를 보였다(p<0.05). DSA의 simK를 5가지 인공수정체 계산공식에 대입하여 계산된 평균예측오차는 SRK-T 공식에서 가장 작았다. 결론: 정상각막을 가진 백내장 환자에서 인공수정체 도수 계산 시, DSA의 TCP보다 simK와 SRK-T 공식을 사용하는 것이 유용할 것으로 생각된다.

Abstract

Purpose: To investigate the accuracy of intraocular lens power calculations using simulated keratometry (simK) of dual Scheimpflug analyzer and 5 types of formulas in cataract patients. Methods: The keratometry (K), axial length (AXL) and anterior chamber depth (ACD) were measured using ultrasound biometry (USB) combined with auto-keratometry (Auto-K), parital coherence interferometry (PCI; IOL master®) and dual Scheimpflug analyzer (DSA; Galilei®) in 39 eyes of 39 patients. Predicted refraction was calculated using Auto-K, mean K of PCI, and simK and total corneal power (TCP) of DSA in the Sanders-Retzlaff-Kraff (SRK-T) formula. The SRK-II, SRK-T, Holladay II, Haigis, and Hoffer-Q formula were used to calculate predicted refraction with the simK of DSA and AXL of USB. Manifest refraction, mean numerical error (MNE) and mean absolute error were evaluated 1, 3 and 6 months after cataract surgery. Results: TCP of DSA was lower compared with other keratometric values (p < 0.05). The MNE was not different among Auto-K, mean K and simK. The MNE using TCP was larger compared with Auto-K, mean K and simK at 1 month after surgery (p < 0.05). There was a difference in MNE between simK and TCP of DSA at 6 months after surgery (p < 0.05). The MNE of SRK-T formula was the smallest in the intraocular lens (IOL) power calculation using the simK of DSA. Conclusions: We suggest using IOL power calculations with simK of DSA and SRK-T formula rather than TCP of DSA in cataract patients with normal corneas.

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