백내장 수술 후 각막 전면, 후면 및 전체 난시 변화
Analysis of Changes in Anterior, Posterior and Total Corneal Astigmatism after On-Axis Cataract Surgery
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목적: 직난시와 도난시 환자에서 백내장 수술 후 각막 전면 및 후면 난시 변화를 분석하였다. 대상과 방법: 백내장 환자 48안(직난시 24안, 도난시 24안)에 직난시 군은 상측, 도난시 군은 이측으로 투명각막절개를 시행하였다. 도난시 군은 후면난시 경축이 수직인 제1군과 수평인 제2군으로 분류하였다. 수술 전과 수술 후 1주, 1달, 2달의 각막 전면, 후면 및전체 난시량을 Pentacam®으로 측정하였다. 결과: 직난시군과 도난시 1군에서 술 전 각막 전면난시와 후면난시 및 전체난시는 양의 상관관계를 보였다. 각막 전면난시는 술 후 모든 군에서 유의하게 감소하였다(all p＜0.05). 술 후 2달째 각막 후면난시는 직난시 군과 도난시 제2군에서 유의한 차이가 없었고(p＞0.05), 도난시 제1군에서는 감소하였다(p＜0.05). 전체 각막난시는 술 후 2개월째 직난시 군과 도난시 제1군에서 유의하게 감소하였으나(p＜0.05) 도난시 제2군에서는 유의한 차이가 없었다(p＞0.05). 도출된 상관관계식에 의거, 각막 전면 직난시가 1.7디옵터일 때 0.3디옵터의 각막 후면난시 및 0.5디옵터의 전체 각막 난시를, 도난시가 0.4디옵터 이상일 때 0.2디옵터의 각막 후면난시 및 0.4디옵터의 전체 각막 난시를 예측할 수 있었다. 결론: 각막 후면 난시 경축이 수직 경선을 따르는 경우가 대다수이므로 도난시 군에서 이측 절개가 난시 감소에 효과적이다. 직난시가 1.7디옵터 이상이거나 도난시가 0.4디옵터 이상일 경우 술 후 난시 예측을 위해서 전면 난시뿐 아니라 후면 난시도 고려해야 한다.
Abstract
Purpose: To assess the changes in anterior, posterior, and total corneal astigmatism after cataract surgery with on-axis clear corneal incision cataract surgery. Methods: This study included 48 eyes (24 eyes with ‘with-the-rule [WTR]’ and 24 eyes with ‘against-the-rule [ATR]’) that underwent phacoemulsification and intraocular lens insertion through on-axis clear corneal incision. The ATR group with vertically steep axis of posterior corneal astigmatism was divided into subgroups 1 and 2 for the opposite axis. Autorefraction, uncorrected and best-corrected visual acuities were measured. Corneal astigmatism (anterior, posterior and total) was measured using Pentacam® preoperatively and 1 week, 1 month, and 2 months postoperatively. Results: Multivariate linear regression analysis of preoperative data showed positive correlations among anterior, posterior and total astigmatism. Anterior corneal astigmatism showed a significant decrease in both WTR and ATR groups in all measured points (all p < 0.05). Posterior corneal astigmatism showed no statistical difference in the WTR group and ATR subgroup 2 (p > 0.05) and significant decrease in the ATR subgroup 1 (p < 0.05) at 2 months postoperatively. Total corneal astigmatism showed significant decrease 2 months after surgery in the WTR group and ATR subgroup 1 (all p < 0.05), but not in the ATR subgroup 2 (p > 0.05). According to correlation analysis based on trend line equations, 1.7 diopters of anterior astigmatism could expect 0.3 diopters of posterior astigmatism and 0.5 diopters of total astigmatism for the WTR group and 0.4 diopters of anterior astigmatism could expect 0.2 diopters of posterior astigmatism and 0.4 diopters of total astigmatism for the ATR group. Conclusions: Considering the majority of cataract patients have vertically steep posterior corneal astigmatism, temporal incision for ATR patients is generally effective. Moreover, for patients with WTR astigmatism of more than 1.7 diopters or ATR astigmatism greater than 0.8 diopters, additional preoperative correction based on posterior astigmatism is needed for more precise prediction of postoperative total corneal astigmatism.
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