근시교정 굴절수술을 받았던 눈에서 회절형 다초점 인공수정체삽입 후 시각 및 광학 결과
Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery
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목적: 과거 근시교정 굴절수술을 받았던 눈에서 회절형 다초점 인공수정체 삽입 후 임상 및 광학적 결과를 알아보고자 하였다. 대상과 방법: 근시교정 굴절수술을 받았던 19안 15명(LASIK 14안, PRK 4안, LASEK 1안)을 대상으로 비구면 회절형 다초점 인공수정체 AcriSof ReSTOR® SN6AD1을 삽입하였다. 술 전과 술 후 시력, 현성굴절검사를 시행하였다. 술 전 산동하여 KR-1W®로 각막 수차를 측정하고 술 후 1달에 암순응 상태에서 KR-1W®와 OQAS®로 광학적 질을 측정하였다. 술 후 2개월에 설문조사를 통해 만족도를평가하였다. 결과: 술 후 2개월에 원거리 나안시력은 평균 0.11 ± 0.19, 근거리 나안시력은 0.19 ± 0.12 (logMAR)였다. 술 후 구면렌즈대응치가±0.50 이내는 16안(84.2%), 모든 눈에서 ±1.00 (diopter) 이내였다. 4 mm 동공크기에서 술 전 각막 구면 수차는 0.08 ± 0.08, 술후 안구 구면 수차는 0.07 ± 0.07 (μm)였다. 술 후 객관적 산란지수(OSI)는 3.43 ± 1.71, MTF 컷 오프 값은 21.03 ± 12.37 cpd였다. 전반적인 만족도는 5점 만점에 3.52 ± 0.96점으로 11안 8명이 불만족하였다. 결론: 근시교정 굴절수술을 받았던 눈에서 회절형 다초점 인공수정체 삽입술은 술 전 목표 도수에 가까운 구면렌즈대응치를 보였으나광학적 질과 만족도가 낮았다.
Abstract
Purpose: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantationafter myopic refractive surgery. Methods: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR® SN6AD1, the aspheric DMIOL after myopic refractivesurgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assistedsubepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction weremeasured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer indilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass systemunder mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. Results: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 ± 0.19, and 0.19 ± 0.12 (log MAR),respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within ±0.50 diopters (D) and all eyes were within±1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were0.08 ± 0.08 and 0.07 ± 0.07 (μm), respectively. Objective scatter index was 3.42 ± 1.71 and modulation transfer function (MTF)cut-off value was 21.03 ± 12.37 cpd. General satisfaction score was 3.52 ± 0.96 points out of 5, and 8 patients (11 eyes) were notsatisfied with DMIOL implantation. Conclusions: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to thetarget D, but optical qualities and patient satisfaction were poor.
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