하측 및 상측 투명각막절개창을 이용한 백내장 수술 후 난시 변화 비교
The Comparison of Astigmatic Outcomes after Cataract Surgery of Inferior versus Superior Clear Corneal Incision
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목적: 미세절개백내장수술 시 투명각막절개의 위치를 하측에 형성한 경우와 상측에 형성한 경우, 술 후 난시 변화를 비교 분석하였다. 대상과 방법: 0.5D 이상의 직난시를 보이는 환자 55명(55안)을 대상으로, 1군(26안)에서는 하측 투명각막절개창을 이용한 백내장 수술을 하였고, 2군(29안)에서는 상측 투명각막절개창을 이용한 백내장 수술을 하였다. 후향적으로 술 전 및 술 후 1개월에 나안시력, 교정시력, 수술 후 유발된 난시량(surgically induced astigmatism, SIA) 및 난시의 절대적인 변화량(술 전 난시 절대량-술 후 난시 절대량)을 비교하여 분석하였다. 결과: 술 전 및 술 후 측정한 나안시력과 교정시력은 두 군 간에 통계학적 차이를 보이지 않았다(p=0.933, p=0.253, p=0.664,p=0.926). 1군에서 수술 후 유발된 난시량(SIA)은 0.50 ± 0.33디옵터, 난시는 0.50 ± 0.96디옵터 감소하였으며 2군에서 수술 후유발된 난시량(SIA)은 0.57 ± 0.34디옵터, 난시는 0.38 ± 0.86디옵터 감소하였으나, 수술 후 유발된 난시량(SIA)과 술 후 난시의절대적인 변화량은 두 군 간에 통계학적 차이를 보이지 않았다(p=0.324, p=0.426). 결론: 술 전 직난시가 있는 환자에서 하측 투명각막절개창을 이용한 백내장 수술은 상측 결막을 보전해야 되는 녹내장 환자, 눈꺼풀긴장도가 심한 환자, 함몰된 안구 환자인 경우 시도해 볼 수 있다.
Abstract
Purpose: To analyze the difference in astigmatism and the mean change in total astigmatism between inferior clear corneal incisionand superior clear corneal incision following cataract surgery in surgically-induced astigmatism (SIA). Methods: Fifty-five eyes of 55 patients with with-the-rule astigmatism >0.5 diopters were evaluated. Patients were divided intotwo groups according to incision location (Group 1, 26 eyes with an inferior incision; Group 2, 29 eyes with a superior incision). Patients were evaluatied one month postoperatively. Uncorrected visual acuity (UCVA, log MAR), best-corrected visual acuity(BCVA, log MAR), SIA and mean change in corneal astigmatism were measured in both groups. Results: One month postoperatively, mean UCVA was 0.15 ± 0.17 log MAR in Group 1 and 0.23 ± 0.24 log MAR in Group 2 (p= 0.253). Mean BCVA was 0.08 ± 0.13 and 0.08 ± 0.12 log MAR in Groups 1 and 2, respectively (p = 0.926). The SIA was 0.50± 0.17 diopter and 0.57 ± 0.34 diopter (p = 0.253) and mean change in total astigmatism was 0.50 ± 0.96 diopter and 0.38 ± 0.86diopter in Groups 1 and 2, respectively (p = 0.426). Conclusions: There was no statistically significant difference between the two groups. Thus, corneal incision on the inferior sidein patients of with-the-rule astigmatism can reduce the SIA and mean change in corneal astigmatism for patients with glaucoma,hard upper eyelid tension or sunken eye.
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