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각막 구면수차의 교정을 동반한 백내장 수술의 임상 결과 분석

Clinical Outcomes of Cataract Surgery with Correction of Corneal Spherical Aberration

김미금|최혁진|이진호|위원량
대한안과학회 (The Korean Ophthalmological Society)|2014.06|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제55권 제6호|pp. 809-816

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키워드

Cataract surgerySpherical aberrationAspheric intraocular lens
주제분류안과학

초록

목적: 수술 전 각막지형도로 알아낸 구면수차를 고려하여 비구면 혹은 구면 인공수정체를 선택하여 백내장 수술을 시행하였을 때 수술전후 구면수차의 변화를 분석하고자 한다. 대상과 방법: 2011년 2월부터 2012년 10월까지 한 명의 술자에게 수정체초음파유화술 및 낭내 후방 인공수정체 삽입술을 시행 받은68명 97안을 분석하였다. 수술 전 ATLAS 9000 각막지형도를 이용하여 각막 구면수차를 분석하였으며 수술 후 목표 구면수차를 0 μm로 설정하고 다음 중 적절한 인공수정체를 선택하였다: Acrysof SA60AT (n=25), Acrysof IQ (n=36), TecnisⓇ ZCB00 (n=36). 수술 3개월 후 WaveScan 수차계 및 ATLAS 9000 각막지형도를 이용해 안구 및 각막 구면수차를 다시 측정하였고 수술 전에 예측한수술 후 안구 구면수차와 실측된 안구 구면수차의 절대오차를 계산하였다. 결과: 수술 전 전체 평균 각막 구면수차는 0.241 μm이었고 수술 후 전체 평균 각막 구면수차는 0.232 μm였다(p=0.199). 수술 후 안구구면수차는 0.051 μm였다. 각 그룹의 술후 안구 구면수차는 각각 0.095 μm, 0.034 μm, 0.037 μm로 사용된 두 비구면 인공수정체는각각 0.185 μm (Acrysof IQ), 0.311 μm (TecnisⓇ ZCB00)의 구면수차를 상쇄하는 효과를 보였다. 세 군 간의 절대오차는 유의한 차이가 없었다(p=0.089). 결론: 수술 전 각막 구면수차를 고려한 인공수정체 선택으로 구면수차를 효과적으로 감소시킬 수 있다.

Abstract

Purpose: To evaluate preoperative and postoperative spherical aberrations after cataract surgery based on selecting sphericalor aspheric intraocular lens (IOL) according to preoperative corneal aberration. Methods: The medical records of patients who underwent phacoemulsification and IOL implantation in the posterior chamber bya surgeon (H.J.C) were reviewed (68 patients, 97 eyes). IOL was selected based on preoperative corneal spherical aberrationmeasured by corneal topography (ATLAS 9000, Carl Zeiss). The target postoperative total ocular spherical aberration was set tozero (0) and one of the following lenses was chosen: Acrysof SA60AT (n = 25), Acrysof IQ (n = 36) or Tecnis® ZCB00 (n = 36). The Wavescan aberrometer and the corneal topography were obtained postoperatively. Absolute prediction errors of postoperativetotal ocular spherical aberration were analyzed. Results: Preoperative corneal spherical aberration was 0.241 μm; total postoperative ocular spherical aberration was 0.0509 μm(Acrysof SA60AT: 0.0954 μm, Tecnis® ZCB00: 0.0374 μm, Acrysof IQ: 0.0335 μm). Postoperative corneal spherical aberrationwas 0.232 μm, which was not significantly different from the preoperative value (p = 0.199). Postoperative ocular spherical aberrationwas 0.051 μm; 0.095 μm (Acrysof SA60AT), 0.034 μm (Acrysof IQ), and 0.037 μm (ZCB00). The reducing amounts ofspherical aberration were 0.185 μm (Acrysof IQ) and 0.311 μm (ZCB00). The overall absolute prediction error was 0.068 μm. Theabsolute prediction error of the Acrysof SA60AT group was 0.092 μm, Tecnis® ZCB00 group was 0.067 μm and Acrysof IQ groupwas 0.054 μm. There was no significant difference among the 3 groups (p = 0.089). Conclusions: Aspheric IOLs can efficiently reduce total ocular spherical aberrations according to preoperative corneal sphericalaberrations.

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