펨토초 레이저와 매뉴얼 트레파인을 이용한 심부표층각막이식의 초기 임상성적 비교
Comparison of Early Clinical Result of Deep Anterior Lamellar Keratoplasty Using FSlaser Versus Manual Trephine
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목적: 펨토초레이저를 이용하여 심부표층각막이식술을 시행하여 그 임상결과를 매뉴얼 트레파인(manual trephine)을 이용한 심부표층각막이식술과 비교하여 보고하고자 한다. 대상과 방법: 매뉴얼 트레파인(manual trephine)을 이용한 심부표층각막이식술을 받은 17안(17명), 펨토초레이저를 이용한 심부표층각막이식술을 받은 13안(13명)에 대해 최대교정시력, 각막난시, 굴절난시, 각막내피세포수 등의 술후 임상성적을 비교하였다. 결과: 펨토초레이저를 이용한 심부표층각막이식술군에서 최대교정시력(logMAR)은 수술 후 2, 4, 6개월째에 각각 0.31 ± 0.17, 0.23± 0.15, 0.18 ± 0.14였으며, 매뉴얼 트레파인(manual trephine)을 사용한 군에서는 각각 0.55 ± 0.41, 0.45 ± 0.28, 0.35 ± 0.22(p=0.056, p=0.025, p=0.313)로 측정되었다. 자동굴절검사상 평균 각막난시는 펨토초레이저군에서 2, 4, 6개월째에 각각 5.35 ± 1.57,4.24 ± 1.97, 3.65 ± 1.31, 매뉴얼 트레파인 사용군 8.32 ± 2.75, 6.80 ± 2.50, 4.54 ± 1.25 (p=0.031, p=0.041, p=0.370)로 측정되었다. 술후 6개월째 두 군에 있어서 각막내피세포수는 두 군에서 유의한 차이를 보이지 않았다. 결론: 펨토초레이저를 이용한 심부표층각막이식술은 기존의 매뉴얼 트레파인을 이용한 심부표층각막이식술과 비교해 수술 후 초기시력 회복과정이 빠르고, 난시의 유발량이 더 적어 이를 대체할 수 있는 수술방법이라 하겠다.
Abstract
Purpose: To compare outcomes of femtosecond laser-enabled deep anterior lamellar keratoplasty (IE-DALK) versus manualtrephine using deep anterior lamellar keratoplasty (Manual DALK, M-DALK). Methods: Seventeen eyes from 17 patients underwent manual deep anterior lamellar keratoplasty, and femtosecond laser-enabled deep anterior lamellar keratoplasty was performed in 13 eyes of 13 patients. Postoperative clinical outcomessuch as best corrected visual acuity, refractive astigmatism, keratometric astigmatism, endothelial cell density were comparedbetween the two groups. Results: The mean log MAR best spectacle-corrected visual acuity (BSCVA) was 0.31 ± 0.17, 0.23 ± 0.15, 0.18 ± 0.14 inthe IE-DALK group, and 0.55 ± 0.41, 0.45 ± 0.28, 0.35 ± 0.22 (p = 0.056, p = 0.025, p = 0.313) in the M-DALK group at postoperative2, 4, and 6 months respectively. The mean keratometric cylinder was 5.35 ± 1.57, 4.24 ± 1.97, 3.65 ± 1.31 in theIE-DALK, 8.32 ± 2.75, 6.80 ± 2.50, 4.54 ± 1.25 (p = 0.031, p = 0.041, p = 0.370) in the M-DALK group at postoperative 2,4, and 6 months respectively. Endothelial cell counts in the two groups did not differ significantly at postoperative 6 months. Conclusions: The IE-DALK showed better results in BSCVA and keratometric astigmatism in the early postoperative period,in comparison with the M-DALK, and can be considered as a valuable method in deep anterior lamellar keratoplasty.
참고문헌 (25)
- Tsubota K, "new surgical technique for deep lamellar keratoplasty with single running suture adjustment", Am J Ophthalmol, 126, pp.1~8 (1998)
- Stern D, "Corneal ablation by nanosecond, picosecond, and femtosecond lasers at 532 and 625nm", Arch Ophthalmol, 107, pp.587~592 (1989)
- Farid M, "Results of penetrating keratoplasty performed with a femtosecond laser zigzag incision initial report", Ophthalmology, 114, pp.2208~2212 (2007)
- Ignacio TS, "Top hat wound configuration for penetrating keratoplasty using the femtosecond laser: a laboratory model", Cornea, 25, pp.336~340 (2006)
- Malta JB, "Femtosecond laser-assisted keratoplasty: laboratory studies in eye bank eyes", Curr Eye Res, 34, pp.18~25 (2009)
- Anwar M, "Deep lamellar keratoplasty: surgical techniques for anterior lamellar keratoplasty with and without baring of Descemet's membrane", Cornea, 21, pp.374~383 (2002)
- Archila EA, "Deep lamellar keratoplasty dissection of host tissue with intrastromal air injection", Cornea, 3, pp.217~218 (1984)
- Benson WH, "Visual improvement as a function of time after lamellar keratoplasty for keratoconus", Am J Ophthalmol, 116, pp.207~211 (1993)
- Panda A, "Deep lamellar keratoplasty versus penetrating keratoplasty for corneal lesions", Cornea, 18, pp.172~175 (1999)
- Tan DT, "Future directions in lamellar corneal transplantation", Cornea, 26(9 Suppl 1), pp.S21~S28 (2007)
- Watson SL, "Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus", Ophthalmology, 111, pp.1676~1682 (2004)
- Amayem AF, "Fluid lamellar keratoplasty in keratoconus", Ophthalmology, 107, pp.76~79 (2000)
- Funnell CL, "Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus", Eye (Lond), 20, pp.527~532 (2006)
- Trimarchi F, "Deep lamellar keratoplasty", Ophthalmologica, 215, pp.389~393 (2001)
- Yoo SH, "Femtosecond laser-assisted sutureless anterior lamellar keratoplasty", Ophthalmology, 115, pp.1303~1307 (2008)
- Mosca L, "Femtosecond laser-assisted lamellar keratoplasty: early results", Cornea, 27, pp.668~672 (2008)
- Noble BA, "Deep Anterior Lamellar Keratoplasty (DALK): visual outcome and complications for a heterogeneous group of corneal pathologies", Cornea, 26, pp.59~64 (2007)
- Sugita J, "Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement", Br J Ophthalmol, 81, pp.184~188 (1997)
- Buratto L, "The use of the femtosecond laser in penetrating keratoplasty", Am J Ophthalmol, 143, pp.737~742 (2007)
- Bahar I, "Femtosecond laser-assisted penetrating keratoplasty: stability evaluation of different wound configurations", Cornea, 27, pp.209~211 (2008)
- Sarayba MA, "A 60 kHz IntraLase femtosecond laser creates a smoother LASIK stromal bed surface compared to a Zyoptix XP mechanical microkeratome in human donor eyes", J Refract Surg, 23, pp.331~337 (2007)
- Alió JL, "Very high-frequency digital ultrasound measurement of the LASIK flap thickness profile using the IntraLase femtosecond laser and M2 and Carriazo-Pendular microkeratomes", J Refract Surg, 24, pp.12~23 (2008)
- Bourne WM, "Cellular changes in transplanted human corneas", Cornea, 20, pp.560~569 (2001)
- van Dooren BT, "Endothelial cell density after deep anterior lamellar keratoplasty (Melles technique)", Am J Ophthalmol, 137, pp.397~400 (2004)
- Arentsen JJ, "Corneal transplant allograft reaction: possible predisposing factors", Trans Am Ophthalmol Soc, 81, pp.361~402 (1983)