2.2 mm 미세각막절개 백내장수술 시 회전진동방식 초음파유화술과 직선운동방식 초음파유화술을 이용한 임상결과 비교
Comparison of Clinical Outcomes Between Torsional Phacoemulsification of Infiniti® and Longitudinal Phacoemulification of Stellaris® Through 2.2 mm Microincision
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목적: 초음파유화술에서 회전진동방식과 직선운동방식을 이용하여 2.2 mm 미세각막절개 백내장수술 후 결과를 비교하고자 하였다. 대상과 방법: 양안에 중등도의 백내장을 진단받은 환자를 대상으로 한쪽 눈에 InfinitiⓇ의 회전진동방식, 다른 쪽 눈에 StellarisⓇ의 직선운동방식의 초음파유화술을 이용하여 2.2 mm 미세각막절개 백내장 수술을 시행하였다. 수술 중 초음파 시간, 평균 초음파 세기, 누적소비에너지, 평형염액 사용량을 조사하였다. 환자는 술 전, 술 후 1일째, 7일째, 30일째, 60일째 추적관찰하여 술 후의 각막내피 세포개수 및 중심각막 두께를 비교하였고, 술 후 최대 교정시력, 각막 난시 정도를 비교하였다. 결과: 연구는 LOCS Classification NO2 또는 NO3인 중등도의 백내장 환자 34명(68안)을 대상으로 하였다. 수술 중 누적 소비에너지를비교하였을 때, 회전진동방식의 에너지 전달이 직선방식에 비해 통계적으로 유의하게 적었으나, 평형염액 사용량은 직선운동방식을사용한 눈에서 더 적었다. 각막내피세포 개수 및 중심각막 두께는 술 전과 술 후 추적관찰 기간 동안, 두 군간에 통계적인 차이는없었고, 술 후 최대교정시력 및 수술유발 각막난시에도 차이가 없었다. 결론: 중등도 백내장의 2.2 mm 미세각막절개 백내장 수술에 있어 InfinitiⓇ의 회전진동방식이 StellarisⓇ의 직선운동방식에 비해 누적소비에너지가 유의하게 적었지만 수술 결과 및 각막내피 손상에 미치는 영향은 서로 차이가 없으므로, 술자의 숙련도와 경험에 따라자유롭게 초음파 유화장치를 선택할 수 있겠다.
Abstract
Purpose: To compare clinical outcomes of a 2.2 mm microcoaxial cataract surgery, using torsional mode and longitudinal mode. Methods: In this comparative study, patients with bilateral cataract were assigned to get microcoaxial cataract surgery by torsional mode of infiniti in one eye and longitudinal mode of Stellaris® in the other eye. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), mean amount of balanced salt solution (BSS) used and surgical complications. Patients were seen 1, 7, 30, and 60 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell count and surgically induced astigmatism (SIA). Results: The study evaluated 68 eyes of 34 patients (nuclear opalescence (NO)2: 40 eyes, and NO3: 28 eyes). CDE was significantly lower in torsional mode (3.52 ± 2.93) than in longitudinal mode (6.20 ± 3.32) (p = 0.001). Torsional mode (60.88 ± 21.18 ml) had more BSS use than longitudinal mode (34.58 ± 13.54 ml) (p < 0.001). There were no significant differences in postoperative BCVA, CCT change, endothelial change, and SIA (p > 0.05). Conclusions: The torsional mode may provide lower level of phacoemulsification energy than the longitudinal mode and Torsional mode is considered effective and safe phacoemulsification. However the surgical outcomes were not significantly different in 2.2 mm microcoaxial cataract surgery of moderate cataract. So surgeon can choose any phaco machine based on experience and preference.
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