원추각막에서 수기 각막링 터널 생성을 이용한 인택스(IntacsⓇ)링 삽입술의 임상 결과
The Clinical Results of Intacs® Ring Implantation by Manual Tunnel Creation in Patients with Keratoconus
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목적: 원추각막 환자에서 수기로 각막링 터널을 만들고 인택스링 삽입술을 시행한 후 임상 결과에 대해 알아보고자 한다. 대상과 방법: 수술 후 6개월 이상 경과 관찰한 8명 10안을 대상으로 술 전, 술 후 1, 3, 6개월에 시력, 굴절값, 각막곡률값, 전방 깊이,중심각막두께, 각막내피세포밀도를 측정하고 술 후 6개월에 전안부 빛간섭단층촬영을 통해 삽입된 각막링의 깊이를 측정하였으며 합병증 발생유무를 조사하였다. 결과: 10안 중 9안에서 시력 향상을 보였으며(p˂0.05) 10안 모두에서 구면렌즈대응치의 감소, 각막곡률값의 감소를 보였다(p˂0.05). 수술 전후 중심각막두께는 큰 변화를 보이지 않았고 전방 깊이, 각막내피세포밀도의 경한 감소를 보였다. 전안부 빛간섭단층촬영 결과각막링이 균일한 깊이로 삽입되어 있음을 알 수 있었다. 술 후 합병증으로 10안 중 1안에서 각막링의 하방이동이 발생하였으며 10안중 6안에서 각막실질주변침착물 소견을 보였으나 시력에는 영향 없었으며 1안에서 각막링 노출이 있어 제거하였다. 결론: 원추각막환자에서 수기로 시행한 인택스 각막링 삽입술은 시력 교정 및 각막 굴절력의 안정화에 효과적인 치료방법이라 생각한다.
Abstract
Purpose: To report the clinical results after the implantation of intrastromal corneal ring segments (Intacs®) by manual tunnel creation for the correction of keratoconus. Methods: This retrospective case series was comprised of 10 eyes of 8 consecutive keratoconic patients. Visual acuity, refractive outcome, keratometric values, anterior chamber depth, central corneal thickness, and endothelial cell density were evaluated before and at 1 month, 3 months, and 6 months postoperatively. In addition, the implanted ring segment depth was measured by anterior segment optical coherence tomography at postoperative 6 months. Any postoperative complications were also recorded. Results: Visual acuity was improved in 9 out of 10 eyes. Spherical equivalent and keratometric values were decreased in all eyes. There was no significant difference in central corneal thickness, but endothelial cell density and anterior chamber depth were slightly decreased. The depth of ring segments was almost constant at superior, middle, and inferior. There was a single case of descented implanted ring segments and 6 cases of stromal infiltration around ring segments, but visual acuity was unaffected. In addition, 1 case showed implanted ring exposure, thus the superior ring segment was removed at postoperative 4 months. Conclusions: Intrastromal corneal ring segment implantation (Intacs®) by manual tunnel creation appears to be effective in improving the visual acuity and stabilizing corneal refractive power in keratoconic patients.
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