양안 위수정체안에 적용한 단안시의 시각 기능과 환자 만족도 평가
Visual Function and Patient Satisfaction in Pseudophakic Monovision
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목적: 양안 백내장 수술 시 적용한 단안시(monovision)의 시각 기능과 환자 만족도를 평가하고 임상 효과와 관련이 있는 인자를 알아보고자 하였다. 대상과 방법: 후향적 연구를 통해 양안 백내장 수술 후 구면렌즈대응치의 차이로 단안시를 갖게 된 환자를 대상으로 하여 수술 전과6개월 후의 나안 근거리 및 원거리 시력과 구면렌즈대응치를 비교하였다. 술 후 티트무스(titmus)검사를 통해 근거리 입체시를 평가하고, 안경 의존도 및 환자의 만족도에 대한 설문조사를 시행하였다. 결과: 수술 전후의 양안 나안 근거리 및 원거리시력, 양안 굴절부등은 통계적으로 유의한 차이를 보였다(p＜0.001). 술 후 근거리 입체시는 107.1 arsec이었고, 설문조사 결과 71.4%에서 안경 의존도가 감소하였으며 85.7%에서 원거리 및 근거리 시력 개선에 만족한다고대답하였다. 다양한 설계의 단안시에서 환자의 만족도에 차이는 없었다. 60세 이상의 고령, 술 전 양안 나안 원거리 시력이 나쁜 경우만족도가 높았다. 결론: 단안시는 60세 이상 고령 환자의 양안 백내장 수술 후 발생하는 조절력 상실에 따른 시력 저하에 대처할 수 있는 효과적인 방안이다.
Abstract
Purpose: To evaluate visual performance as well as patient satisfaction and to explore factors associated with clinical outcomes in pseudophakic monovision acquired after bilateral phacoemulsification and sequential monofocal intraocular lens (IOL) implantation. Methods: The present retrospective study examined patients with pseudophakic monovision. Preoperative and postoperative binocular uncorrected distant visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), refractive errors and postoperative near stereopsis were measured. Postoperative measurements were obtained at least 6 months after the fellow eye surgery. Patient satisfaction and independence from glasses were evaluated using a questionnaire. Results: Preoperative and postoperative binocular UCDVA, UCNVA, and differences in spherical equivalent refractive error were statistically significant. Postoperative near stereopsis was 107.1 arcsec. Questionnaire responses showed that 71.4% of patients were less dependent on glasses and 85.7% were satisfied with the postoperative visual performance. Various designs of monovision, such as crossed monovision or customized minimonovision with moderate myopic defocus showed the same level of patient satisfaction. Patients who were older than 60 years or had poorer preoperative binocular UCDVA showed higher satisfaction. Conclusions: Pseudophakic monovision is an effective approach for managing loss of accommodation after cataract surgery,especially in patients older than 60 years.
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