원추각막 환자에서의 알코올을 이용한 각막 콜라겐 교차결합술 후 각막곡률의 변화
Changes in Corneal Keratometry Readings after Corneal Collagen Cross-Linking Using Alcohol in Keratoconus Patients
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목적: 진행하는 원발성 원추각막 및 굴절수술 후 각막확장증에서 알코올을 이용한 각막콜라겐 교차결합술 후 각막곡률 변화를 알아본다. 대상과 방법: 진행성의 원발성 원추각막 10명 12안, 굴절수술 후 각막확장증 3명 3안에 20% 알코올을 이용한 각막콜라겐교차결합술을시행했다. 술 전 최대교정시력과 각막지형도의 평균 K값과 난시, 자동굴절검사의 평균 K값과 난시, 구면렌즈대응치를 술 후 6개월과비교하고 7명 8안은 술 후 1년과 비교했다. 결과: 수술 6개월 후 최대교정시력은 logMAR 0.66 ± 0.50에서 logMAR 0.55 ± 0.58로 호전됐고 각막지형도의 평균 K값은 50.04± 5.88D에서 49.18 ± 6.15D로 감소했다. 자동굴절검사의 평균 K값은 48.53 ± 5.94D에서 47.95 ± 5.76D로, 난시는 3.95 ± 2.54D에서3.52 ± 2.40D로, 구면렌즈대응치는 -6.25 ± 3.45D에서 -5.40 ± 2.91D로 감소했다. 술 후 1년에도 각막지형도상 평균 K값과 난시가유의하게 감소했다. 결론: 알코올을 이용한 각막콜라겐교차결합술은 각막실질 손상을 줄이면서 진행성의 원발성 원추각막 및 굴절수술 후 각막확장증 진행을 억제하는 안전한 치료방법이다.
Abstract
Purpose: To evaluate the changes in corneal keratometry (K) readings after corneal collagen cross- linking (CXL) using 20% alcohol in primary keratoconus and keratectasia after refractive surgery. Methods: Twelve eyes of 10 patients with primary keratoconus and 3 eyes of 3 patients with keratectasia after refractive surgery were included in the present study. Best-corrected visual acuity (BCVA) and mean K, corneal astigmatism by corneal topography, and mean K, corneal astigmatism, and spherical equivalent (SE) by auto refractometer were evaluated at baseline, and 6 months postoperatively. Eight eyes of 7 patients were also evaluated 1 year postoperatively. Results: Mean BCVA improved from log MAR 0.66 ± 0.50 to log MAR 0.55 ± 0.58 (p = 0.100) at 6 month after CXL. In corneal topography, mean K significantly decreased from 50.04 ± 5.88 D to 49.18 ± 6.15 D (p = 0.019), and corneal astigmatism slightly decreased from 5.33 ± 4.47 D to 5.29 ± 4.88 D (p = 0.755) at 6 months after CXL. According to the auto refractometer,mean K significantly decreased from 48.53 ± 5.94 D to 47.95 ± 5.79 D (p = 0.038), corneal astigmatism significantly decreased from 3.95 ± 2.54 D to 3.52 ± 2.40 D (p = 0.010), and SE significantly decreased from -6.25 ± 3.45 D to -5.40 ± 2.91 D (p = 0.037) at 6 months after CXL. Significant mean K and corneal astigmatism decreases in topography were also observed at 1 year after CXL. Complications related to CXL were not observed. Conclusions: CXL using 20% alcohol appears to be a safe and promising treatment modality with less corneal stromal damage in progressive primary keratoconus and keratectasia after refractive surgery.
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