후방인공수정체 위치이상의 수술적 처치에 대한 임상 결과
Clinical Outcomes of the Surgical Management with Dislocated Posterior Chamber Intraocular Lens
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목적: 후방인공수정체 위치 이상으로 시행한 수술의 임상 결과에 대하여 연구하였다. 대상과 방법: 후방인공수정체 위치이상으로 수술 시행 후 1개월 이상 경과관찰한 눈을 대상으로, 술 후 나안 및 교정시력, 굴절 이상을 측정하였으며, 술 후 합병증 여부를 조사하였다. 결과: 총 48명 48안, 남32명, 여16명, 평균 나이 56.7세(33-76세)였다. 백내장 수술 후 후방인공수정체 위치 이상이 발생한 평균기간은 4.9년이었다. 재위치술은 35안, 인공수정체 교환술은 13안에서 이루어졌다. 재위치술의 방법에 따라 매듭 없이 재위치술 11안, 눈속매듭 공막고정술 10안, 눈밖매듭 공막고정술이 14안이었다. 수술 전과 최종 경과관찰에서 나안시력은 logMAR 1.21±0.70에서 0.70±0.48로(p=0.001), 최대교정시력은 0.82±0.68에서 0.35±0.30으로(p=0.002) 유의하게 호전되었다. 눈속매듭 공막고정술을 시행한 4안에서 재이탈이 발생하여 지지부를 눈 밖으로 꺼내어 눈밖매듭 공막고정술을 시행하였다. 결론: 후방인공수정체의 위치이상에 대한 수술적 처치로 술 전에 비해 유의한 시력호전이 있었다. 눈속매듭 공막고정술은 매듭을 단단히 하기 힘들어 재이탈 위험이 높다.
Abstract
Purpose: To evaluate the clinical outcomes of the surgical treatment in patients with dislocation of an intraocular lens (IOL). Methods: The present study investigated the postoperative naked visual acuity, corrected visual acuity, astigmatism, and postoperative complications in patients with a minimum follow-up of 1 month after the surgical treatment of a dislocated posterior chamber IOL. Results: The study included 48 eyes of 48 patients (32 males and 16 females) with an age ranging from 33 to 76 years with a mean of 56.7 years at initial visit. The mean time interval from cataract extraction and IOL implantation to dislocation of IOL was 4.9 years. The IOL was exchanged in 13 eyes and was repositioned in 35 eyes. The IOL was repositioned without tying in 11 eyes, by scleral fixation with tying inside the eye in 10 eyes, and by scleral fixation with tying outside the eyeball in 14 eyes. The mean naked visual acuity improved from 1.21±0.70 to 0.70±0.48 (p = 0.001) and the best corrected visual acuity improved significantly from 0.82±0.68 to 0.35±0.30 (p = 0.002). Among the repositioned IOLs managed by IOL repositioning using scleral fixation with tying inside the eye, 4 eyes re-dislocated. These eyes were re-treated for a second time with IOL repositioning and scleral fixation with tying outside the eye. Conclusions: Surgical management of dislocated IOLs resulted in significant improvement of visual acuity. Scleral fixation with tying inside the eye had a high risk of re-dislocation because of the difficulty in tightly securing the knot.
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