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빛간섭단층촬영을 이용한 백내장 수술 전후의 황반두께 변화

Changes in Macular Thickness after Cataract Surgery According to Optical Coherence Tomography

이상준|김수영|이승욱|유재호
대한안과학회 (The Korean Ophthalmological Society)|2012.02|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제53권 제2호|pp. 246-255

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키워드

Optical coherence tomographyCataract extractionMacular thickness
주제분류안과학

초록

목적: 빛간섭단층촬영을 이용하여 백내장 수술 후 중심영역황반두께 변화를 알아보고, 술 후 황반부종 발생군의 특징을 알아보았다. 대상과 방법: 본원에서 백내장 수술을 시행한 환자 50명(55안)을 대상으로 술 전, 술 후 1개월 교정시력, 안저검사, 빛간섭단층촬영을시행하여 대조군 및 반대안과 비교하였다. 황반부종은 중심영역황반두께가 술 전보다 30% 이상 증가한 경우로 정의하였다. 결과: 백내장 술 후 중심영역황반두께 변화는 수술안이 22.2 ± 47.10 μm로 반대안에 비해 유의하게 증가하였다(p=0.01). 특히 당뇨망막병증군과 고혈압군에서 통계적으로 유의한 증가를 보였다. 황반부종은 총 55안 중 7안에서 발생, 5안은 중등도 이상의 당뇨망막병증, 2안은 망막앞막이 동반된 증례였다. 황반부종군에서 술 후 4주째 시력이 유의하게 낮았으며, 당뇨유병기간, 수술 절개창의 형태,당화혈색소 등은 술 후 황반부종과 관련성을 보이지 않았다. 결론: 백내장 술 후 유의한 중심영역황반두께의 증가가 동반되었다. 이는 당뇨망막병증, 고혈압과 유의한 관련이 있었다. 당뇨망막병증환자 중 중증도 이상의 당뇨망막병증 및 망막앞막과 같은 황반부 병변이 술 후 황반부종 발생의 위험인자로 생각한다.

Abstract

Purpose: To compare the changes in central subfield macular thickness (CSMT) using optical coherence tomography (OCT) after cataract surgery and to evaluate the risk factors of macular edema. Methods: The retrospective study consisted of 55 eyes of 50 patients who underwent phacoemulsification. All of these eyes were assessed by OCT and best-corrected visual acuity, and fundus examination before and one month after surgery. CSMT was measured based on a central thickness of 1 mm, and macular edema was defined as an increase of CSMT in 30% or more after surgery than before. Results: CSMT significantly increased by 22.2 ± 47.10 μm at 1 month after cataract surgery in the operated eye compared with the fellow eye (p = 0.01). The diabetic retinopathy group and hypertensive group showed more significant increases than the non-diabetic and non-hypertensive group. Macular edema developed in seven of 55 eyes (12.7%), and they consisted of five moderate or more severe diabetic retinopathies and two epiretinal membrane. Four weeks after surgery, the macular edema group showed more decrease in visual acuity; however, the CSMT was not correlated with the duration of diabetes mellitus, types of surgical incision, HbA1c or other factors. Conclusions: CSMT increased in the operated eye after cataract surgery, especially in eyes with diabetic retinopathy and hypertension. Moderate or more severe diabetic retinopathy and macular lesions such as epiretinal membrane increased the risk of macular edema after cataract surgery.

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