각막이식 삼중수술 시 인공수정체 삽입 시점에 따른 각막 내피 생존 비교
The Effect of Intraocular Lens Insertion Sequence during the Triple Procedure on Corneal Endothelial Cell Survival
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목적: 각막이식과 백내장 수술을 동시에 시행할 때 인공수정체를 삽입한 시점에 따른 술후 각막내피세포의 손실을 비교해 보았다. 대상과 방법: 2003년 1월부터 2008년 1월까지 백내장을 제거하고, 인공수정체를 삽입한 다음 공여각막을 봉합한 군(I군) 20명 20안과,공여각막을 3 mm 남기고 봉합한 틈으로 인공수정체를 넣은(II군) 17명 17안을 대상으로 수술 후 안압, 각막두께 및 각막내피세포 밀도를 비교하였다. 결과: 3개월 후의 두 군에서 안압변동의 차이는 없었으나, 각막두께는 II군에서 유의하게 감소하였다. 각막내피세포 밀도는 1, 2, 3개월째 각각 II군에서 유의하게 더 높았으나(p=0.01, 0.02, 0.04, respectively), 술 후 관찰기간 동안 각막내피 손실정도는 차이가 없었다(p=0.33). 결론: 삼중수술 시 전방이 완전한 상태에서의 인공수정체 삽입이 전방형성이 불완전한 상태에서 인공수정체를 삽입하는 것에 비해수술 도중 각막내피와 안내구조물 또는 인공수정체와의 기계적 접촉이 적어 술 후 각막내피세포 손실이 적을 것이라 추정된다.
Abstract
Purpose: To evaluate the differences in corneal endothelial cell density in patients undergoing intraocular lens insertion at 2 different sequences during the triple procedure. Methods: The present retrospective study divided 37 eyes of 37 patients and into 2 groups: trephination, phacoemulsification and intraocular insertion, followed by graft suturing (20 eyes, Group I), and trephination, phacoemulsification, graft suturing leaving 3 mm gap, followed by intraocular lens insertion and suturing of the gap (17 eyes, Group II). Intraocular pressure, corneal thickness, and endothelial cell density were measured for 3 months postoperatively. Results: No significant difference in intraocular pressure between the 2 groups (p = 0.14) was observed. However in Group II, the mean corneal thickness showed a greater decrease (p = 0.02) during the 3 months following surgery, and the mean corneal endothelial cell density in this group was higher at 1, 2, and 3 months postoperatively than that of Group I (p = 0.01, 0.02 and 0.04 respectively). There were no significant difference in the rate of endothelial cell loss during the postoperative period between the 2 groups. Conclusions: The anterior chamber formation before intraocular lens insertion in the triple procedure is hypothesized to decrease corneal endothelial cell loss by minimizing mechanical contact with intraocular structures or intraocular lenses during surgery.
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