미세절개백내장수술에서 투명각막절개창의 위치에 따른 난시 변화 분석
Steep Axis Incision Versus Temporal Incision in Microcoaxial Cataract Surgery
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목적: 미세절개백내장수술 시 투명각막절개의 위치를 각막곡률이 가파른 축에 형성한 경우와 이측에 형성한 경우의 난시 변화를 비교 하였다. 대상과 방법: 0.5D 이상의 난시를 가진 환자 193명(193안)을 대상으로, 1군(95안)에는 각막곡률이 가파른 축에 절개 후 미세절개백내장 수술을 하였고, 2군(98안)에는 이측 절개 후 수술을 하였다. 전향적으로 나안시력, 교정시력 및 각막지형도 상 난시를 술 전, 술 후 3개월에 조사하여 비교하였다. 결과: 두 군에서 술 후 측정한 나안시력, 교정시력은 통계학적 차이를 보이지 않았다. 1군에서 수술로 인한 난시 유발은 0.45 ± 0.27 D였으며, 난시는 0.31 ± 0.37D 감소하였다. 2군에서 수술로 인한 난시 유발은 0.30 ± 0.17D였으며, 난시는 0.06 ± 0.29D 증가하였다. 이 경우, 술전 도난시 양상을 띈 경우를 제외하면 난시량이 증가하였다(직난시: 0.15D 증가;사난시: 0.11D 증가;도난시: 0.13D 감소). 수술로 인한 난시 유발 및 난시의 변화량은 통계학적 차이를 보였다(p = 0.002, p = 0.000). 결론: 술 전 0.5D 이상의 사난시나 직난시가 있다면 각막곡률이 가파른 축에 절개를 하는 것이 난시 교정에 효과가 있다.
Abstract
Purpose: To determine if a difference exists in surgically-induced astigmatism (SIA) and the mean change in keratometric astigmatism in patients who underwent microcoaxial cataract surgery (MCCS). Methods: A prospective study including 193 eyes with astigmatism of greater than 0.5 diopters was performed. The eyes were randomized into two groups: (1) 95 eyes with steep axis incision, and (2) 98 eyes with temporal incision. A 2.2-mm microcoaxial phacoemulsification was performed. The UCVA, BCVA and corneal topography (Orbscan II, Bausch & Lomb) were measured preoperatively and three months postoperatively. Surgically induced astigmatism was calculated via vector analysis, and the mean change in keratometric astigmatism was also calculated. Results: There were no significant differences in UCVA or BCVA between the two groups three months postoperative. The mean SIA was 0.45 ± 0.27 diopters in the steep axis incision group and 0.30 ± 0.17 diopters in the temporal incision group. In the steep axis incision group, the mean keratometric astigmatism showed a mean reduction of 0.31 ± 0.37 diopter (WTR: 0.37 D; oblique: 0.35D; ATR: 0.16 D), while the mean keratometric astigmatism showed a mean increase of 0.06 ± 0.29 diopters (WTR: 0.15 D increased; oblique: 0.11 D increased; ATR: 0.13 D reduced) in the temporal incision group. There were statistically significant differences in SIA and change in astigmatism between the two groups (p = 0.002, p = 0.000). Conclusions: In MCCS, steep axis incision achieved superior astigmatism correction in patients having with-the-rule or oblique astigmatism of greater than 0.5 diopters.
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