봉합사를 이용한 공막고정술과 변형된 Yamane 무봉합공막고정술의 단기 임상 결과 비교
Comparison of Short-term Clinical Outcomes between Sutured Scleral Fixation and Modified Yamane Sutureless Scleral Fixation
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목적: 인공수정체 혹은 수정체 탈구 및 무수정체 환자에서 기존 10-0 polypropylene 봉합사를 이용한 공막고정술과 변형된 Yamane 무봉합공막고정술의 단기 임상 결과를 비교 분석하고자 하였다. 대상과 방법: 2012년 8월부터 2022년 5월까지 봉합사를 이용한 공막고정술을 시행받은 환자 43명 43안과 무봉합공막고정술을 시행받은 환자 40명 40안에 대해 의무기록을 후향적으로 분석하였다. 수술 전과 수술 후 1주일, 1개월, 3개월째 나안시력, 최대교정시력, 전체 난시, 인공수정체 난시, 굴절 오차, 각막내피세포 밀도, 수술 시간 및 합병증을 비교하였다. 결과: 두 군에서 수술 3개월 후 나안시력과 최대교정시력은 수술 전에 비해 유의하게 호전되었고, 두 군의 유의한 차이는 없었다. 수술 후 1주일째 전체 난시와 절대 굴절 오차 및 수술 후 1주일, 1개월째 인공수정체 난시가 무봉합군에서 유의하게 낮았다. 각막내피세포 밀도의 변화는 두 군에서 유의한 차이가 없었고, 전체 수술 시간과 인공수정체 공막고정 시간은 무봉합군에서 유의하게 더 적게측정되었다. 결론: 변형된 Yamane 무봉합공막고정술은 기존 봉합사를 이용한 공막고정술과 비교하여 유의한 시력 호전은 없었으나, 수술 후 초기에 인공수정체 안정성이 더 좋은 것으로 생각되며, 수술 소요 시간이 짧아 수정체 혹은 인공수정체 탈구 및 무수정체 환자에서 기존봉합사를 이용한 공막고정술의 유효한 대안이 될 수 있다.
Abstract
Purpose: To compare and investigate the short-term clinical outcomes between 10-0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state. Methods: From August 2012 to May 2022, medical records were retrospectively analyzed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month, and 3 months after surgery. Results: In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for one week after surgery and IOL astigmatism for one week and one month after surgery were significantly lower in sutureless fixation group. There was no significant difference in postoperative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group. Conclusions: Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.
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