무봉합 후방인공수정체 공막고정술의 단기 임상결과 다섯 예 분석
Knotless External Fixation Technique for Posterior Chamber Intraocular Lens Transscleral Fixation: A 5-Case Analysis
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목적: 무봉합 후방인공수정체 공막고정술의 단기 임상성적을 분석하여, 공막피판 생성이 어려울 경우 대치 가능한 수술 방법인지를확인하고자 하였다. 대상과 방법: 공막피판 생성이 어려웠던 환자 5명에서 무봉합공막고정술을 시행하였다. 공막고정사를 공막천자부 주변의 공막에 3회부분층 통과시킨 후, 그 끝을 공막 위를 지나는 공막고정사 밑으로 재통과시켰다. 양측 공막고정사를 당겨 긴장시켜 인공수정체를적절한 위치에 고정시킨 후, 결막편으로 공막고정사를 덮었다. 술 후 합병증 여부 및 인공수정체난시의 변화를 관찰하였다. 결과: 평균 8.0개월의 추적기간 동안 수술 중 발생한 섬모체출혈 1예 및 수술 중 공막고정사의 비적절 긴장에 의한 인공수정체 기울어짐 1예 외의 합병증은 발생하지 않았다. 전층각막이식수술을 동시에 시행한 1예를 제외한 모든 증례에서 인공수정체난시는 경과관찰중 유의한 변화를 보이지 않았으며, 봉합 및 공막피판을 사용한 공막고정술의 인공수정체난시와 유의한 차이를 보이지 않았다. 결론: 무봉합 후방인공수정체 공막고정술은 인공수정체를 안정적으로 고정하여, 공막피판 생성이 불가능할 경우 공막고정사의 노출을예방하기 위하여 대치 가능한 수술방법이다.
Abstract
Purpose: To determine whether the knotless technique can be an alternative for the scleral flap-making technique in posterior chamber intraocular lens transscleral fixation when a scleral flap cannot be made. Methods: Five patients underwent the knotless technique for posterior chamber intraocular lens transscleral fixation when a scleral flap could not be made. Partial thickness scleral anchoring sutures were repeated three times near the transscleral penetration site in both ends. The end of the anchoring suture was passed under the exposed part of the partial thickness scleral anchoring suture and pulled to adjust the position of the intraocular lens. Then, anchoring sutures were covered with a conjunctival flap. Complications and change of intraocular lens astigmatism were evaluated. Results: During the 8-month postoperative follow-up period, one case of ciliary body hemorrhage due to intraoperative transscleral penetration and one case of mild intraocular lens tilting owing to the improper tension of the string were observed. Except for one case with a concurrent penetrating keratoplasty, intraocular lens astigmatism showed no significant change during the postoperative follow-up period and no significant difference compared to transscleral fixation with a scleral flap. Conclusions: Knotless technique for external fixation of posterior chamber intraocular lens transscleral fixation is a safe and easy technique and may be a good alternative for the scleral flap-making technique in posterior chamber intraocular lens transscleral fixation when a scleral flap cannot be made.
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