전안부 빛간섭단층촬영기를 이용한 백내장 절개창의 크기에 따른 창상치유과정의 형태학적 관찰
The Morphological Changes in Main Corneal Incision (2.2 mm vs. 2.8 mm) Evaluated Using Anterior Segment Optical Coherence Tomography
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목적: 백내장 수술 후 절개부위를 전안부 빛간섭단층촬영기로 촬영하여 시간에 따른 창상치유과정의 변화를 관찰하였다. 대상과 방법: 백내장 수술을 시행받은 총 34명(44안)을 절개범위에 따라 1군(2.2 mm)과 2군(2.8 mm)으로 분류하고 절개부위를 술 후1일, 1주일, 1개월째 빛간섭단층촬영기로 기록하여, 시간에 따른 절개각도, 절개길이, 각막상피/내피 결손길이, 각막상피/내피 결손면적, 절개부위의 최대각막두께 등을 측정하고 데스메막박리의 유무를 비교하였다. 결과: 수술 후 1개월까지 각막내피결손길이, 각막내피결손면적은 1군에서 2군보다 더 높은 경향을 보였고, 술 후 30일째 차이는 통계학적으로 유의미하였다(p=0.015, 0.027). 두 절개군 간 절개각도, 절개길이, 절개부위 최대각막두께는 통계학적 유의한 차이는 없었고,데스메막박리는 절개창 크기에 따른 발생비율의 차이는 없었으나, 연령이 높고 수술 후 안압이 낮을수록 발생이 증가하였다(p˂0.05). 결론: 두 절개군 모두 우수한 창상치유과정을 보였으며, 데스메막박리를 줄이기 위해선 고령의 환자일수록 술 중 절개부위 조작과 술후 안압조절에 더 유의해야 할 것으로 생각한다.
Abstract
Purpose: To investigate wound characteristics and ultrastructural changes in the 2.2-mm and 2.8-mm main corneal incisions. Methods: Forty-four eyes of 34 patients undergoing cataract surgery were randomized to receive a 2.2-mm or 2.8-mm main corneal incision. All incisions were evaluated 1, 7, and 30 days postoperatively using anterior segment optical coherence tomography. The angle, length, maximal thickness of the incision, and if present, corneal gap length and incision gap area were calculated. The existence of Descemet’s membrane detachment was recorded. Results: The mean endothelial gap length and gap area of the 2.2-mm wound were larger than the 2.8-mm, with the only statistically significant difference observed on postoperative day 30 (p = 0.015 and 0.027, respectively). There was no difference in the mean incision angle, length, and corneal thickness between the 2 incision sizes. The ratio of Descemet’s membrane detachment increased with older age and low postoperative IOP, but not associated with incision size (p < 0.05). Conclusions: Both the 2.2-mm and 2.8-mm main corneal incisions showed excellent wound healing outcome without significant postoperative complications. Older patients with low postoperative IOP required a more careful wound care management. The incision parameters in the present study can be used as an indicator of the healing process to reduce wound-related complications.
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