굴절교정레이저각막절제술에서 각막기하중심-보정 연마중심의 정확도에 난시교정량이 미치는 영향
Influences of Cylindrical Correction Amount of PRK on Accuracy of Geometric Corneal Center-Adjusted Ablation Centration
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목적: ASA-PRK (advanced surface ablation-photorefractive keratectomy)에서 수술자가 지정한 각막기하중심-보정 연마중심의 정확도에 난시교정량이 미치는 영향을 알아보고자 하였다. 대상과 방법: ASA-PRK를 시행한 95안을 난시교정량(-0.20D~-2.50D)에 따라 세 군으로 나누어(1군＜-0.50D, 22안; -0.50D≤2군 ＜-1.00D, 45안; -1.00D≤3군, 28안), 술 후 1개월 각막형태검사로 연마중심의 분포와 동공중심으로부터의 거리를 통계적으로 분석하였다. 또한 환자인자(성, 나이, 좌우안, 중심각막두께, 첫/두 번째 수술안)와 수술인자(근시교정량, 연마깊이, 수직척도값, 술자의 학습효과)별로 연마중심이탈(＞0.3 mm)에 영향을 미치는 위험인자를 분석하였다. 결과: 연마중심이탈은 평균 0.26 ± 0.15 mm (0.04-0.83 mm)이었으며, 세 군 간에 유의한 차이는 없었다(p=0.879). 연마중심의 분포는 모든군에서 상비측이 가장 많았다(전체 53.7%). 연마중심이탈에 영향을 미치는 위험인자는 모든 군에서 환자 또는 수술인자별로 나타나지 않았다. 결론: 난시교정량에 따른 세 군의 연마중심이탈 값에 유의한 차이를 보이지 않았다. 따라서 ASA-PRK에서 수술자가 지정하는 각막기하중심-보정 중심잡기방식은 난시교정량에 영향을 받지 않았으며, 우수한 연마중심 성적을 보였다.
Abstract
Purpose: To evaluate the effect of the amount of cylindrical correction on the accuracy of geometric corneal centeradjusted ablation centration selected by the surgeon in advanced surface ablation-photorefractive keratectomy (ASA-PRK). Methods: Ninety-five myopic eyes of 62 patients who underwent ASA-PRK were divided into three groups based on the amount of myopic cylindrical correction: Group 1 <-0.50 D, 22 eyes; Group 2 ≥-0.50 D and <-1.00 D, 45 eyes; Group 3 ≥-1.00 D, 28 eyes. The distances and distribution of the ablation centers from the entrance pupil center were analyzed by corneal topography at one month after ASA-PRK. Risk factors for decentration (>0.3 mm) were determined from patient-related factors such as gender, age, laterality, central corneal thickness, and order of procedure and surgery-related factors such as amount of spherical correction, ablation depth, vertical scale bar percentage, and learning effect of surgeon. Results: Mean decentration was 0.26 ± 0.15 mm (0.04 to 0.83 mm). There was no statistically significant difference in the amount of decentration among the three groups (p = 0.879). Superior-nasal displacement (53.7%) of the ablation center most frequently occurred after ASA-PRK. The amount of decentration among the three groups was not dependent on either patient-related or surgery-related factors. Conclusions: ASA-PRK using the surgeon-selected ablation center with adjustment toward the geometric corneal center was found to be highly accurate in ablation centration and did not influence the amount of ablation decentration regardless of the amount of myopic cylindrical correction.
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