백내장수술 중 전방 내 에피네프린과 인도시아닌그린 주입이 각막내피세포에 미치는 영향
Effect of Intracameral Epinephrine and Indocyanine Green Use on Corneal Endothelium during Cataract Surgery
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목적: 백내장수술 중 에피네프린과 인도시아닌그린, 그리고 이 두 약물의 중복 사용이 수술 후 각막내피세포수에 미치는 영향에 대해 확인하여 그 안전성에 대해 알아보고자 한다. 대상과 방법: 2017년 1월부터 2021년 10월까지 백내장수술을 받은 121명의 132안을 대상으로 에피네프린 사용군(n=20), 인도시아닌그린 사용군(n=49), 중복 사용군(n=12), 대조군(n=51)으로 나누어 후향적 의무기록을 분석하였다. 각 군별로 수술 전후 각막내피세포수 변화를 비교하였으며, 이와 연관된 인자를 분석하였다. 결과: 수술 전후 각막내피세포수 변화량(endothelial cell count change, △ECC) 비교 시 각막내피세포수는 모든 군에서 수술 후 감소되는 양상이었으나 각 군 간 유의한 차이는 보이지 않았다(p=0.845). 단순회귀분석에서 △ECC와 유의하게 연관된 인자는 수술 후 육각형세포비율, 백내장 핵경화 정도, 초음파 사용 시간, 초음파 누적소비에너지(beta=-0.216, 0.256, 0.351, 0.343, p=0.013, p=0.003, p<0.001, p<0.001)로, 다중회귀분석 시 △ECC에 유의하게 영향을 미치는 인자는 수술 후 육각형세포비율, 초음파 사용 시간(beta=-0.215, 0.367, p=0.010, p<0.001)으로 나타났다. 결론: 수술 후 각막내피세포수 감소와 밀접하게 연관된 인자는 수술 후 육각형세포비율, 초음파 사용 시간이었다. 에피네프린과 인도시아닌그린은 단독 또는 중복 사용 시 수술 후 각막내피세포의 유의한 손상은 관찰되지 않았으므로 안전하게 사용할 수 있을 것으로 판단된다.
Abstract
Purpose: To investigate the safety of single and combined use of epinephrine and indocyanine green during cataract surgery by evaluating the effects on corneal endothelial cells. Methods: From January 2017 to October 2021, 121 patients (132 eyes) who underwent cataract surgery were enrolled. Patients were divided into 4 groups: epinephrine (n = 20), indocyanine green (n = 49), epinephrine and indocyanine green combination (n = 12), and control (n = 51). Retrospective medical chart findings and endothelial cell count change data were compared among study groups before and after operation. Results: Endothelial cell count change (△ECC) decreased for all groups; however, a significant difference among groups was not observed (p = 0.822). Univariate linear regression showed that △ECC was associated with postoperative hexagonality, nuclear sclerosis grade, ultrasound time, and cumulative dissipated energy (beta = -0.216, 0.254, 0.368, 0.351 and p = 0.013, p = 0.003, p < 0.001, p < 0.001). Multivariate linear regression showed that △ECC was associated with postoperative hexagonality and ultrasound time (beta = -0.215, 0.367, p = 0.010, p < 0.001). Conclusions: Factors closely associated with postoperative endothelial cell loss were postoperative hexagonality and ultrasound time. No significant damage to the corneal endothelium was observed when epinephrine and indocyanine green were used alone or in combination. Thus, these agents appear safe for use in this context.
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