한국인 대상 자동굴절검사와 현성굴절검사로 계산된 최적화 인공수정체 상수 비교
Comparison of the Optimized Intraocular Lens Constants Calculated by Automated and Manifest Refraction for Korean
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목적: 한국인을 대상으로 백내장수술 후 자동굴절검사와 현성굴절검사로부터 최적화된 인공수정체 상수를 도출하고, 굴절검사 방법에따라 최적화된 인공수정체 상수에 차이가 있는지 확인하고자 하였다. 대상과 방법: 후향적 다기관 코호트 연구를 통하여 수정체유화술 및 인공수정체 낭내삽입술을 시행받은 환자 4,103명 4,103안이 18개기관에서 등록되었다. 동일한 생체계측장비와 인공수정체를 사용한 표본에서 자동굴절검사 또는 현성굴절검사로부터 SRK/T, Holladay, Hoffer Q, Haigis 공식의 최적화된 인공수정체 상수를 계산하였다. 자동굴절검사값과 현성굴절검사값으로 최적화된 인공수정체 상수를 비교하였다. 결과: 4,103안 중 IOLMaster 500으로 생체계측을 시행한 경우(62.9%)가 가장 많았으며, 다음은 IOLMaster 700 (15.2%)이었다. 총33가지의 인공수정체가 사용되었으며, Tecnis ZCB00 (53.0%)가 가장 많았다. 대상자 수가 많은 경우 자동굴절검사와 현성굴절검사로부터 최적화된 인공수정체 상수에 유의한 차이가 없었지만, 대상자 수가 적은 경우 자동굴절검사값으로부터 최적화된 인공수정체상수는 현성굴절검사값으로부터 최적화된 인공수정체 상수보다 유의하게 작았다. 결론: 한국인을 대상으로 최적화된 인공수정체 상수가 도출되어 인공수정체 도수 계산에 사용할 수 있게 되었다. 하지만 작은 표본집단에서 자동굴절검사값으로 인공수정체 상수를 최적화하는 경우, 인공수정체 상수가 작게 계산되어 수술 후 굴절 오차가 발생할 수 있다.
Abstract
Purpose: To derive the optimized intraocular lens (IOL) constants from automated and manifest refraction after cataract surgery in Korean patients, and to evaluate whether there is a difference in optimized IOL constants according to the refraction method. Methods: This retrospective multicenter cohort study enrolled 4,103 eyes of 4,103 patients who underwent phacoemulsification and in-the-bag IOL implantation at 18 institutes. Optimized IOL constants for the SRK/T, Holladay, Hoffer Q, and Haigis formulas were calculated via autorefraction or manifest refraction of samples using the same biometry and IOL. The IOL constants derived from autorefraction and manifest refraction were compared. Results: Of the 4,103 eyes, the majority (62.9%) were measured with an IOLMaster 500 followed by an IOLMaster 700 (15.2%). A total of 33 types of IOLs were used, and the Tecnis ZCB00 was the most frequently used (53.0%). There was no statistically significant difference in IOL constants derived from autorefraction and manifest refraction when IOL constants were optimized with a large number of study subjects. On the other hand, optimized IOL constants derived from autorefraction were significantly smaller than those from manifest refraction when the number of subjects was small. Conclusions: It became possible to use the IOL constants optimized from Koreans to calculate the IOL power. However, if the IOL constant is optimized using autorefraction in a small sample group, the IOL constant tends to be small, which may lead to refractive error after surgery.
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