성공적인 펨토초레이저 백내장수술을 위한 수술 중 합병증 위험인자 분석
Possible Risk Factors Affecting Successful Femtosecond Laser-assisted Cataract Surgery
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 펨토초레이저 백내장수술 시 발생하는 합병증의 위험인자를 알아보고자 하였다. 대상과 방법: 2012년 7월부터 2017년 1월까지 본원에서 펨토초레이저 백내장수술을 시행한 337명 598안을 대상으로 연구를 실시하였다. 모든 안에 투명각막절개, 수정체전낭절개, 수정체분할을 시행하였으며, 필요시 윤부이완절개술을 추가하였다. 수술 중 합병증은 녹화된 영상을 이용하여 결과를 확인하였고, 합병증 관련 위험인자는 의무기록을 후향적으로 분석하였다. 결과: 대상 환자군의 나이는 평균 62.1 ± 11.9세였으며, 불완전한 투명각막절개 18안 중 위험인자는 각막중심혼탁, 각막주변부변성, 익상편, 결막이완이 있었고, 불완전한 수정체전낭절개 43안 중 위험인자는 과숙백내장, 전극백내장, 각막중심혼탁, 비정상동공, 수정체탈구, 산동불량이 있었으며, 불완전한 수정체분할 22안 중 위험인자는 과숙백내장, 수정체이탈, 각막중심혼탁, 전극 백내장, 비정상동공이 있었다. SoftFit™ 인터페이스 사용 후 합병증 발생률은 투명각막절개(3.56%에서 2.24%, p=0.367), 수정체전낭절개(9.31%에서 4.03%, p<0.05), 수정체분할(5.20%에서 1.34%, p<0.05) 모두 감소하였으며, 초기 사례와 후기 사례의 합병증 발생률 비교 시 투명각막절개, 수정체전낭절개, 수정체분할 모두 초기보다 후기에 발생률이 유의하게 감소하였다(p<0.05). 결론: 펨토초레이저는 백내장수술을 안전하고 효과적으로 할 수 있는 장점이 있다. 그러나 관련된 위험인자가 존재하는 경우 합병증의 가능성을 고려하여 접근해야 할 것으로 보이며, SoftFit™ 인터페이스를 사용하고, 술자의 숙련도가 높을수록 합병증 발생을 감소시킬 수 있을 것으로 생각된다.
Abstract
Purpose: To determine the risk factors of intraoperative complications in femtosecond laser-assisted cataract surgery. Methods: This study included 598 eyes of 337 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) between July, 2012 and January, 2017. All eyes had corneal incisions, anterior capsulotomy, nuclear fragmentation, and limbal relaxing incisions (if required). Intraoperative complications were analyzed by watching videos, and the related factors of each complication were retrospectively reviewed alongside the medical records. Results: The mean age of the patients was 62.1 ± 11.9 years. Among the study group, 18 eyes required manual creation of corneal incisions; because the corneal incisions could not be made due to corneal central opacity, corneal peripheral degeneration, ptreygium, conjunctival chalasis, or idiopathic. The anterior capsulotomy was incomplete in 43 cases and manual capsulorrhexis was required for completion. These cases were associated with various conditions, including hypermature cataract, anterior polar or subcapsular cataract, corneal central opacity, pupillary abnormality, lens subluxation, poor pupil dilation, and idiopathic. Overall, 22 eyes had difficulties with nuclear fragmentation, with either mature cataract, lens subluxation, corneal central opacity, anterior polar or subcapsular cataract, or pupillary abnormality. Using the Laser SoftFit™ patient interface decreased the incidences of incomplete corneal incision (from 3.56% to 2.24%, p = 0.367), anterior capsulotomy (from 9.31% to 4.03%, p < 0.05), and nuclear fragmentation (from 5.20% to 1.34%, p < 0.05). The incidences of complications in the experienced group was statistically lower compared with the novice group (p < 0.05 for all comparisons). Conclusions: The femtosecond laser platform was effective and safe for cataract surgery. However, in the presence of related factors, use of this platform might need to be re-assessed and should be considered for intraoperative complications. Additionally, with the Laser SoftFit™ patient interface and improved surgeon experience, better intraoperative results can be expected for FLACS surgery.
참고문헌 (26)
- Krasnov MM, "Laser-phakopuncture in the treatment of soft cataracts", Br J Ophthalmol, 59, pp.96~98 (1975)
- Ratkay-Traub I, "Ultra-short pulse (femtosecond) laser surgery: initial use in LASIK flap creation", Ophthalmol Clin North Am, 14, pp.347~355 (2001)
- Sugar A, "Ultrafast (femtosecond) laser refractive surgery", Curr Opin Ophthalmol, 13, pp.246~249 (2002)
- Nagy Z, "Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery", J Refract Surg, 25, pp.1053~1060 (2009)
- Masket S, "Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility", J Cataract Refract Surg, 36, pp.1048~1049 (2010)
- Chang JS, "Initial evaluation of a femtosecond laser system in cataract surgery", J Cataract Refract Surg, 40, pp.29~36 (2014)
- 박재홍, "펨토초레이저 백내장 수술과 고식적 백내장 수술에서 수정체낭원형절개의 비교", 대한안과학회지, 55(12), pp.1800~1807 (2014), 대한안과학회
- Kránitz K, "Femtosecond laser capsulotomy and manual continuous curvilinear capsulorrhexis parameters and their effects on intraocular lens centration", J Refract Surg, 27, pp.558~563 (2011)
- Friedman NJ, "Femtosecond laser capsulotomy", J Cataract Refract Surg, 37, pp.1189~1198 (2011)
- Auffarth GU, "Comparison of the maximum applicable stretch force after femtosecond laser-assisted and manual anterior capsulotomy", J Cataract Refract Surg, 39, pp.105~109 (2013)
- Conrad-Hengerer I, "Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery", J Refract Surg, 28, pp.879~883 (2012)
- Conrad-Hengerer I, "Effect of femtosecond laser fragmentation of the nucleus with different softening grid sizes on effective phaco time in cataract surgery", J Cataract Refract Surg, 38, pp.1888~1894 (2012)
- Abell RG, "Toward zero effective phacoemulsification time using femtosecond laser pretreatment", Ophthalmology, 120, pp.942~948 (2013)
- Kránitz K, "Intraocular lens tilt and decentration measured by Scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy", J Refract Surg, 28, pp.259~263 (2014)
- Miháltz K, "Internal aberrations and optical quality after femtosecond laser anterior capsulotomy in cataract surgery", J Refract Surg, 27, pp.711~716 (2012)
- Takács AI, "Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification", J Refract Surg, 28, pp.387~391 (2012)
- Conrad-Hengerer I, "Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month follow-up", J Cataract Refract Surg, 39, pp.1307~1313 (2013)
- Abell RG, "Anterior chamber flare after femtosecond laser-assisted cataract surgery", J Cataract Refract Surg, 39, pp.1321~1326 (2013)
- Chen M, "A review of femtosecond laser assisted cataract surgery for Hawaii", Hawaii J Med Public Health, 72, pp.152~155 (2013)
- Filkorn T, "Comparison of IOL power calculation and refractive outcome after laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification", J Refract Surg, 28, pp.540~544 (2012)
- Roberts TV, "Surgical outcomes and safety of femtosecond laser cataract surgery: a prospective study of 1500 consecutive cases", Ophthalmology, 120, pp.227~233 (2013)
- Abell RG, "Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4000 cases at a single center", J Cataract Refract Surg, 41, pp.47~52 (2015)
- Chen M, "Comparing the intraoperative complication rate of femtosecond laser-assisted cataract surgery to traditional phacoemulsification", Int J Ophthalmol, 8, pp.201~203 (2015)
- Asena BS, "Laser-assisted cataract surgery: soft lens assisted interface (SoftFit) versus direct contact interface", Eur J Ophthalmol, 26, pp.242~247 (2016)
- Chee SP, "Clinical outcomes in the first two years of femtosecond laser-assisted cataract surgery", Am J Ophthalmol, 159, pp.714~719 (2015)
- Bali SJ, "Early experience with the femtosecond laser for cataract surgery", Ophthalmology, 119, pp.891~899 (2012)