펨토초레이저 백내장수술 도입 초기의 단기 임상경과 및 고식적 백내장수술과의 비교
Short-term Clinical Outcomes of Femtosecond Laser-assisted Cataract Surgery: Comparison with Conventional Phacoemulsification
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목적: 펨토초레이저를 이용한 백내장수술 도입 초기의 단기적인 임상 경과를 고식적 백내장수술과 비교하고, 안정성에 대해 알아보고자 하였다. 대상과 방법: 2016년 1월부터 2017년 1월까지 삼성서울병원 안과에서 펨토초레이저 장비의 도입 초기 펨토초레이저 백내장수술을 받은 50안 및 같은 시기에 고식적 백내장수술을 시행받은 50안을 대상으로 의무기록을 후향적으로 분석하였다. 펨토초레이저 백내장수술을 받은 군의 수술 전후의 시력, 구면 대응치를 포함한 단기 임상 경과를 고식적 백내장수술을 받은 군과 비교하였으며, 펨토초레이저 백내장수술 중 발생한 합병증을 분석하고, 도입 직후 수술을 받은 25안과, 그 이후 수술을 받은 25안의 합병증 발생을 비교 분석하여 펨토초레이저 수술 초기 학습의 영향을 분석하였다. 결과: 펨토초레이저 백내장수술을 받은 군과 고식적 백내장수술을 받은 군의 수술 1개월 후 나안시력(p=0.78) 및 교정시력(p=0.89)의 차이는 없었으며, 구면 대응치의 차이도 없었다(p=0.09). 초음파시간에는 유의한 차이가 없었으나(p=0.15), 누적분사에너지는 펨토초레이저 백내장수술 군에서 유의하게 작았다(p=0.04). 펨토초레이저 백내장수술 중 결막 충혈, 축동, 부정확한 각막 절개창 위치 및 불완전한 각막 절개창 형성 등의 문제를 경험하였으며, 초기 25안과 비교하여 후기 25안에서 그 비율이 전체적으로 감소하는 경향을 보였고, 결막하 출혈은 통계적으로 유의한 감소를 보였다(p=0.02). 결론: 펨토초레이저 백내장수술의 도입 초기의 단기적인 임상 결과는 고식적 백내장수술과 비교하여 수술 후 최대교정시력의 차이는 없었으며, 안구에 가해지는 초음파 에너지는 감소하였다. 또한 펨토초레이저 백내장수술의 도입 초기 학습기간이 필요하지만, 학습에 걸리는 시기는 비교적 길지 않았다.
Abstract
Purpose: To evaluate the short-term clinical outcome of femtosecond laser-assisted cataract surgery at the initial phase and to compare it with results from conventional phacoemulsification. Methods: This retrospective study was performed on 50 eyes who underwent femtosecond laser-assisted cataract surgery and 50 eyes who underwent conventional phacoemulsification. The short-term outcomes included uncorrected and corrected distance visual acuity and spherical equivalent. The complications of femtosecond laser-assisted cataract surgery were evaluated, and the prevalences of complications between the initial 25 eyes and latter 25 eyes of the cases were compared to evaluate the importance of the learning curve. Results: There were no significant differences in uncorrected (p = 0.78) and corrected (p = 0.89) distance visual acuity between groups 1 month postoperatively. There was no difference in spherical equivalent (p = 0.09). The phacoemulsification time was not different between groups (p = 0.15). However, there was a significant decrease in cumulative dissipated energy in the femtosecond laser-assisted cataract surgery group (p = 0.04). There were complications during femtosecond laser-assisted cataract surgery, such as subconjunctival hemorrhage, miosis, early entry corneal incision, and incomplete corneal incision. The prevalence of complications in the latter 25 eyes was less than that of the first 25 eyes treated with femtosecond laser-assisted cataract surgery; the prevalence of subconjunctival hemorrhage was reduced significantly (p = 0.02). Conclusions: The short-term clinical outcomes of the femtosecond laser-assisted cataract surgery group at the initial phase were not different, and in some cases, better than those of the conventional phacoemulsification group. A learning period is therefore required during the initial phase of femtosecond laser-assisted cataract surgery.
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