인공수정체 공막고정술에서 공막누르기를 이용한 주변부 유리체절제술의 효과
The Utility of Peripheral Vitrectomy Featuring Scleral Indentation during Scleral Fixation of Intraocular Lenses
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목적: 인공수정체 탈구 환자에서 인공수정체 공막고정술과 함께 유리체절제술을 시행할 때 공막누르기를 이용한 주변부 유리체절제술을 시행한 군의 수술 성적을 대조군과 비교하여 공막누르기를 이용한 주변부 유리체절제술의 효과를 확인해보고자 한다. 대상과 방법: 2018년 1월부터 2020년 12월까지 전체 유리체절제술, 인공수정체 제거술, 인공수정체 공막고정술을 시행받은 인공수정체 탈구 환자 20안을 대상으로 하였으며, 이 중 10안에서는 공막누르기를 통한 주변부 유리체절제술을 추가 시행하였다. 수술은 1명의술자에 의해 진행되었으며 6개월 미만의 추적 관찰 기간, 망막 및 녹내장수술의 과거력, 시력에 중대한 영향을 미치는 망막이상 및녹내장 환자는 제외하였다. 수술 후 최대교정시력, 안압, 난시 변화, 수술 후 합병증을 의무기록지를 바탕으로 후향적으로 분석하였다. 결과: 수술 6개월 후 공막누르기를 이용한 주변부 유리체절제술을 시행한 군에서 최대교정시력은 0.95(스넬렌), 대조군에서 0.60이었으며(p=0.029), 전체난시굴절량은 공막누르기를 이용한 주변부 유리체절제술을 시행한 군에서 0.48디옵터, 대조군에서는 2.80디옵터로 통계적으로 유의한 차이를 보였다(p＜0.001). 결론: 인공수정체 탈구 환자에서 인공수정체 공막고정술과 함께 유리체절제술을 시행하는 경우, 공막누르기를 이용한 주변부 유리체절제술을 시행하는 것이 시력 개선 효과를 더욱 증진시킬 수 있을 것으로 보이며, 이는 주변부 유리체를 최대한 제거함으로써 잔존유리체에 의해 발생할 수 있는 인공수정체 위치 불안정화 감소에 의한 것으로 생각된다.
Abstract
Purpose: We evaluated the utility of peripheral vitrectomy featuring scleral indentation; we compared a group who underwent peripheral vitrectomy to a control group for whom vitrectomy was combined with scleral fixation of intraocular lenses (IOLs) in patients exhibiting IOL dislocations. Methods: From January 2018 to December 2020, 20 eyes of patients evidencing IOL dislocations that underwent total vitrectomy, IOL removal, and IOL scleral fixation were evaluated; peripheral vitrectomy with scleral indentation was performed in 10 patients. All operations were performed by the same surgeon. We excluded patients with follow-up periods less than 6 months, those with a history of retinal and/or glaucoma surgery, and patients with retinal abnormalities or glaucoma that might significantly compromise visual acuity. The postoperative best-corrected visual acuity, intraocular pressure, astigmatism changes, and complications were retrieved from the medical records. Results: Six months after surgery, the best corrected visual acuity was 0.95 (the Snellen measure) in the group who underwent peripheral vitrectomy featuring scleral indentation, and 0.60 in the control group (p = 0.029). The total astigmatism values were 0.48 diopter in the former and 2.80 diopter in the latter group; the difference was significant (p < 0.001). Conclusions: In patients with IOL dislocations who underwent vitrectomy combined with IOL scleral fixation, improvements in visual acuity were further enhanced when peripheral vitrectomy was combined with scleral indentation. Complete removal of the peripheral vitreous may stabilize IOL positioning by the remnant vitreous.
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