학술논문
백내장수술시 후낭원형절제술이 술 후 인공수정체 및 굴절력에 미치는 영향 / Intraocular lens stability and refractive outcome after cataract surgery using primary posterior continuous curvilinear capsulorrhexis
Document Type
Dissertation/ Thesis
Author
Source
Subject
Language
Korean
Abstract
백내장 수술시 수정체후낭원형절개술을 동시에 시행한 경우 술 후 인공수정체의 안정성 및 굴절 예후에 도움이 되는지를 알아보고자 하였다. 2007년 10월 부터 2008년 12월 까지 백내장 수술시 수정체후낭원형절개술을 동시에 시행한 77명의 환자 86안 (PCCC군)과 그렇지 않은 68명의 환자 79안 (대조군)을 대상으로 하여 prospective unmasked randomized comparative case series가 진행되었다. 두 군 모두 polymethylmethacrylate (PMMA) 재질의 지지부를 가진 인공수정체 (VA-60BB, Hoya corporation, Tokyo, Japan)가 삽입되었다. 술 후 6개월까지의 각 내원 시마다 (술 후 1, 3, 7, 14, 30, 60, 90, 120, 150, 180일째) 최대교정시력, 자동굴절검사, 펜타캠 (Pentacam?? instrument, Oculus, Wetzlar, Germany)을 이용한Scheimpflug imaging, 역반사조명을 이용한 세극등 사진촬영 등이 시행되었다. 인공수정체의 축방향 편위는 펜타캠에서 각막내피부터 인공수정체 표면까지의 거리의 변화로 측정하였고, 수평방향 편위는 세극등 사진에서 각막윤부 및 동공의 기하학적 중심과 인공수정체의 기하학적 중심 사이의 거리로 각각 측정하였다.PCCC군에서 술 후6개월째 인공수정체의 평균 수평방향 편위는 동공기준0.25 ± 0.14 mm, 각막윤부기준 0.31 ± 0.17 mm로 측정되었으며, 대조군에서는 평균 수평방향 편위는 동공기준0.26 ± 0.09 mm, 각막윤부기준 0.31 ± 0.13 mm로 측정되었다. 두 군 모두 술 후 1일째에 비해 유의한 변화는 보이지 않았다 (각각 P=0.515, P=0.263, P=0.421, P=0.875). PCCC군에서 인공수정체는 술 후 6개월째에 평균 -0.08 ± 0.24 mm만큼 앞 쪽(각막에 가까워지는 방향)으로 이동하여 술 후 1일째에 비해 유의한 변화는 없었으나, 대조군에서는 인공수정체의 유의한 전방 이동이 관찰되었다 (-0.42 ± 0.27 mm, P=0.009). 술 후 1일째에 비한 술 후 6개월째 평균 굴절 변화는 PCCC군에서는 -0.16 ± 0.67 D, 대조군에서는 -0.60 ± 0.70 D였다 (P=0.042).백내장 수술 시 수정체후낭원형절개술의 동시 시행은 술 후 수정체낭의 섬유화 및 결과적인 수축으로 인한 인공수정체의 편위를 감소시켜 술 후 굴절변화를 최소화하고 안정화 시킬 수 있는 유용한 방법이라 판단된다.
This study was performed to evaluate the amount of intraocular lens (IOL) decentration and refractive changes after cataract surgery using posterior continuous curvilinear capsulorrhexis (PCCC).A prospective unmasked randomized comparative case series consisting of 86 eyes of 77 patients who had cataract surgery employing PCCC (the PCCC group), and 79 eyes of 68 patients treated without PCCC (the control group) from October 2007 to December 2008. Foldable intraocular lenses with polymethylmethacrylate (PMMA) haptics (VA-60BB, Hoya corporation, Tokyo, Japan) were implanted in both groups. Measurement of best-corrected visual acuity, automated refractokeratometry, Scheimpflug imaging using Pentacam?? instrument (Oculus, Wetzlar, Germany), and slit lamp photography with retroillumination were performed at each follow-up visit (1, 3, 7, 14, 30, 60, 90, 120, 150, 180 days after cataract surgery) over 6 months. The amount of axial displacement of each IOL was measured as the distance between the corneal endothelium and the anterior surface of the IOL on Scheimpflug images. The horizontal shift was assessed as the distance between the geometric center of the IOL and the centers of the pupil and the limbus respectively.In the PCCC group, the mean horizontal shift of the IOL at 6-month follow-up was 0.25 ± 0.14 mm with respect to the pupil, and 0.31 ± 0.17 mm with respect to the limbus. In the control group, the mean horizontal shift at 6-month follow-up was 0.26 ± 0.09 mm with respect to the pupil, and 0.31 ± 0.13 mm with respect to the limbus. There was no significant difference between horizontal shift measured the first day after surgery and 6 months after surgery in either group (P=0.515 and P=0.263 in PCCC group, P=0.421 and P=0.875 in control group, for measurement with respect to pupil and limbus, respectively). The IOL shifted insignificantly in the PCCC group (-0.08 ± 0.24 mm anterior shift to the cornea), but the shift was significant in the control group (-0.42 ± 0.27 mm anterior shift, P=0.009). Mean postoperative refractive shift 6 months after surgery compared to refraction on the first day after surgery was -0.16 ± 0.67 D in the PCCC group and -0.60 ± 0.70 D in the control group (P=0.042).PCCC employed during cataract surgery is useful to stabilize and minimize postoperative refractive changes. IOL displacement attributable to capsular contraction is less when cataract surgery involves PCCC.
This study was performed to evaluate the amount of intraocular lens (IOL) decentration and refractive changes after cataract surgery using posterior continuous curvilinear capsulorrhexis (PCCC).A prospective unmasked randomized comparative case series consisting of 86 eyes of 77 patients who had cataract surgery employing PCCC (the PCCC group), and 79 eyes of 68 patients treated without PCCC (the control group) from October 2007 to December 2008. Foldable intraocular lenses with polymethylmethacrylate (PMMA) haptics (VA-60BB, Hoya corporation, Tokyo, Japan) were implanted in both groups. Measurement of best-corrected visual acuity, automated refractokeratometry, Scheimpflug imaging using Pentacam?? instrument (Oculus, Wetzlar, Germany), and slit lamp photography with retroillumination were performed at each follow-up visit (1, 3, 7, 14, 30, 60, 90, 120, 150, 180 days after cataract surgery) over 6 months. The amount of axial displacement of each IOL was measured as the distance between the corneal endothelium and the anterior surface of the IOL on Scheimpflug images. The horizontal shift was assessed as the distance between the geometric center of the IOL and the centers of the pupil and the limbus respectively.In the PCCC group, the mean horizontal shift of the IOL at 6-month follow-up was 0.25 ± 0.14 mm with respect to the pupil, and 0.31 ± 0.17 mm with respect to the limbus. In the control group, the mean horizontal shift at 6-month follow-up was 0.26 ± 0.09 mm with respect to the pupil, and 0.31 ± 0.13 mm with respect to the limbus. There was no significant difference between horizontal shift measured the first day after surgery and 6 months after surgery in either group (P=0.515 and P=0.263 in PCCC group, P=0.421 and P=0.875 in control group, for measurement with respect to pupil and limbus, respectively). The IOL shifted insignificantly in the PCCC group (-0.08 ± 0.24 mm anterior shift to the cornea), but the shift was significant in the control group (-0.42 ± 0.27 mm anterior shift, P=0.009). Mean postoperative refractive shift 6 months after surgery compared to refraction on the first day after surgery was -0.16 ± 0.67 D in the PCCC group and -0.60 ± 0.70 D in the control group (P=0.042).PCCC employed during cataract surgery is useful to stabilize and minimize postoperative refractive changes. IOL displacement attributable to capsular contraction is less when cataract surgery involves PCCC.