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스마일 수술 중 흡입소실이 발생하여 라식 수술로 전환한 1예
정영택(Young Taek Chung),이대규(Dae Gyu Lee),문수정(Su Joung Mun),김부기(Bu Ki Kim) 대한안과학회 2015 대한안과학회지 Vol.56 No.8
목적: 스마일 수술 중 흡입소실이 발생하여 라식 수술로 전환하여 좋은 결과를 보인 1예를 보고하고자 한다. 증례요약: 20세 여자 환자가 굴절교정 수술을 받기 위해 내원하였다. 스마일 수술 중 좌안의 각막 실질조각 후면의 광분해가 65% 이루어졌을 때 흡입소실이 일어났다. 펨토초라식으로 전환하여 수술하였고, 우안은 예정대로 스마일 수술을 진행하였다. 술 후 3개월 째 나안시력이 1.2, 굴절력은 +0.25 Dsph=0 Dcyl였다. 수술 후 3개월간의 경과관찰 동안 합병증은 관찰되지 않았다. 결론: 흡입소실은 스마일 수술 중 드물게 나타날 수 있는 합병증인데, 라식 수술로 전환하여 수술을 마쳤고 좋은 결과를 보였다. Purpose: To report a case of suction loss during small incision lenticule extraction (SMILE) and a good visual outcome after switching to femtosecond laser-assisted in-situ keratomileusis (LASIK). Case summary: A 20-year-old female was admitted to receive refractive surgery. During SMILE in the left eye, suction loss oc-curred at 65% of posterior cut completion. We switched to LASIK and SMILE was performed in the right eye as planned. The un-corrected distance visual acuity was 1.2 with a manifest refraction of +0.25 Dsph with 0 Dcyl. The patient had no complications at 3 months postoperatively. Conclusions: Suction loss during SMILE is a rare complication. Good visual outcome was achieved by switching to LASIK.
라식수술과 스마일수술 후 안압의 변화 및 그에 영향을 미치는 인자들
김부기(Bu Ki Kim),정영택(Young Taek Chung) 대한안과학회 2021 대한안과학회지 Vol.62 No.10
목적: 라식수술과 스마일수술 후 안압 측정값의 변화 양상과 그에 영향을 미치는 인자들을 비교해보고자 하였다. 대상과 방법: 라식수술을 받은 117명, 234안과 스마일수술을 받은 122명, 244안을 대상으로 후향적으로 조사하였다. 각 군의 수술 전, 수술 후 1개월, 3개월, 6개월에 비접촉안압계로 측정한 안압과 이중샤임플러그 전안부분석기로 측정한 중심각막두께, 평균각막곡률, 편평각막곡률, 가파른각막곡률 등의 변화의 차이를 비교하였고, 단순선형회귀분석을 통해 수술 전후 안압 변화와 관련된 인자들의 관련성을 분석하였다. 결과: 술 후 6개월째 안압감소는 라식군에서 5.41 ± 2.28 mmHg, 스마일군에서 4.77 ± 2.38 mmHg로 스마일군에서 유의하게 적었고 (p=0.004), 안압이 라식군에서 수술 후 1개월부터 6개월간 유의미한 변화가 없었던 반면 스마일군에서 안압은 술 후 3개월째 12.07 ± 1.77 mmHg에서 6개월째 12.77 ± 1.89 mmHg로 유의미하게 상승하였다(p=0.002). 두 군 모두에서 안압감소량은 수술 전 구면렌즈 대응치, 수술 전 안압, 평균각막곡률 변화, 편평각막곡률 변화, 가파른각막곡률 변화, 중심각막두께 변화와 유의미한 연관성을 보였고, 두 군 모두에서 수술 전 안압이 술 후 안압감소량과 가장 높은 상관관계를 보였다(라식군 R2=0.414, 스마일군 R2=0.292). 결론: 라식수술과 스마일수술 후 안압은 술 전에 비하여 유의미하게 감소하였는데 그 정도는 라식군에서 더 높았으며, 두 수술 모두에서 술 전 안압이 술 후 안압감소에 가장 중요한 예측 인자였다. Purpose: We compared the intraocular pressure (IOP) changes and the relationships thereof with corneal biomechanics after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Methods: A total of 234 eyes of 117 patients who underwent FS-LASIK surgery and 244 eyes of 122 patients who underwent SMILE surgery were included in this retrospective study. Data were collected preoperatively, and at 1, 3, and 6 months postoperatively, including IOP measured via non-contract tonometry, central corneal thickness (CCT), and mean keratometry (Km), flat keratometry (Kf), and steep keratometry (Ks) data obtained using a dual Scheimpflug analyzer. Between-group differences were compared. Simple linear regression analysis was used to determine the relationship between changes in the IOP and the various parameters. Results: The IOP changes were 5.41 ± 2.28 mmHg in the FS-LASIK group and 4.77 ± 2.38 mmHg in the SMILE group, thus significantly different (p = 0.004). The IOP did not change significantly from 1 to 6 months after FS-LASIK but increased significantly from 12.07 ± 1.77 mmHg at 3 months postoperatively to 12.77 ± 1.89 mmHg at 6 months postoperatively after SMILE (p = 0.002). All of the preoperative spherical equivalent and IOP, and changes in the Km, Kf, Ks, and CCT, were significantly associated with the IOP changes in both groups. The preoperative IOP evidenced the strongest relationship with the IOP changes in both groups (R2 = 0.414 in the FS-LASIK group, R2 = 0.292 in the SMILE group). Conclusions: The IOP fell significantly after FS-LASIK and SMILE surgery, significantly more so after FS-LASIK than SMILE. The preoperative IOP exhibited the greatest influence on the IOP decreases after both FS-LASIK and SMILE. J Korean Ophthalmol Soc 2021;62(10):1355-1363
경도 및 중등도 근시환자와 고도근시환자에서의 스마일수술 임상성적 비교
김재련,김현승,문수정,정영택,Jae Ryun Kim,Hyun Seung Kim,Su Joung Mun,Young Taek Chung 대한안과학회 2014 대한안과학회지 Vol.55 No.7
<b>Purpose:</b> To evaluate the refractive outcomes of small incision lenticule extraction (SMILE) in high myopia patients compared with mild to moderate myopia patients. <b>Methods:</b> This study included 332 eyes of 166 myopic patients treated with SMILE using Visumax 500 kHz femtosecond laser. Treated eyes were divided into 2 groups according to preoperative spherical equivalent (SE): mild to moderate myopia (A group, <-6.0 D) and high myopia (B group, ≥-6.0 D). Follow-up visits were at 1 day, 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BDVA), postoperative SE, efficacy index, safety index and predictability. <b>Results:</b> Preoperative SE was -4.85 ± 0.86 D in the A group and -7.70 ± 1.0 D in the B group. No differences were observed between -0.04 ± 0.29 D in the A group and -0.30 ± 0.37 D in the B group at 6 months postoperatively (<em>p</em> = 0.062). At 6 months postoperatively, 98.3% and 97.3% had UDVA of 20/25 or better in the A group and B group, respectively. In the A group, 97.3% and 100% were within ±0.5 D and ±1.0 D of intended correction and in the B group, 91.7% and 96.9% were within ±0.5 D and ±1.0 D, respectively. Efficacy indices were 1.02 ± 0.19 in the A group and 0.99 ± 0.18 in the B group. Safety indices were 1.16 ± 0.16 in the A group and 1.14 ± 0.16 in the B group. The efficacy and safety indices were not significantly different between the A and B groups at 6 months postoperatively (<em>p</em> = 0.09, <em>p</em> = 0.695, respectively). `<b>Conclusions:</b> This study showed that SMILE is effective and safe for correcting high myopia as well as mild to moderate myopia. J Korean Ophthalmol Soc 2014;55(7):963-968