피브린 접착제를 이용한 공막 내 인공수정체고정술의 안축장 및 전방깊이에 따른 효과 분석

손현우(Hyeon Woo Son),박정민(Jung Min Park) 대한안과학회 2021 대한안과학회지 Vol.62 No.5

목적: 유리체절제술과 피브린 접착제를 이용한 공막 내 인공수정체고정술을 실시한 환자에서 안축장 길이와 전방깊이에 따른 효과차이를 알아보고자 한다. 대상과 방법: 인공수정체 이탈 환자에 대한 치료로 유리체절제술과 피브린 접착제를 이용한 공막 내 인공수정체고정술 후 6개월 이상 경과 관찰이 가능한 61명, 61안에 관하여 후향적으로 분석하였다. 안축장의 길이에 따라 22 mm 미만을 1군, 22 mm 이상, 25 mm 미만을 2군, 25 mm 이상을 3군, 전방깊이가 3.0 mm 미만을 A군, 3.0 mm 이상, 3.6 mm 미만을 B군, 3.6 mm 이상을 C군으로 나누어 각 군의 술 전후 교정 시력, 구면값, 원주값, 구면렌즈대응치를 측정 비교 분석하였다. 결과: 술 전후 최대교정시력의 유의미한 향상을 확인할 수 있었으며, 술 전후 구면값, 구면렌즈대응치는 모든 군에서 유의미한 차이를 관찰할 수 있었다(p<0.05). 다만 안축장의 길이와 전방깊이가 길어질수록 Haptic slippage, IOL dislocation 등의 합병증 발생률이 증가함을 확인할 수 있었다. 결론: 안축장의 길이와 전방깊이는 굴절이상에 영향을 줄 수 있어 수술 방법을 선택할 때 고려 요인 중 하나이다. 피브린 접착제를 이용한 공막 내 인공수정체고정술 후 최대교정시력, 구면값, 구면렌즈대응치의 유의한 향상으로 시력호전을 확인할 수 있고 술 후원주값의 유의한 변화가 없어 인공수정체의 뒤틀림과 난시의 유발이 낮음을 알 수 있다. Purpose: The purpose of this study was to evaluate the effect of axial length and anterior chamber depth in vitrectomy and intraocular lens intrascleral fixation with a fibrin adhesive. Methods: The study retrospectively reviewed 61 eyes of 61 patients, who were followed up for over 6 months after surgery. The patients were divided into three groups according to their axial length: group 1, < 22 mm; group 2, 22 to < 25 mm; and group 3, > 25 mm. The patients were further divided into three sub-groups according to their anterior chamber depth: group A, < 3.0 mm; group B, 3.0 mm to < 3.6 mm; and group C, > 3.6 mm. We measured and analyzed the best-corrected visual acuity, spherical value, cylindrical value, and spherical equivalent of each group before surgery and at 6 months postoperatively. Results: When comparing the groups preoperatively and postoperatively, the best-corrected visual acuity, spherical value, and spherical equivalent showed significant improvement in all groups (p < 0.05). The incidence of complications, such as haptic slippage and intraocular lens dislocation, increased with the axial length and anterior chamber depth. Conclusions: The use of fibrin adhesive for intraocular lens intrascleral fixation improves visual acuity and reduces refractive error. Postoperatively, there was no significant change in cylindrical value. Because axial length and anterior chamber depth affect refractive error, both should be considered in correlation with the surgical method.

비구면 인공수정체와 구면 인공수정체의 중심이탈, 경사도 및 전방깊이의 비교

이자영,이승희,정성근 대한안과학회 2009 대한안과학회지 Vol.50 No.6

Purpose: To compare the decentration, tilt and anterior chamber depth between aspheric AcrySofⓇ IQ IOL (SN60WF) and spheric AcrySofⓇ Natural IOL (SN60AT). Methods: The subjects of this study consisted of 22 patients (26 eyes) using an aspheric AcrySofⓇ IQ IOL and 26 patients (31 eyes) using spheric AcrySofⓇ Natural IOL. All lenses were inserted into the capsular bag after 5 mm continuous curvilinear capsulorhexis and phacoemulsification. The decentration, tilt and anterior chamber depth of both IOLs were measured on the 1st, 30th and 60th postoperative day using an anterior eye segment analysis system (Scheimpflug camera, EAS-1000, Nidek, Japan). Results: There was no statistically significant difference in the decentration between the IQ IOL and Natural IOL on the 1st (p=0.05), 30th (p=0.09) and 60th (p=0.06) postoperative day. There was a statistically significant difference in tilt between IQ IOL and Natural IOL on the 1st (p=0.000053) and 30th (p=0.018) postoperative day. However, there was no statistically significant difference in tilt on the 60th postoperative day (p=0.05). The anterior chamber depth of IQ IOL was decreased, but was not statistically significant on the 1st (p=0.10), 30th (p=0.07) or 60th (p=0.06) postoperative day. Conclusions: There were no significant differences between AcrySofⓇ IQ IOL and AcrySofⓇ Natural IOL in decentration, tilt or anterior chamber depth, showing that posterior aspheric surface causes little effect on the IOL stability. 목적: 비구면 인공수정체인 AcrySofⓇ IQ IOL (SN60WF)와 구면 인공수정체인 AcrySofⓇ Natural IOL (SN60AT)의 중심이탈, 경사도 및 전방깊이를 비교하였다. 대상과 방법: AcrySofⓇ IQ IOL이 삽입된 22명(26안)과 AcrySofⓇ Natural IOL이 삽입된 26명(31안)을 대상으로 전향적인 연구를 시행 하였다. 수정체 중심부에 5 mm 크기의 수정체낭원형절개술 및 수정체유화술을 시행한 후 낭내로 인공수정체를 삽입하였다. 수술 후 1일, 30일, 60일에 전안부분석기(EAS-1000, Nidek, Japan)를 이용하여 중심이탈, 경사도 및 전방깊이를 측정하였다. 결과: 중심이탈의 정도는 술 후 1일(p=0.05), 30일(p=0.09), 60일(p=0.06)에 유의한 차이가 없었다. 경사도는 술 후 1일(p=0.000053), 30일(p=0.018)에는 통계적으로 유의한 차이를 보였으나, 술 후 60일에는 유의한 차이가 없었다(p=0.05). 전방깊이는 AcrySofⓇ IQ IOL이 AcrySofⓇ Natural IOL에 비해 감소된 결과를 보였으나, 술 후 1일(p=0.10), 30일(p=0.07), 60일(p=0.06)에 통계적으로 유의한 차이는 없었다. 결론: AcrySofⓇ IQ IOL은 AcrySofⓇ Natural IOL과 비교하여 수술 후 2개월까지 중심이탈, 경사도 및 전방깊이에 있어서 통계적으로 유의한 차이가 없었다. 그러므로 광학부 비구면 부위는 인공수정체의 위치적 안정성에 큰 영향을 주지 않는 것으로 생각한다.

한국 성인에서 샤임플러그 사진기를 이용한 전방 계측치

김효진,박창원,안영주 대한시과학회 2020 대한시과학회지 Vol.22 No.2

Purpose : To evaluate the anterior segment parameters (anterior chamber depth: ACD and anterior chamber angle: ACA) according to sex and age in Korean adults. Methods : The average age of the 92 subjects(160 eyes) was 35.38±15.75(20∼68) years old. The anterior segment parameters was measured by a rotating Scheimpflug camera(Pentacam, Oculus, Wetzlar, German). The ACD and ACA at 4 quadrants(superior, inferior, nasal and temporal) were measured and their averages were evaluated. Results : The total ACD was 2.97±0.39 mm in average. As the age increased, the ACD became shallower. The ACD for the nasal(1.87±0.39 mm) and the superior(1.85±0.39 mm) showed the significantly shallow depth than the ones for temporal(2.29±0.40 mm) and inferior (2.20±0.41 mm). In all 4 quadrants, the ACD gradually became shallower as the age increased 20s to 60s. The total ACA was 36.44±6.76°in average. As the age increased, the ACA became narrower. The ACA for superior(34.23±7.52°) and inferior(33.27±6.76°) showed the significantly narrow angle than the ones for the nasal(38.28±7.28°) and temporal (39.98±7.13°). In all 4 quadrants, the ACA gradually became narrower as the age increased 20s to 60s. Conclusion : As the age increases, the ACD and ACA become shallow and narrow but the decreases for 4 quadrants appeared different in tendency. 목적 : 한국 성인에서 성별과 연령에 따른 전안부 계측치(전방깊이와 전방각)를 평가하고자 하였다. 방법 : 평균 연령 35.38±15.75(20∼68)세의 92명 160안을 대상으로 하였다. 회전 샤임플러그 카메라(Pentacam,Oculus, Wetzlar, German)를 이용하여 안구 전안부를 측정하였다. 촬영된 샤임플러그 이미지에서 전방깊이와 전방각의 평균값과 네 지점(상측, 하측, 코측, 그리고 귀측)에서의 방향별 측정값을 평가하였다. 결과 : 전체 대상자의 전방깊이는 평균 2.97±0.39 mm로 연령이 증가할수록 전방깊이가 얕아졌다. 코측(1.87±0.39 mm)과 상측(1.85±0.39 mm)은 귀측(2.29±0.40 mm)과 하측(2.20±0.41 mm)보다 통계적으로 유의하게 얕은 전방깊이를 보였으며, 4방향에서 모두 20대에서 60대로 갈수록 점차 전방깊이가 얕아졌다. 전방각은 평균 36.44±6.76°로 연령이 증가할수록 전방각이 좁아졌다. 상측(34.23±7.52°)과 하측(33.27±6.76°)은 코측(38.28±7.28°)과 귀측(39.98±7.13°)보다 통계적으로 유의하게 좁은 전방각을 보였으며, 4방향에서 모두 20대에서 60대로 갈수록 점차 전방각이 좁아졌다. 결론 : 연령이 증가함에 따라 전방깊이는 얕아지고 전방각은 좁아졌으며, 연령증가에 따른 방향별 감소의 경향이 다르게 나타났다.

세극등현미경과 전방각경을 이용한 전안부계측

오종현,김용연,정해륜,Jong Hyun Oh,M,D,Yong Yeon Kim,M,D,Hai Ryun Jung,M,D 대한안과학회 2006 대한안과학회지 Vol.47 No.9

Purpose: To evaluate the accuracy of the Smith method, van Herick technique, and Shaffer grading system, using a slit-lamp biomicroscope and gonioscope that measure anterior chamber depth (ACD), peripheral chamber depth (PCD), and angle width. Methods: The anterior chamber of 94 eyes of 53 subjects was evaluated by slit-lamp examination with a gonioscope. An A-scan was carried out on all of the subjects, but ultrasound biomicroscope (UBM) was performed on only 42 of 94 eyes. Slit-lamp biomicroscope-assisted measurements, such as ACD, PCD, and angle width, were compared with those by A-scan and UBM. Results: The correlations among ACD measurements, obtained by the Smith method, and those obtained using A-scan (r=0.673, p<0.001) and UBM (r=0.824, p<0.001) were statistically significant. The mean PCD, measured by van Herick technique, was 14.01±15.04 %, and its correlation with that of UBM was statistically significant (r=0.706, p<0.001). In addition, the correlation between the mean angle width, measured by Shaffer grading system and by UBM, was also statistically significant (r=0.853, p<0.001). Conclusions: Assessments of the anterior segment, using a slit-lamp biomicrosope and a gonioscope, are comparable to those of A-scan and UBM measurements and are, therefore, useful for evaluation of the anterior chamber.

에이엘 스캔과 펜타캠을 이용한 전안부 계측값의 비교

윤상문,임성협,이호영,Sang Moon Youn,MD,Sung Hyup Lim,MD,Ho Young Lee,MD 대한안과학회 2014 대한안과학회지 Vol.55 No.6

Purpose: To investigate the clinical availability of AL-Scan<sup>® (Nidek, GAMAGORI, Japan) by comparing anterior segment parameters measured with AL-Scan<sup>® and Pentacam<sup>® (Oculus, Wetzlar, Germany). Methods: Seventy-three patients (117 eyes) who received refractive surgery at our hospital were tested with AL-Scan<sup>® and Pentacam<sup>®. We compared measurements including anterior chamber depth, central corneal thickness, white-to-white, and corneal curvature. Results: When comparing measurements obtained with AL-Scan<sup>® and Pentacam<sup>®, the anterior chamber depth (<em>p</em> < 0.001), central corneal thickness (<em>p</em> < 0.001) and 2.4 mm zone K value (<em>p</em> = 0.038) showed significant differences; the white-to-white (<em>p</em> = 0.348) and 3.3 mm zone K value (<em>p</em> = 0.429) showed no significant differences. All AL-Scan<sup>® and Pentacam<sup>® parameters had a strong positive linear correlation (<em>p</em> < 0.001). The Bland-Altman plots showed a high degree of agreement between AL-Scan<sup>® and Pentacam<sup>® in all parameters except for anterior chamber depth. Conclusions: AL-Scan<sup>® is convenient to use clinically because simultaneous measurements of ocular biometry including axial length, intraocular lens power, and topography are possible. However, because differences in some anterior segment parameters exist when compared with Pentacam<sup>®, measurements with AL-Scan<sup>® may require comparisons with other instruments. J Korean Ophthalmol Soc 2014;55(6):801-808

조니사미드 복용 후 발생한 급격한 근시 변화 및 전방깊이의 감소

김유진(Yoo Jin Kim),정준규(Junkyu Chung),주진호(Jin-Ho Joo),김태기(Tae Gi Kim) 대한안과학회 2020 대한안과학회지 Vol.61 No.12

목적: 항전간증제인 조니사미드에 의한 급격한 근시 변화 및 전방깊이의 감소의 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 전두엽뇌전증으로 신경과 입원 중인 40세 남자 환자가 항전간증제인 조니사미드 100 mg을 사용한 지 1일 뒤 발생한 양안의 시력저하로 내원하였다. 내원 시 환자 본인의 안경으로 측정한 최대교정시력은 양안 0.3이었고, 안압은 우안 16 mmHg, 좌안 17 mmHg였다. 굴절검사상 현재 안경에 비해 우안 -1.25 D, 좌안 -1.00 D의 근시가 유발된 것을 확인할 수 있었고, 세극등현미경검사에서 얕아진 전방 소견을 확인하였다. 조니사미드에 의한 급격한 근시 변화 및 전방깊이의 감소가 의심되어 약물 중단을 지시하였다. 약물중단 후 3일째 전방은 깊어졌으며 유발된 근시는 회복되어 환자 본인의 안경으로 측정한 최대교정시력은 1.0으로 호전되었다. 결론: 설파제제인 조니사미드는 드물게 근시 변화 및 전방깊이의 감소를 유발할 수 있어 항전간제 약물 복용 후 발생한 시력저하의 감별진단으로 조니사미드의 부작용을 고려하여야 한다. Purpose: To report a case of acute myopic change and anterior chamber depth decrease induced by zonisamide, which is an antiepileptic drug. Case summary: A 40-year-old male with no ophthalmologic history, who was admitted to the neurology department through the emergency center for evaluation and treatment of frontal lobe epilepsy, was referred to the ophthalmology department due to a visual disturbance that occurred while the patient was being treated with 100 mg of zonisamide during hospitalization. Corrected visual acuities with the patient’s own glasses were 0.3 in both eyes, with intraocular pressure of 16 and 17 mmHg in the right and left eye, respectively. Automated refraction revealed a bilateral myopic change of -1.25 diopters (D) in the right eye and -1.00 D in the left eye, and the anterior chambers in both eyes were shallow under slit-lamp examination. As we assumed these symptoms were related to the intake of zonisamide, we immediately instructed the patient to discontinue the drug. At 3 days after discontinuing the drug, his myopia improved, and corrected visual acuities with the previous glasses increased to 1.0 in both eyes. Conclusions: Zonisamide is a sulfonamide anticonvulsant that may cause acute myopic shift and a reduction in the anterior chamber depth. Therefore, physicians must consider the possibility of these complications occurring, when diagnosing a sudden blurring of vision in patients who are taking sulfonamide medications.

고령의 연령에서 굴절이상과 안광학 성분들의 연관성 분석

임병관,전순우,정연홍 한국안광학회 2011 한국안광학회지 Vol.16 No.3

Purpose: This study was to know the correlation among refractive error and the dimensions of ocular components on older adults. Methods: The subjects were 95 older age who had no eye diseases. The refractive error, corneal radius, corneal diopter, axial length, anterior chamber depth and lens thickness were measured and analysed. Results: The axial length(AL)/corneal radius(CR) ratio was positively correlated with the corneal diopter, axial length, the anterior chamber depth. Then it was negatively correlated with corneal radius. It was shown that the highest correlation was between the corneal diopter and axial length (r=-0.545, p=0.000). The spherical equivalent of the refractive error was negatively correlated with the AL/CR ratio. Conclusions: It was shown that the AL/CR ratio was a very important indicator for diagnosing the refractive error of the old age.

친수성 및 소수성 아크릴 재질의 인공수정체 삽입술 후 장기간 임상 결과의 비교분석

양민규,한영근,권지원,위원량.Min Kyu Yang. MD. Young Keun Han. MD. PhD. Ji Won Kwon. MD. PhD. Won Ryang Wee. MD. PhD 대한안과학회 2015 대한안과학회지 Vol.56 No.1

Purpose: To assess long-term clinical outcomes and factors influencing refractive change after implantation of hydrophilic (Akreos AO) and hydrophobic (Acrysof IQ) acrylic intraocular lens. Methods: After phacoemulsification, intraocular lens was inserted in the bag (Akreos AO for 84 eyes and Acrysof IQ for 19 eyes). Uncorrected visual acuities (UCVA), refraction in both spherical equivalent (SE) and astigmatism were compared longitudinally in more than 2 years follow-up. Factors associated with SE change ≥0.5 diopter (D) after Akreos AO implantation were analyzed with logistic regression. Results: Although Akreos AO showed hyperopic change mainly within 6 months, UCVA and astigmatism change were not statistically significant during follow up (+0.15 ± 0.43 D, p = 0.027). UCVA, SE, astigmatism were not changed after Acrysof IQ implantation and not significantly different between two groups during follow up. Preoperative anterior chamber depth was a sole factor associated with SE change ≥0.5 D after Akreos AO implantation (p = 0.006).Conclusions: Possible hyperopic shift after Akreos AO implantation should be considered in setting target diopter, especially in eye with shallow anterior chamber. J Korean Ophthalmol Soc 2015;56(1):33-38

초음파생체현미경과 각막지형도 검사를 이용한 전방 깊이 및 전방각 계측치

제승연,정석철,엄부섭,Seung Youn Jea,Suk Chul Jung,Boo Sup Oum 대한안과학회 2006 대한안과학회지 Vol.47 No.1

Purpose: To compare the measured values of anterior chamber depth and angle in glaucoma patients using Ultrasound Biomicroscopy (UBM) and OrbscanTM IIz Topography. Methods: We measured the anterior chamber depth and angles of four directions in 26 eyes of 13 primary open angle glaucoma (POAG) patients, 26 eyes of 13 normal tension glaucoma (NTG) patients, and 20 eyes of 10 angle closure glaucoma (ACG) patients, with UBM and Orbscan. Results: The values of anterior chamber depth did not show any difference between UBM and Orbscan. The values for anterior chamber angle in POAG and NTG eyes were not different between UBM and Orbscan, but the values for all anterior chamber angles except the superior angle, measured with UBM were significantly larger than those for ACG measured by Orbscan. Conclusions: Both UBM and Orbscan showed similar results in the measurement of anterior chamber depth and angle in POAG and NTG patients, but showed different results in the anterior chamber angle for ACG patients. UBM will be more useful in evaluating the anterior chamber angle in ACG patients because it can assess the structures of the anterior chamber angle objectively.

전안부 빛간섭단층촬영기와 이중샤임플러그 전안부사진기로 측정한 전안부 계측치의 비교

하대영,정지원 대한안과학회 2017 대한안과학회지 Vol.58 No.12

Purpose: To compare the anterior segment measurements with a Galilei® dual Scheimpflug analyzer and anterior segment optical coherence tomography (Cirrus OCT®). Methods: Forty-eight eyes of 24 normal young adults were assessed for repeatability with two identical measurements of the central corneal thickness, minimum corneal thickness, anterior chamber depth, and anterior chamber angle using the Galilei® dual- Scheimpflug analyzer and Cirrus OCT®. Results: The central corneal thickness, anterior chamber depth, and anterior chamber angle were highly reproducible and repeatable (intraclass correlation coefficient ≥ 0.90). Repeatability of the minimum corneal thickness was slightly lower (intraclass correlation coefficient ≥ 0.69). The mean corneal thickness measured using the Galilei® dual Scheimpflug analyzer was 0.26 ± 7.11 μm thinner than that measured using the Cirrus OCT®, and the mean corneal thickness was 0.37 ± 7.35 μm thicker, but was not statistically significant. The anterior chamber depth was 0.22 ± 0.08 mm deeper than the Cirrus OCT® (p < 0.007), and the anterior chamber angle was 7.87° ± 1.32° larger than the Cirrus OCT® (p = 0.04). The 95% agreements of the central corneal thickness, anterior chamber depth, and anterior chamber angle between instruments were 85.30 μm, 1.43 mm, and 27.90°, respectively, and showed a high correlation (r ≥ 0.90; p < 0.001). The repeatability of the minimum corneal thickness was slightly low (r = 0.69; p <0.001), and the range of agreement was larger (109.58 μm). Conclusions: The anterior segment measurements obtained with the dual rotating Scheimpflug camera and new anterior segment OCT in normal eyes was comparable and reproducible. However, the agreement ranges of the measured values were relatively large, so it was difficult to exchange values between instruments. 목적: Galilei® dual-Scheimpflug analyzer와 Anterior segment optical coherence tomography (Cirrus OCT®)로 측정한 전안부 계측치의 비교 및 반복성에 대해서 알아보고자 하였다. 대상과 방법: 정상인 24명의 48안을 대상으로 Galilei®와 Cirrus OCT®로 중심각막두께, 최소각막두께, 앞방깊이, 전방각을 동일한 검사자가 2회 측정하여 검사자 내 반복성을 평가하고 두 기계 간의 측정값을 비교하였다. 결과: 두 검사기구로 측정한 중심각막두께, 앞방깊이, 전방각은 모두 높은 반복성을 보였으며(급내상관계수≥0.90) 최소각막두께의 반복성은 다소 낮았다(급내상관계수≥0.69). Galilei®로 측정한 중심각막두께는 Cirrus OCT®로 측정한 값보다 평균 0.26 ± 7.11 μm 만큼 얇았고, 최소 각막두께는 평균 0.37 ± 7.35 μm 더 두껍게 측정하였으나 통계적 유의성은 없었다. 앞방깊이는 Cirrus OCT®로 측정한 값보다 평균 0.22 ± 0.08 mm 깊었고(p<0.007), 전방각은 7.87°± 1.32°더 큰 소견을 보였다(p=0.04). 두 검사기구의 중심각막두께, 앞방깊이, 전방각의 95% 일치도 범위는 각각 85.30 μm, 1.43 mm, 27.90°였으며 최소각막두께의 일치도의 범위는 다소 컸다(109.58 μm). 결론: 정상안에서 서로 다른 원리의 전안부 계측장비로 측정한 결과가 비교적 상응하는 결과를 보였고 두 장비 모두 재현성이 우수함을 알 수 있으나 계측치의 일치도 범위가 다소 커 장비 간 수치의 상호교환은 어려움을 확인하였다.