급성폐쇄각녹내장 환자의 초기치료에서 수정체유화술과 레이저홍채절개술 비교

이창훈(Chang Hoon Lee),유인천(In Cheon You),김유라(You Ra Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

목적: 급성폐쇄각녹내장 환자들을 대상으로 수정체유화술과 레이저홍채절개술의 효과를 비교하고자 한다. 대상과 방법: 급성폐쇄각녹내장으로 진단 받은 환자 61명을 대상으로 하여 연구를 진행하였다. 레이저홍채절개술 혹은 수정체유화술을 실시하였으며, 연령, 성별, 치료 시행 전후 안압, 시력, 안압하강제의 사용 개수 및 치료 시행 후 합병증에 대해 술 후 하루, 한달, 6개월, 12개월째 후향적으로 조사하였다. 경과관찰 기간 내 레이저홍채절개술 및 수정체 유화술이 병합된 경우 및 섬유주절제술을 받은 군은 제외하였으며, 발병 후 3일 이내 시술을 시행한 경우만 포함하였다. 결과: 총 61명의 환자 중 45명이 레이저홍채절개술을, 16명이 수정체유화술을 시행 받았다. 술 후 1일째 시력(logMAR)에서는 레이저홍채절개술군이 0.62 ± 0.51로 유의하게 높았으며(p=0.048) 6개월째에는 수정체유화술군이 0.07 ± 0.15로 통계적으로 유의하게 높았지만(p=0.013) 1년째 경과 관찰 시에는 두 군 간의 유의한 차이는 보이지 않았다. 술 후 안압의 경우 1달째에 수정체유화술군의 안압이 9.5 ± 1.3 mmHg로 낮게 관찰되었으나(p=0.032) 이외의 관찰 기간에서 통계적으로 유의한 차이는 보이지 않았다. 술 후 1년째의 안압 하강제의 사용 개수는 레이저홍채절개술군 0.7 ± 0.4개, 수정체유화술군 0.4 ± 0.5개로 유의한 차이를 보였다(p=0.031). 안내염이나 시력상실 등의 심각한 합병증은 두 군에서 모두 관찰되지 않았다. 결론: 급성폐쇄각녹내장의 초기 치료로서 초기 수정체 유화술은 레이저홍채절개술에 비해 술 후 시력 및 안압, 그리고 합병증 발생에 있어 유의한 차이를 보이지 않았으며, 술 후 1년째의 안압 하강제의 사용 개수가 적었다. Purpose: We compared the outcomes of laser iridotomy and primary phacoemulsification when treating acute angle-closure glaucoma. Methods: This study was conducted with 61 patients diagnosed with acute angle closure glaucoma from January, 2005 to January, 2015. The patients received either laser iridotomy or primary phacoemulsification. The age and gender of each patient, differences of intraocular pressure (IOP) before and after treatment, visual acuity, need for IOP lowering agents and complications were analyzed retrospectively at 1-day, 1-month, 6-month and 12-month after the treatment. Patients who received laser iridotomy with phacoemulsification or trabeculectomy were excluded from this study. Additionally, we included only cases in which treatments were given within 3 days after the onset of symptom. Results: Among the 61 patients, 45 patients received laser iridotomy and 16 patients received primary phacoemulsification. One day after the treatment the laser iridotomy group showed better outcome in their visual acuity (log MAR 0.62 ± 0.51; p = 0.048). At 6-month postoperatively, the primary phacoemulsification group showed better visual acuity (log MAR 0.07 ± 0.15; p = 0.013). However, at 12-month postoperatively, the visual acuities were not significantly different between the 2 groups. Regarding IOP, at postoperative 1-month, the group of primary phacoemulsification shows significantly lower IOP (9.5 ± 1.3 mm Hg), compared with the group of laser iridotomy. A significant difference was observed in the number of IOP lowering agents that patients at 12 month after the treatment. There were no severe complications in either group. Conclusions: Following the initial treatment of acute angle-closure glaucoma, the primary phacoemulsification showed no significant differences in postoperative visual acuity, IOP and complications compared to the outcomes of laser iridotomy. Additionally, the need for IOP lowering agents was less in the primary phacoemulsification groups at 1 year after the operation.

미세각막절개 양손 백내장 수술과 고전적 백내장 수술의 비교

김현경,이현수,박신혜,주천기,Hyun Kyung Kim,Hyun Soo Lee,Shin Hae Park,Choun-Ki Joo 대한안과학회 2009 대한안과학회지 Vol.50 No.4

Purpose: To evaluate corneal endothelial cell changes after conventional coaxial phacoemulsification and bimanual microincision cataract surgery (MICS). Methods: Forty patients were divided into 2 groups, coaxial phacoemulsification (Group 1, n=20), and MICS (Group 2, n=20). To evaluate corneal endothelial cell changes after coaxial phacoemulsification and bimanual MICS, intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS®, Alcon, U.S.A) were measured. Central corneal thickness and endothelial cell count were also evaluated, preoperatively and at 1 week, and 2 months postoperatively. Results: Between the 2 groups, there was no statistically significant difference in intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS®, Alcon, U.S.A.) (p>0.05). In addition, there was no statistically significant difference between the 2 groups in endothelial cell count and central corneal thickness (p>0.05). Conclusions: When comparing bimanual MICS and conventional coaxial phacoemulsification, bimanual MICS appears to have similar endothelial cell changes. In conclusion, MICS has the same safety as compared to coaxial phacoemulsification. J Korean Ophthalmol Soc 2009;50(4):537-541

Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification

Sung Uk Baek,Kwang Hyun Kim,Joo Yeon Lee,Kyung Wha Lee 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.2

Purpose: To assess long-term changes in intraocular pressure (IOP) and the development of glaucoma after early phacoemulsification in acute primary angle closure. Methods: Retrospective chart review of acute primary angle closure patients treated with phacoemulsification in attack eyes versus fellow eyes. Within a month after the angle closure attack, all subjects underwent cataract surgery and were divided into two groups: group A received cataract surgery on their attack eyes. Group B also received cataract surgery on their fellow eye after phacoemulsification of the attack eyes. Study outcomes were the prevalence of IOP rise (occurrence of IOP >21 mmHg) and the incidence of newly developed glaucoma. Results: Eighty-nine eyes were included, with 62 attack eyes in group A and 27 fellow eyes in group B. Group A (14 eyes, 22.58%) had a higher cumulative rate of IOP rise than group B (3 eyes, 11.11%) at 12 months (p = 0.001). Newly developed glaucoma was not observed in group B; however, 6 patients in group A developed glaucoma during the 12-month follow-up period (p < 0.001). Conclusions: The attack eyes treated with phacoemulsification showed a significantly higher prevalence of IOP rise and newly developed glaucoma than fellow eyes that received phacoemulsification. These findings suggest that there is a possibility of IOP rise and development of glaucoma even when angle closure and successful IOP control have apparently been achieved after phacoemulsification.

백내장수술 중 낙하된 유리체 내 수정체 조각에 대한 유리체 내 회전진동방식 수정체유화술의 결과

김상범,이승우 대한안과학회 2020 대한안과학회지 Vol.61 No.5

목적: 백내장수술 중 유리체 내로 떨어진 수정체 조각에 대해 미세절개 유리체절제술과 같이 시행한 유리체 내 회선진동방식 수정체유화술의 치료 결과에 대해 알아보고자 하였다. 대상과 방법: 2014년 1월부터 2017년 12월까지 시행한 백내장수술 중 유리체 내로 떨어진 수정체 조각에 대해 미세절개 유리체절제술과 유리체 내 회선진동방식 수정체유화술을 시행한 후 6개월 이상 경과 관찰이 가능하였던 환자 22명 22안을 대상으로 후향적으로 연구하였다. 수술 전후의 최대교정시력과 수술 후 망막박리, 망막 째짐, 낭포황반부종, 공막절개 부위의 화상 등과 같은 합병증에 대해 조사하였다. 결과: 남자 17명, 여자 5명이었고, 평균 연령은 71.3 ± 8.2세였다. 백내장수술 후 유리체절제술까지는 평균 0.4 ± 0.8일이었으며, 모두 3일 이내에 시행되었다. 평균 최대교정시력(logMAR)은 수술 전 1.37 ± 0.79에서 수술 후 0.21 ± 0.15로 유의하게 호전이 되었다(p<0.001). 수술 중 공막절개 부위의 화상이나 수술 중 망막의 손상은 관찰이 되지 않았다. 수술 후 낭포황반부종 2예가 발생하였으나 보전적 치료로 모두 호전되었으며 망막박리가 발생한 경우는 없었다. 결론: 유리체 내로 떨어진 수정체 조각에 대한 미세절개 유리체절제술과 유리체 내의 회선진동방식 초음파유화기를 이용한 수술 방법은 수정체유화기의 첨단부에 의한 특별한 합병증 없이 시력회복을 기대할 수 있는 안전하고 효과적인 수술 방법으로 생각된다. Purpose: To evaluate the surgical outcomes of microincision pars plana vitrectomy (PPV) and intravitreal torsional phacoemulsification in eyes with dropped nuclear fragments following complicated cataract surgery. Methods: A retrospective analysis of 22 eyes of 22 patients who underwent microincison PPV for lens fragments dropped into the vitreous cavity during cataract surgery between January 2014 and December 2017 with a minimum 6-month follow-up was performed. Pre- and postoperative visual acuity, and intra- and postoperative complications (retinal detachment, retinal tear, cystoid macular edema, and thermal burns of the sclerotomy site) were recorded. Results: The study included 17 males and 5 females. The mean age of patients was 71.3 ± 8.2 years. The mean interval between cataract surgery and PPV was 0.4 ± 0.8 days, and all PPV procedures were performed within 3 days after cataract surgery. The mean best-corrected visual acuity (LogMAR) was 1.37 ± 0.79 in the preoperative state, which improved significantly to 0.21 ± 0.15 in the postoperative state (p < 0.001). No complication such as thermal burns of the sclerotomy site and retinal damage due to lens fragments occurred during intravitreal torsional phacoemulsification. Postoperative cystoid macular edema occurred in two eyes, which was managed medically. No retinal detachment was noted. Conclusions: Microincision PPV and intravitreal phacoemulsification using a torsional phacoemulsification probe for lens fragments dropped into the vitreous cavity during cataract surgery was a safe and effective method, which resulted in visual improvement without any complication directly attributable to the probe.

Comparison of Surgically-induced Astigmatism after Combined Phacoemulsification and 23-Gauge Vitrectomy: 2.2-mm vs. 2.75-mm Cataract Surgery

김용규,김용우,우세준,박규형 대한안과학회 2014 Korean Journal of Ophthalmology Vol.28 No.2

Purpose: The 2.2-mm microincision cataract surgery and small-gauge vitrectomy system is known to result inless surgically-induced astigmatism (SIA) in comparison to conventional surgical methods. We compared theamounts of SIA after combined phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy(23G-TSV) using the 2.2-mm microincision and 2.75-mm standard incision methods. Methods: We studied 59 patients (61 eyes) who underwent combined phacoemulsification and 23G-TSV fromNovember 2008 to September 2012. Twenty-eight patients (28 eyes) underwent 2.2-mm microincision coaxialphacoemulsification, and 31 patients (33 eyes) underwent 2.75-mm standard incision phacoemulsification. SIAwas evaluated using Naeser’s polar method with the simulated keratometric values obtained from corneal topography. Preoperative and 1-week and 1-month postoperative KP (Naeser’s polar value along the specific axis) andΔKP values were compared between the 2.2-mm microincision and 2.75-mm standard incision groups. Results: One week after surgery, both groups exhibited similar amounts of SIA (-ΔKP[120], 0.40 ± 0.41 vs. 0.51± 0.56 diopters [D]; p = 0.390). One month after surgery, however, the amount of SIA was significantly smallerin the 2.2-mm microincision group as compared to the 2.75-mm standard incision group (-ΔKP[120], 0.31 ± 0.54vs. 0.56 ± 0.42 D; p = 0.045). Conclusions: In combined phacoemulsification with 23G-TSV, 2.2-mm microincision coaxial phacoemulsificationinduces less SIA than does 2.75-mm standard coaxial phacoemulsification.

녹내장 환자에서 수정체초음파유화술이 녹내장의 진행에 미치는 영향과 이에 관련된 인자의 분석

유가영,황형빈,박명희,김현승 대한안과학회 2013 대한안과학회지 Vol.54 No.8

Purpose: To evaluate the factors affecting glaucoma progression after cataract surgery with phacoemulsification. Methods: The medical charts of 109 eyes of 68 patients with glaucoma who had phacoemulsification were retrospectively reviewed. The course of glaucoma was followed up for at least 2 years. Age, sex, diabetes, hypertension, preoperative mean deviation, phacoemulsification time, cataract type, refractive error, preoperative and postoperative visual acuity, preoperative and postoperative intraocular pressure, axial length, and central corneal thickness between the progression group and the non-progression group were compared. Results: Among 109 eyes with glaucoma, 19 (17.4%) eyes were classified into the glaucoma progression group. In the multivariate analysis, age (p = 0.026), preoperative mean deviation (p < 0.001), and phacoemulsification time (p < 0.001) were statistically associated with glaucoma progression. Conclusions: For patients with glaucoma, phacoemulsification may result in its progression. Special attention should be given to patients with the above risk factors.

녹내장환자에서 백내장수술 후 안압하강에 영향을 미치는 전방각경 점수 및 술 전 인자

박율리,김영빈,조경진 대한안과학회 2019 대한안과학회지 Vol.60 No.5

Purpose: To evaluate a new gonioscopy score and preoperative factors as a potential predictor for intraocular pressure (IOP) reduction after phacoemulsification. Methods: This is a retrospective review of 182 eyes with glaucoma of either open or narrow angles that underwent phacoemulsification. Preoperative variables such as age, IOP, refractive errors, anterior chamber depth (ACD), axial length, and lens position were evaluated at 6 months after surgery. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants. To determine variables associated with IOP change at 6 months, univariate and multivariate linear regression analysis was performed. Results: The mean age of the patients was 72.8 ± 9.5 years and the average preoperative IOP was 16.4 ± 3.7 mmHg with 1.2 glaucoma medications. The mean IOP reduction after phacoemulsification was 2.7 ± 2.2 mmHg at postoperative 6 months. Preoperative IOP (β = 0.55, p < 0.001), gonioscopy score (β = -0.29, p < 0.001), ACD (β = -0.67, p = 0.02), and IOP/ACD ratio (β = 0.58, p = 0.01) were associated with IOP reduction at 6 months. Conclusions: Preoperative predictors for IOP reduction after phacoemulsification were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio in patients with glaucoma. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification. 목적: 녹내장환자에서 수정체유화술 후 안압에 영향을 주는 전방각경 점수를 포함한 술 전 인자에 대해 알아보고자 하였다. 대상과 방법: 녹내장환자 중 백내장수술을 받은 182안을 대상으로 후향적 의무기록 분석을 시행하였다. 나이, 안압, 안축장, 전방 깊이, 수정체 위치, 굴절력을 술 후 6개월째에 비교 분석하였다. 술 전 전방격경 점수는 4사분면의 Shaffer 전방각경 grading을 합하여 계산하였다. 단변량 및 다변량 회귀분석을 이용하여 위 인자들과 술 후 안압의 관계를 분석하였다. 결과: 환자들의 평균 나이는 72.8 ± 9.5세, 평균 술 전 안압은 16.4 ± 3.7 mmHg로 측정되었으며, 평균 1.2개의 안압하강제를 사용하고 있었다. 술 후 6개월째에 평균 2.7 ± 2.2 mmHg의 안압하강을 보였다. 다변량 분석상 술 전 안압(β=0.55, p<0.001). 전방 깊이(β=-0.67, p=0.02), 전방각경 점수(β=-0.29, p<0.001) 및 intraocular pressure/anterior chamber depth (IOP/ACD)비(β=0.58, p=0.01)가 통계적으로 유의하게 술 후 6개월의 안압하강과 연관성을 보였다. 결론: 녹내장환자에서 수정체유화술 후 안압하강과 관련된 술 전 인자는 술 전 안압, 전방 깊이, 전방각경 점수 그리고 IOP/ACD비였다. IOP/ACD비와 전방각경 점수는 백내장수술 후 안압하강을 예측하는 데에 도움이 될 것으로 생각된다.

초음파유화술의 높고 낮은 유체 역동학 지표들에 따른 수술 결과 비교

허원재(Won Jae Heo),이진영(Jin Young Lee),김홍균(Hong Kyun Kim) 대한안과학회 2015 대한안과학회지 Vol.56 No.12

목적: 백내장 수술 장비의 유체 역동학 지표의 설정값 차이에 따른 술 중 및 술 후 결과를 비교 분석하고자 한다. 대상과 방법: 2010년 10월부터 2015년 1월까지 Lens Opacities Classification System III (LOCS III) 등급 3-4에 해당하는 노인성백내장을 가진 환자 162명의 183안을 대상으로 후향적으로 분석하였다. 초음파유화술의 역동학 지표의 설정값을 낮은 지표와 높은 지표의 두 군으로 나누어 초음파유화술을 시행하였다. 술 전 나이, 성별, 백내장 등급, 나안시력, 최대교정시력, 중심각막두께, 각막내피세포밀도를 측정하였고, 술 중 cumulative dissipated energy (CDE), 평형염액 소모량, 초음파 사용 시간, 동공크기 변화, 수술 중 합병증들을 비교하였다. 수술 후에 나안시력, 최대교정시력, 중심각막두께, 각막내피세포밀도를 측정하여 분석하였다. 결과: 초음파유화술 중 사용된 평형염액 소모량, 초음파 사용 시간, CDE는 두 군 간에 유의한 차이가 없었다. 수술 중 합병증의 발생은 두 군 간에 유의한 차이를 보이지 않았으며, 낮은 지표군에서 수술 후 동공크기 변화는 유의하게 더 작았다. 두 군 간의 수술 후7일, 30일에 측정한 나안시력, 교정시력은 차이가 없었고, 수술 후 30일에 두 군 간의 각막내피세포 감소율은 차이가 없었고, 중심각막두께 증가율은 낮은 지표군에서 낮았다. 결론: 낮은 지표를 이용한 초음파유화술은 수술 결과에서 유의한 차이를 보이지 않으면서 안정된 전방이 유지되어 보다 안전한 수술을 시행할 수 있다. Purpose: To compare the clinical outcomes between high and low fluid-dynamic parameter settings during phacoemulsification. Methods: In this retrospective study we analyzed 183 consecutive eyes with senile cataracts that underwent cataract surgery between October 2010 and January 2015. The phacoemulsifications were performed with high and low fluidic parameter settings, which were designated by different fluid heights, aspiration flow rates, and vacuum settings. We measured and compared the intraoperative factors including fluid consumption, cumulative dissipated energy (CDE), ultrasound time, intraoperative complications, and pupil size changes during the phacoemulsification. Central corneal thickness (CCT), endothelial cell density (ECD), uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) were measured and compared preoperatively and postoperatively. Results: There was no statistically significant difference in the fluid consumption, CDE, or ultrasound time during phacoemulsification between the 2 groups. The frequencies of intraoperative complications were not statistically significant. UCVA, BCVA, and ECD were not statistically significantly different between the 2 groups during the postoperative follow-up. The low parameter group showed the lower increase in CCT on postoperative day 30. Conclusions: The phacoemulsifications with low fluid-dynamic parameter resulted in less damage to intraocular tissue without any significantly different postoperative findings. The phacoemulsification with low fluid-dynamic parameter setting is more advantageous due to stable and safe aspects.

Original Articles : Surgical Outcomes for Primary Rhegmatogenous Retinal Detachments in Patients with Pseudophakia after Phacoemulsification

( Ji Won Lim ),( Soo Jeong Ryu ) 대한안과학회 2011 Korean Journal of Ophthalmology Vol.25 No.6

Purpose: To evaluate the clinical features and surgical outcomes for primary rhegmatogenous retinal detachments (RDs) in patients with pseudophakia after phacoemulsification. Methods: The medical records of patients with pseudophakia after phacoemulsification and intraocular lens implantation who had undergone surgery for primary rhegmatogenous RDs with a minimum duration of follow-up of 12 months were reviewed retrospectively. Results: A total of 104 patients were enrolled in this study and 106 eyes were analyzed. Post-operative retinal attachment was achieved in 87 of the eyes (82.1%) and the final visual acuities (logarithm of the minimum angle of resolution) were improved to 0.65 ± 0.49 from the baseline measurement of 1.51 ± 1.14 (p < 0.001). Re-operations were performed in 24 of the eyes (22.6%) and there were no visible retinal breaks in 30 of the eyes (28.3%). The failure to identify a retinal break during surgery was associated with a lower rate of retinal reattachment, worse final visual acuity, and a higher rate of re-operation (p = 0.002, p = 0.02, and p = 0.002, respectively). The location of the identified retinal break was more common in the superotemporal quadrant than in the other quadrants. Conclusions: The inability to identify a retinal break during surgery was associated with a poor final outcome. Other factors were less important for the functional and anatomic success in patients with pseudophakic RDs.

미세각막절개 백내장 수술과 고전적 백내장 수술에서의 각막내피세포의 손상정도 비교

김희중,김진형,이도형,Hee Jung Kim,Jin Hyoung Kim,Do Hyung Lee 대한안과학회 2007 대한안과학회지 Vol.48 No.1

Purpose: To evaluate the damage to corneal endothelial cells following coaxial phacoemulsification and bimanual microincision cataract surgery (MICS). Methods: We measured and compared the changes in the corneal endothelial mean cell density, cell size variation coefficient, hexagonality, and central corneal thickness in senile cataract patients who had received either coaxial phacoemulsification (Group 1, n=20), MICS using ultrasound (Group 2, n=20), and MICS using laser (Group 3, n=20). The endothelial cell parameters and corneal thickness were evaluated preoperatively and at 1 week, 1 month, and 2 months postoperatively. Results: There was no significant difference among the three groups in terms of the endothelial cell parameters and corneal thickness during two months (p>0.05). Conclusions: MICS is a safe technique that does not appear to be associated with more damage to the corneal endothelium than coaxial phacoemulsification. A longer follow-up study is necessary to investigate its potential benefits for replacing conventional surgery.