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1 대한안과학회지 2009 년제 50 권제 10 호 J Korean Ophthalmol Soc 2009;50(10): DOI : /jkos = 증례보고 = 접수번호 : 백내장수술에서 2 가지비구면인공수정체삽입후임상결과의비교 이상엽 정재림 홍진표 서경률 김응권 김태임 연세대학교의과대학안과학교실시기능개발연구소 목적 : 미세소절개창을사용하는비구면 aberration free 인공수정체 MI60 또는고식적백내장절개창을사용하는비구면 aberration free 인공수정체 Akreos AO 를삽입한환자군간의임상결과를비교하였다. 대상과방법 : 무작위로분류된두환자군에서술전, 술후 1 개월, 술후 3 개월의최대교정시력, 굴절이상, 각막난시도, 수술유발난시를비교하였고, 술후 1 개월과술후 3 개월의전체수차, 구면수차및고위수차를비교하였다. 결과 : MI60 을삽입한군이술후 1 개월에통계적으로유의하게낮은각막난시 (p=0.020) 를보였다. 수술유발난시의경우술후 1 개월 (p=0.021) 과술후 3 개월 (p=0.043) 에 MI60 삽입군이통계적으로유의하게낮은값을보였다. 구면수차및고위수차, 전체수차는술후 1 개월과 3 개월에서두군간에통계적으로유의한차이를보이지않았다. 결론 : MI60 은 Akreos AO 보다술후적은각막난시및수술유발난시를보였고, 고위수차및구면수차, 전체수차에서는두군간에큰차이를보이지않았다. < 대한안과학회지 2009:50(10): > 백내장수술은 1970년대부터실리콘이나아크릴등의새로운인공수정체재질의개발및후방인공수정체의개발과더불어초음파유화흡인술및소절개창을이용한수술과같은수술기법의발달로인해지금까지꾸준하게발전되어왔다. 최근에는환자와의사에게수술전부터수술후까지모든과정에서의편의성을높이고, 수술결과를좋게하기위한노력의 결과로점안마취제의사용, 연속원형전낭절개 (continuous curvilinear capsulorhexis), 접힘인공수정체 (foldable IOL) 및말림인공수정체 (rollable IOL) 의사용, 무봉합수술 (no stitch surgery) 등이시행되고있다. 1-4 이런노력에힘입어최근백내장수술은단순시력향상에서벗어나굴절교정및시력의질향상에초점이맞추어지고있으며, 이를위해미세소절개창을이용한수술방법 (MICS: micro incision cataract surgery) 및난시교정용인공수정체, 다초점인공수정체가사용되고있다. 수술시각막절개길이가난시에영향을줄수있다는연구가이루어지면서각막절개를최소화하려는노력이이루어 접수일 : 2009 년 2 월 25 일 심사통과일 : 2009 년 7 월 7 일 책임저자 : 김태임서울시서대문구신촌동 134 연세대학교신촌세브란스병원안과 Tel: , Fax: tikim@yuhs.ac * This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea Government (MEST) (No.M1AQ19, ) 져왔으며, 이를위해 2.0 mm 이하의미세각막절개창에삽입가능한인공수정체가개발되었다. 절개창이작아질수록수술시간의단축및빠른시력회복, 안내염의감소, 절개창관련합병증의감소, 수술유발난시의감소와같은이점이있다고알려져있으며, 이효과를극대화하기위해많은연구가진행되고있다. 5,6 시력의질을판단하는데있어서는일반적인시력측정을기초로하여, 최근연구에서는 wavefront 분석을통한고위수차및구면수차측정방법이사용되고있다 안구전체뿐만아니라각막및수정체의수차를측정하는여러기계들이개발되어, 측정된결과를바탕으로굴절교정수술을시행하여수술로인한안구전체나각막의수차변화가시력의질에미치는영향에대한연구들이진행되고있다. 11,12 기존의인공수정체는양의구면수차값을가져양의구면수차값을가진각막과함께전체안구에높은구면수차값을유발하여눈부심등의현상을심화시킬수있었는데, 이를해결하기위해음의구면수차를가지는비구면인공수정체들이개발되었다. 최근에는음의구면수차를가지는인공수정체사용시나타나는문제점들을보완하기위해 aberration free 인공수정체도사용되고있다. 13 본논문에서는미세소절개창을사용하는 aberration free 비구면인공수정체인 MI60 (Bausch & Lomb, Rochester, NY) 을삽입한환자군과, 미세소절개창용이아니면서동일한 aberration free 비구면인공수정체인 Akreos AO (Bausch & Lomb, Rochester, NY) 를삽입한환자군의수술후각막난시와수술유발난시및구면수차, 고위수차 1520

- 이상엽외 : 2 가지비구면인공수정체삽입결과 - 를비교하였다. 대상과방법 본연구는 2007년 8월부터 2008년 10월까지본원에서초음파유화백내장적출술및후방인공수정체삽입술을시행받은 31명 35안중 20안의 MI60 삽입군과 15안의 Akreos AO 삽입군을대상으로진행하였다.

2 - 이상엽외 : 2 가지비구면인공수정체삽입결과 - 를비교하였다. 대상과방법 본연구는 2007년 8월부터 2008년 10월까지본원에서초음파유화백내장적출술및후방인공수정체삽입술을시행받은 31명 35안중 20안의 MI60 삽입군과 15안의 Akreos AO 삽입군을대상으로진행하였다. 두인공수정체는환자들에게무작위로삽입하였으며, 이들모두는외상이나눈속수술의과거력, 염증, 녹내장, 망막이상및기타시력에영향을줄수있는안내질환의기왕력이없는 45세에서 85세사이의환자들로구성되었다. 수술은동일한술자에의해진행되었고, 0.5% proparacaine hydrochloride (ALCAINE, Alcon, Fort Worth, TX) 과 4% lidocaine hydrochloride 점안마취하에시행되었다. 각막절개도로투명각막절개를시행한후점탄물질을전낭에채워넣고 26 gauge 바늘을이용하여원형전낭절개를시행하였다. 모두이측투명각막절개를시행하였으나 MI60 사용시 1.8 mm 크기의절개창을, Akreos AO 사용시 3.0 mm 크기 의절개창을만들었다. 수력분리술과수력윤곽술을시행한후초음파유화기로핵의수정체유화술과피질흡입을시행하였다. 이후인공수정체를 injector system 으로삽입후관류흡입장치로점탄물질을제거하였고, 투명각막절개는기질수화를시행하였으며봉합은시행하지않았다. Akreos AO는 26% acrylic material 로구성되어있고, 굴절률은 1.458이며, 광학부는 Biconvex aspheric anterior and posterior로만들어진 aberration free 인공수정체이다. MI60 은 Akreos AO와동일한굴절률및광학부의특징을가지는 aberration free 인공수정체로, 26% hydrophilic acrylic material 로구성되어있다는점에서 Akreos와차이를보인다. MI60 은렌즈구성성분의 hydrophilic한성질로인해미세소절개창을사용하여인공수정체를삽입할수있을만큼의충분한유연성을가지게된다고알려져있다 (Table 1, Fig. 1). 모든환자는수술전, 수술후 1개월, 수술후 3개월에각각의나안시력, 최대교정시력, 안압, 각막난시, 수술유발난시등을측정하였으며, 세극등을이용하여합병증유무검사를시행하였다. 각막난시측정에는자동각막곡률계 (RK-3, Canon, Figure 1. The appearance of intraocular lenses. Table 1. Characteristics of the two IOL in the study IOL * Characteristics Akreos AO MI60 Type 1 piece 1 piece Optic material 26% Acrylic material 26% Hydrophilic acrylic Refractive index Optic shape Biconvex aspheric anterior and posterior Biconvex aspheric anterior and posterior Haptics shape One-piece 10 average angulation One-piece 0 average angulation * Intraocular lens. 1521

3 - 대한안과학회지 2009 년제 50 권제 10 호 - Table 2. Preoperative and postoperative visual acuity and refraction, corneal astigmatism, surgically induced astigmatism of Akreos AO UCVA * BCVA SE Cor. Astig. SIA П Pre op. 0.44± ± ± ±0.28 Post op. 1M 0.66± ± ± ± ±0.75 Post op. 3M 0.78± ± ± ± ±0.55 p-value * Uncorrected visual acuity; Best corrected visual acuity; Spherical equivalent; Corneal astigmatism; П Surgically induced astigmatism. Table 3. Preoperative and postoperative visual acuity and refraction, corneal astigmatism, surgically induced astigmatism of MI60 UCVA * BCVA SE Cor. Astig. SIA П Pre op. 0.36± ± ± ±0.39 Post op. 1M 0.65± ± ± ± ±0.33 Post op. 3M 0.58± ± ± ± ±0.37 p-value # # * Uncorrected visual acuity; Best corrected visual acuity; Spherical equivalent; Corneal astigmatism; П Surgically induced astigmatism; # p<0.05. Tokyo, Japan) 를이용하였고, 수술유발난시는 Jaffe s 4-point vector-polar method를사용하여분석하였다. 수술후 1개월, 3개월에서전체수차, 고위수차, 구면수차, 코마수차, 트레포일수차를 Ray tracing 방법으로 wavefront를측정하는 i- Trace (Tracey technologies, Houston, TX) 를사용하여측정하였다. 동공크기는모두 6 mm 크기상태에서측정하였다. 통계학적처리는 SPSS 12.0 for Window (SPSS Inc., Chicago, IL) 를이용하였고, Kolmogorov-Smirnov 검정상정규분포를보이지않아측정값들의비교는 Mann Whitney 검정과 KruskalWallis 검정을시행하였다. Mann-Whitney 검정의경우 p<0.05 인경우통계적으로유의하다고보았으며, Kruskal Wallis 검정에서통계적으로유의한차이가있는경우각각의집단을 Mann-Whitney 검정을통해검사한뒤 pairwise comparison이필요함을감안하여 p<0.017이나와야통계적으로유의성이있는것으로보았다. 결과 전체환자 31명중남자는 13명, 여자는 18명이었으며, 총 35안중 Akreos AO 삽입군은 15안 ( 남자 5안여자 10안 ), 평균나이 62.2세였고, MI60 삽입군은 20안 ( 남자 9안, 여자 11안 ) 평균나이 68.5세였다. Akreos AO 삽입군의수술전과술후 1개월, 3개월의시력, 최대교정시력, 굴절이상 ( 구면대응치 ), 각막난시와술후 1개월, 3개월간의수술유발난시를살펴보면, 굴절이상과수술유발난시를제외하고는통계적으로유의한차이를보였다. 각막난시의경우술후 1개월이술후 3개월때보다더큰값을보였으며, 수술유발난시 도술후 1개월에더큰값을보였다 (Table 2). Table 3은동일한항목에서 MI60 삽입군의값을보여주는것으로, 각막난시및수술유발난시를제외하고는모두통계적으로유의한차이를보였다. 각막난시는술전과술후큰차이를보이지않았으며, 수술유발난시는술후 1개월과 3개월에서큰차이를보이지않았다. 술후 1개월과 3개월에서 Akreos AO와 MI60 삽입군간에각막난시와각막난시도의차이 ( 술후각막난시에서술전각막난시를뺀값 ) 를보면, 전체적으로 MI60 삽입군의값이 Akreos AO 삽입군의값보다더작은것을알수있다 (Table 4). 이중술후 1개월에각막난시, 각막난시도의차이, 술후 1개월과술후 3개월의수술유발난시값이통계적으로유의하게 MI60 삽입군에서낮은값을보였다. 동공크기를 6 mm 로표준화시킨후술후 1개월및술후 3개월에시행한 Wavefront 분석결과를 Akreos 삽입군과 MI60 삽입군을비교하면, 대부분의값에서두군간에통계적으로유의한값을보이지않는것으로나타났다 (Table 5). 고찰 백내장수술후시력예후를결정하는인자중수술로발생하는난시와고위수차의변화는시력의질적인면을결정하는중요요소이다 백내장수술에의한난시의변화는봉합사의장력, 봉합의방법과봉합사의종류등에영향을받으며, 절개창의길이와폭, 위치에따라서도달라지는것으로알려져있다 일반적으로봉합시장력이약하고, 절개창의폭이좁으며, 절개 1522

4 - 이상엽외 : 2 가지비구면인공수정체삽입결과 - Table 4. Comparison of postoperative corneal astigmatism, surgically induced astigmatism, difference of corneal astigmatism Akreos AO MI60 p-value Cor. Astig * Post op 1M 1.05± ± Post op 3M 0.87± ± Cor. Astig Diff. Post op 1M 0.43± ± Post op 3M 0.25± ± SIA Post op 1M 1.06± ± Post op 3M 0.93± ± * Corneal astigmatism; Difference of corneal astigmatism (Post op corneal astigmatism Pre op corneal astigmatism); Surgically induced astigmatism. Table 5. Comparison of aberrations in each study group Akreos AO 1M MI60 1M Akreos AO 3M MI60 3M p-value (1M/3M) RMS total * 1.73± ± ± ± /0.012 Sph A 0.25± ± ± ± /0.117 (entire) SphA -0.02± ± ± ± /0.079 (int. optics ) SphA 0.27± ± ± ± /0.682 (Cornea) HOtotal 1.00± ± ± ± /0.762 Int. optics Trefoil6 0.05± ± ± ± /0.215 Trefoil9-0.48± ± ± ± /0.307 Coma7 0.10± ± ± ± /0.929 Coma8 0.08± ± ± ± /0.682 Entire Trefoil6 0.05± ± ± ± /0.361 Trefoil9-0.15± ± ± ± /0.762 Coma7 0.08± ± ± ± /0.509 Coma8 0.05± ± ± ± /0.762 Cornea Trefoil6 0.00± ± ± ± /0.325 Trefoil9 0.33± ± ± ± /0.556 Coma7-0.01± ± ± ± /0.202 Coma8 0.05± ± ± ± /0.762 * Root mean square of total aberrations; Spherical aberration; Root mean square of total higher order aberrations (3rd to 6th order); Internal optics. 길이가짧고절개창의위치가각막중심부로부터뒤에위치하는경우에난시의발생이감소하게된다. 이전보고에따르면절개창의크기가 1.4 mm 일때 2.8 mm 절개창을사용했을때의경우보다수술유발난시가더적었다고하였고, mm 길이의투명각막절개후주사형실리콘인공수정체를삽입한경우와 3.2 mm 절개창으로주사형아크릴인공수정체를삽입한경우, 3.4 mm 절개창으로접힘형아크릴인공수정체를삽입한경우를비교하여 3.0 mm 투명각막절개를사용하는경우난시안정화가초기부터이루어진다고하였다. 20 하지만절개창의크기와수술유발난시에연관성이없다는 보고도있는데, 백내장수술시 1.4 mm 절개창과 2.2 mm 절개창을사용했을경우수술유발난시의차이가없었다고보고와 mm 절개창과 2.75 mm 절개창에서수술유발난시의차이가없다고보고도있으며, 22 Hwang et al 19 도 2.8 mm 절개창의고전적백내장수술의경우와 2.2 mm 절개창의미세절개백내장수술을비교하였을때수술유발난시에차이가없다고보고하였다. 본연구결과를보면광학적특성이동일한두인공수정체에있었어각막절개창의크기가 1.8 mm 인경우가 3.0 mm 인경우보다수술유발난시및각막난시가더작은것으로나 1523

5 - 대한안과학회지 2009 년제 50 권제 10 호 - 타났다. 특히술후 1개월에서두렌즈사용군간의수술유발난시및각막난시의차이가술후 3개월보다더큰경향을보였는데 (Table 4) 이와같이시간이지남에따라난시의차이가줄어드는것으로보아인공수정체의광학적특성및재질이동일할경우절개창의크기에의해발생한수술유발난시및각막난시는수술후시간이지날수록줄어든다는것을알수있다. 이런경향은술후각막난시에서술전각막난시를뺀각막난시변화값의비교에서도알수있다. Table 4를보면술후 1개월의각막난시변화값이술후 3개월의각막난시변화값보다더크고이런경향은본연구에서비교한두인공수정체에서공통적으로나타났다. 나이가들면서시력의질적측면에저하가오는것은고위수차특히그중구면수차의증가와관련이깊다. 각막은양의구면수차를가지고, 수정체는음의구면수차를가져젊었을때는서로상쇄되는값을가지게되나노화가진행되면서각막표면의구면수차는큰변화가없는반면수정체는음의구면수차를잃거나양의구면수차를갖게되어전체적인구면수차가증가하게된다. 9,23,24 이와같은구면수차는눈부심 (glare) 나달무리 (halo) 와관련이있음이알려져있다. 12 구면수차뿐만이아니라코마수차는이중상 (double image) 과관련이있고고위수차는대비감도 (contrast sensitivity) 저하와관련이있음이보고되었다. 12,25 본연구결과 Akreos AO 인공수정체나 MI60 인공수정체에서전체수차와구면수차, 고위수차및트레포일수차코마수차에서대부분통계적으로유의한차이는보이지않았다. 다만 MI60 인공수정체를삽입한군의전체구면수차값이통계적으로유의하지는않지만 Akreos AO 인공수정체를삽입한군보다더작은결과를보였는데 (Table 6) 이에대해서는추가적인연구가필요할것으로생각된다. 각막수차의경우구면수차나코마수차, 트레포일수차에있어두인공수정체에서는통계적으로유의한차이를보이지않았는데각막절개창의크기가이수차변화에는영향을주지않은것으로사료된다. 비구면인공수정체는구면인공수정체에비해수술후낮은구면수차와고위수차를유도하며, 대비감도를높여주는장점을가진다고알려져있다. 12,27-29 하지만이러한비구면인공수정체가술후초점심도를낮게만들어가까운거리를보는데불편을가져온다는연구결과가있으며, 30 인공수정체의기울임이나중심이탈에의해코마수차와같은고위수차가증가하여대비감도저하및눈부심현상이나타난다는보고도있다. 31 기존의비구면인공수정체는노화현상에의해나타나는수정체의구면수차변화를보정하여최종적인전체구면수차값을 0으로만드는것을목적으로하였다. 이경우각각의안구에각막의구면수차를정확하게구할수없는경 우라면때에따라서각막의구면수차가평균치와다른경우에있어서오히려비구면인공수정체를사용함으로써구면수차를유발할수있고, 인공수정체의기울임이나중심이탈이 발생하는경우고위수차의증가를가져와시력의질적인측면에저하를유발할수있다. 본연구에사용된두인공수정체는 aberration free 인공수정체로, 술후더적은구면수차를유도하고, 인공수정체의중심이탈에따라나타날수있는다른수차이상이더적게나타난다고보고된바있다. 13 본연구에서는초점심도나대비감도와같은다른시기능평가지표들을이용하지않았는데, 각막절개창의크기가 aberration free 인공수정체사용시대비감도나초점심도에미치는영향에대해서는추가연구가필요할것으로생각된다. 결론적으로백내장수술시미세소절개창을이용하는 MI60 인공수정체를사용함으로써수술후유발되는안구수차의변화와난시를줄일수있으며, 이로인해굴절이상을최소화하여시력교정을효과적으로할수있을것으로생각된다. 참고문헌 1) Grabow HB. Topical anesthesia for cataract surgery. Eur J Implant Refractive Surg 1993;5: ) Gimbel HV, Neuhann T. Development advantages and methods of the continuous circular capsulorhexis technique. J Cataract Refract Surg 1990;16: ) Dogru M, Honda R, Omoto M, et al. Early visual results with the rollable ThinOptx intraocular lens. J Cataract Refract Surg 2004; 30: ) Pandey SK, Werner L, Agarwal A, et al. Phakonit: cataract removal through a sub 1.0 mm incision and implantation of the Thin- Optx rollable intraocular lens. J Cataract Refract Surg 2002;28: ) Long DA, Monica ML. A prospective evaluation of corneal curvature change with 3.0 to 3.5mm corneal tunnel phacoemulsification. Ophthalmology 1996;103: ) Alio JL, Rodfiguez-Prats JL, Gala A, Ramzy M. Outcomes of microincision cataract surgery versus coaxial phacoemulsification. Ophthalmology 2005;112: ) Mester U, Dillinger P, Anterist N. Impact of a modified optic design on visual function: clinical comparative study. J Cataract Refract Surg 2003;29: ) Rawer R, Stork W, Spraul CW, Lingenfelder C. Imaging quality of intraocular lenses. J Cataract Refract Surg 2005;31: ) Artal P, Berrio E, Guirao A, Piers P. Contribution of the cornea and internal surface to the change of ocular aberrations with age. J Opt Soc Am A Opt Image Sci 2002;19: ) Guirao A, Redondo M, Geraghty E, et al. Corneal optical aberrations and retinal image quality in patients in whom monofocal intraocular lenses were implanted. Arch Ophthalmol 2002;120: ) Applegate RA, Howland HC, Sharp RP, et al. Corneal aberrations and visual performance after keratotomy. J Refract Surg 1998;14:

6 - 이상엽외 : 2 가지비구면인공수정체삽입결과 - 12) Chalita MR, Chavala S, Xu M, Krueger RR. Wavefront analysis in post-lasik eyes and its correlation with visual symptoms, refraction, and topography. Ophthalmology 2004;111: ) Altmann GE, Nichamin LD, Lane SS, Pepose JS. Optical performance of 3 intraocular lens designs in the presence of decentration. J Cataract Refract Surg 2005;31: ) Holladay JT. Optical quality and refractive surgery. Int Ophthalmol Clin 2003;43: ) Jiang Y, Le Q, Yang J, Lu Y. Change in corneal astigmatism and higher order aberrations after clear corneal tunnel phacoemulsification guided by corneal topography. J Refract Surg 2006;22:S ) Steiner GA, Binder PS, Parker WT, Perl T. The natural and modified course of post-cataract astigmatism. Ophthalmic Surg 1982;13: ) Hu YJ, Lee KH, Joo CK. Comparison of surgically induced astigmatism between superior and temporal clear corneal incision in sutureless cataract surgery. J Korean Ophthalmol Soc 1998;39: ) Simsek S, Yasar T, Demirok A, et al. Effect of superior and temporal clear corneal incision on astigmatism after sutureless phacoemulsification. J Cataract Refract Surg 1998;24: ) Hwang SJ, Choi SK, Oh SH, et al. Surgically induced astigmatism and corneal higher order aberrations in microcoaxial and conventional cataract surgery. J Korean Ophthalmol Soc 2008;49: ) Ku HC, Kim HJ, Joo CK. The comparison of astigmatism according to the incision size in small incision cataract surgery. J Korean Ophthalmol Soc 2005;46: ) Cavallini GM, Campi L, Masini C, et al. Bimanual micro phacoemulsification versus coaxial mini phacoemulsification: prospective study. J Cataract Refract Surg 2007;33: ) Kurz S, Krummenauer F, Gabriel P, et al. Biaxial microincision versus coaxial small-incision clear corneal cataract surgery. Ophthalmology 2006;113: ) Oshika T, Klyce SD, Applegate RA, Howland HC. Changes in corneal wavefront aberrations with aging. Invest Ophthalmol Vis Sci 1999;40: ) Artal P, Guirao A, Berrio E, Williams DR. Compensation of corneal aberrations by the internal optics in the human eye. J Vis 2001;1: ) Applegate RA, Howland HC, Sharp RP, et al. Corneal aberrations and visual performance after radial keratotomy. J Refract Surg 1998; 14: ) Rocha K, Soriano E, Chalita M, et al. Wavefront analysis and contrast sensitivity of aspheric and spherical intraocular lenses. Am J Ophthalmol 2006;142: ) Tzelikis P, Akaishi L, Trindade F, Boteon JE. Ocular aberration and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation. J Cataract Refract Surg 2007;33: ) Caporossi A, Martone G, Casprini F, Rapisarda L. Prospective randomized study of clinical performanceof 3 aspheric and 2 spherical intraocular lenses in 250 eyes. J Refract Surg 2007;23: ) Kim HS, Kim SW, Ha BJ, et al. Ocular aberrations and contrast sensitivity in eyes implanted with aspheric and spherical intraocular lenses. J Korean Ophthalmol Soc 2008;49: ) Rocha K, Soriano E, Chamon W, et al. Spherical aberration and depth of focus in eyes implanted with aspherical and spherical intraocular lenses. Ophthalmology 2007;114: ) Oshika T, Kawana K, Hiraoka T, et al. Ocular higher-order wavefront aberration caused by major tilting of intraocular lens. Am J Ophthalmol 2005;140:

7 - 대한안과학회지 2009 년제 50 권제 10 호 - =ABSTRACT= Comparative Study of Two Aspheric, Aberration-Free Intraocular Lenses in Cataract Surgery Sang Yeop Lee, MD, Jae Lim Chung, MD, Jin Pyo Hong, MD, Kyoung Yul Seo, MD, Eung Kweon Kim, MD, PhD, Tae Im Kim, MD The Institute of Vision Research, Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea Purpose: To compare clinical outcomes of aberration-free MI60 intraocular lens (IOL) in microincision cataract surgery and an aberration-free intraocular lens, Akreos AO in conventional cataract surgery. Methods: Patients were randomly assigned to two IOL groups, and were examined preoperatively, and at one and three months postoperatively. The performed ophthalmologic evaluation included best corrected visual acuity (BCVA), measurement of refractive error, corneal astigmatism, and surgically induced astigmatism. The spherical, total, and higher-order aberration analysis of the two groups were assessed at one month and three months after operation. Results: MI60 IOL group provided significantly less corneal astigmatism (p=0.020) one month after operation, compared to Akreos AO group. The MI60 group also showed significantly less surgically-induced astigmatism at one month (p=0.021) and three months postoperatively (p=0.043). There was no statistically significant difference in the spherical, higher-order, and total aberration between the two groups at one and three months after operation. Conclusions: MI60 IOL group resulted in less corneal astigmatism and surgically induced corneal astigmatism than the Akreos AO IOL group. There was no statistically significant difference in spherical, higher-order, and total aberrations between the two groups. J Korean Ophthalmol Soc 2009;50(10): Key Words: Aberration free intraocular lens, Corneal astigmatism, MI60, Spherical aberration, Surgically induced astigmatism Address reprint requests to Tae Im Kim, MD Department of Ophthalmology, Yonsei University College of Medicine #134 Shinchon-dong, Seodaemun-gu, Seoul , Korea Tel: , Fax: , tikim@yuhs.ac 1526

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<30342D30342D333428B1E8C0E7BFEB2DBEF6C5C2BFF5293736372D3737342E687770> = 증례보고 = 대한안과학회지 2012년 제 53 권 제 6 호 J Korean Ophthalmol Soc 2012;53(6):767-774 pissn: 0378-6471 eissn: 2092-9374 http://dx.doi.org/10.3341/jkos.2012.53.6.767 두 가지 친수성 비구면 인공수정체를 삽입한 백내장 수술안에서 6개월 임상 성적