<30332D31362D B1E8C0BAC3B62DB1E8B9CEC8A E687770>

Size: px

Start display at page:

Download "<30332D31362D B1E8C0BAC3B62DB1E8B9CEC8A E687770>"

지희 권
5 years ago
Views:

1 대한안과학회지 2016 년제 57 권제 7 호 J Korean Ophthalmol Soc 2016;57(7): ISSN (Print) ISSN (Online) Original Article 고령에서의백내장수술의안정성 The Safeness of Cataract Surgery in Older Subjects 김민호 김만수 김은철 Min Ho Kim, MD, Man Soo Kim, MD, PhD, Eun Chul Kim, MD, PhD 가톨릭대학교의과대학부천성모병원안과및시과학교실 Department of Ophthalmology and Visual Science, Bucheon St. Mary s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea Purpose: To investigate the safeness of cataract surgery in older subjects by comparing the outcomes among different age groups. Methods: The present study included 150 patients (150 eyes) diagnosed with cataracts that visited the hospital from January 2014 to May 2015 and received phacoemulsification and intraocular lens implantation. The subjects were divided into 5 age groups (40-50, 50-60, 60-70, and 80-90). Among the study subjects, 30 patients from each age group were measured for best corrected visual acuity (BCVA), and endothelial cell density (ECD) 2 months after surgery. Intraoperative ultrasound time, cumulative dissipated energy (CDE) and volume of balanced salt solution were also compared among the subjects. Results: The nuclear sclerosis of cataracts before surgery was significantly lower in the (2.85 ± 1.05), (3.20 ± 0.81), and age groups (3.39 ± 0.67) than the (4.23 ± 0.68) and age groups (4.47 ± 0.51). The CDE during surgery was significantly lower in the (10.10 ± 3.20), (11.20 ± 3.20) and age groups (12.40 ± 3.50) than in the (15.10 ± 3.80) and age groups (16.70 ± 3.90; p < 0.05). BCVA was not significantly different among the age groups 2 months after surgery (p > 0.05). The reduction (%) of ECD 2 months after surgery was significantly lower in the (17.94 ± 13.50), (17.46 ± 9.08) and age groups (19.12 ± 16.01) than in the (26.36 ± 10.82) and age groups (31.80 ± 16.86; p < 0.05). Conclusions: After cataract surgery, BCVA was not significantly different among the age groups. These findings indicate that cataract surgery using phacoemulsification in older patients is recommended and a viable option since it is relatively safe and provides excellent BCVA effects. J Korean Ophthalmol Soc 2016;57(7): Keywords: Cataract surgery, Older people, Safeness Received: Revised: Accepted: Address reprint requests to Eun Chul Kim, MD, PhD Department of Ophthalmology, The Catholic University of Korea Bucheon St. Mary s Hospital, #327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea Tel: , Fax: eunchol@hanmail.net * This research was presented as a narration at the 114th Annual Meeting of the Korean Ophthalmological Society * This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2015R1A1A1A ). 백내장은노화에의한수정체의혼탁으로고령에있어서시력의상실및삶의질을저하시키는흔한원인중의하나이다. 1 우리나라의제4기국민건강영양조사자료를통한보고에따르면 40세이상에서의백내장유병률은 40.1% 이며 70세이상에서는 92.7% 로나타났다. 2 이처럼고령화사회로인해백내장의유병률이증가하고있고의학기술의발달과건강에대한높은관심으로우리나라의평균수명과노인인구의수가점차증가하게되어고령자들에대한백내장수술건수도증가하고있다. 3 고령에서의백내장수술이안전하고효과가있는것인지 c2016 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1044

2 - 김민호외 : 고령에서의백내장수술의안정성 - 에대한연구결과로고령에있어서백내장수술후의시력향상이일상활동의변화를가져와삶을질을높일수있다는보고가있었고, 세이상의초고령자를대상으로백내장수술을하였을때 80% 이상에서시력호전을기대할수있었다는보고도있었다. 8 하지만고령및이로인한수술의지연이수술후의시력예후에안좋은영향을끼칠수있다는보고도있다 현재까지우리나라에서고령자에대한수술후결과보고는있었지만연령에따른백내장수술후결과에대해분석한보고는아직없었다. 이에저자들은연령별로백내장수술의결과를비교하여고령에서의백내장수술의안정성및효과를알아보고자하였다. 대상과방법 2014년 1월부터 2015년 5월까지본원에내원하여백내장진단을받고 1명의동일술자에의해수정체초음파유화술및낭내인공수정체삽입술을시행받은총 150명환자의 150안을대상으로의무기록을후향적으로분석하였다. 모든환자들은수술전시력, 안압검사, 세극등현미경검사, 안저검사를시행하였고, 자동각막굴절력계 (RK-F1, Canon, Tokyo, Japan) 로현성굴절력을측정하였다. 또한비접촉경면현미경 (SP-8000, Konan medical Inc., Hyogo, Japan) 검사를통해중심부각막내피세포의밀도와모양을확인하였다. 그리고 Lens Opacities Classification System (LOCS) III 분류에의해핵경화정도 (nuclear opalescence, NO) 에따라 NO1 (Grade 1), NO2 (Grade 2), NO3 (Grade 3), NO4 (Grade 4), NO5 (Grade 5), NO6 (Grade 6) 의 6군으로분류하여 Garde 1에서 Grade 6까지각각 1에서 6점을부여하였다. 수술전각막내피세포의밀도측정을통해 1,500 cells/mm 2 이상인경우를분석대상에포함하였고각막혼탁, 각막이상증등의각막질환, 유리체혼탁, 연령관련황반변성, 포도막염등의망막질환, 수정체비늘증후군, 녹내장및안외상의병력, 그리고수술중수정체후낭파열, 수정체탈구, 안감염같은합병증이발생한사람은분석대상에서제외하였다. 본연구에서는수술중수정체후낭파열이 2안발생하여최종분석대상에서제외하였다. 40대부터 80대까지연령별로 5군으로분류하여각군당 30명환자의 30안을대상으로분석이이루어졌으며수정체초음파유화술및낭내인공수정체삽입술을시행받은환자들은 0.5% Proparacaine hydrochloride (Alcaine, Alcon, Puurs, Belgium) 를이용한점안마취후가파른난시축을따라서 2.75 mm 크기의투명각막절개를하였다. 그리고전방내에 1.5% sodium hyaluronate (Hyalu Inj., Hanmi, Seoul, Korea) 를주입하고수정체전낭원형절개를한뒤, 관류액으로평형염액 (BSS Plus, Alcon Laboratories Inc., Fort Worth, TX, USA) 을이용하여수력분리술, 수력분층술을시행하였다. 이후초음파유화기 (Infiniti Vision System, Alcon Laboratories Inc., Fort Worth, TX, USA) 로수정체유화술을시행하고, 관류및흡인으로피질을제거한후후방으로인공수정체를삽입하고, 관류및흡인으로남아있는점탄물질을제거하였다. 이후평형염액을전방내로주입하여전방을유지하고, 각막절개창에기질수화를시행한후수술을마쳤다. 수술후에는 0.3% Gatifloxacin 점안액 (Gatiflo, Taejoon, Seoul, Korea) 과 1% Prednisolone acetate 점안액 (PredForte, Allergen, Irvine, CA, USA) 을하루 4회씩점안하도록하였다. 모든환자들의수술중초음파유화기 (Infiniti Vision System, Alcon Laboratories Inc., Fort Worth, TX, USA) 에기록되는초음파사용시간, 누적소비에너지량 (Cumulative dissipated energy), 평형염액사용량을비교하였고수술후 2개월째시력검사, 안압검사, 자동각막굴절력계를이용한현성굴절력검사, 세극등현미경검사그리고비접촉경면현미경 (SP-8000, Konan medical Inc., Hyogo, Japan) 검사를통한각막내피세포의밀도측정을시행하였다. 본연구는가톨릭중앙의료원임상연구심사위원회 (Institutional Review Board, IRB) 승인을통해진행되었으며 ( 승인넘버 : HC 16RISI0035) 헬싱키선언을준수하였다. 통계학적인분석은나이에따른술후 logmar 시력과의관계를비교하기위해 student s t-test를이용하였고각군의차이를비교하기위해 one-way analysis of variance (ANOVA) 를이용해분석하였다. 통계처리를위해 SPSS for window 18.0 (SPSS Inc., Chicago, IL, USA) 을이용하였고 p-value의유의수준은 0.05 미만으로하였다. 결과 대상환자는총 150명 150안이었으며, 남자는 85명 85안, 여자는 65명 65안이었고, 평균연령 (± 표준편차 ) 은 ± 13.16세 ( 범위 : 40-88세 ) 였다. 40대부터 80대까지연령별로 5 군으로분류하여각군당 30명환자의 30안이분석대상이되었다. 각연령군의수술전나안및최대교정시력 (logmar) 에서는차이가없었고각막내피세포의밀도측정에서는 40대가다른군에비해서유의하게높은결과를보였다 (p<0.05). 백내장핵경화도 (Grade 1-6) 는 40대, 50대, 60대가 70대와 80대보다유의하게낮은결과를보였다 (p<0.05) (Table 1). 수술전섬모체소대용해가 6안, 소동공이 4안, 과성숙백 1045

3 - 대한안과학회지 2016 년제 57 권제 7 호 - Table 1. Preoperative clinical characteristics of each group Age (years) ± ± ± ± ± 2.23 UCVA (log MAR) 0.49 ± ± ± ± ± 0.25 BCVA (log MAR) 0.29 ± ± ± ± ± 0.16 ECD (cells/mm²) 2, ± * 2, ± , ± , ± , ± NO Grade 2.85 ± 1.05 * 3.20 ± 0.81 * 3.39 ± 0.67 * 4.23 ± ± 0.51 Values are presented as mean ± SD. UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; ECD = endothelial cell density, NO = nuclear opalescence (Grade 1-6). * p-values were calculated using one-way analysis of variance (ANOVA). The one-way ANOVA was used to check if there is the difference of each parameters among the five groups; Group A (n = 30): years, Group B (n = 30): years, Group C (n = 30): years, Group D (n = 30): years, Group E (n = 30): years. Table 2. Preoperative and intraoperative problems of cataract surgery Zonulysis Small pupil Hypermature Cataract Floppy iris syndrome CCC Extension PC rupture Total Group A (n = 30): years, Group B (n = 30): years, Group C (n = 30): years, Group D (n = 30): years, Group E (n = 30): years. CCC = continuous curvilinear capsulorhexis; PC rupture = posterior capsule rupture. Table 3. Intraoperative parameter UST (seconds) ± * ± ± ± ± CDE (%) (seconds) ± 3.20 * ± 3.20 * ± 3.50 * ± ± 3.90 Used BSS volume (ml) ± * ± * ± * ± ± Values are presented as mean ± SD. UST = ultrasound time; CDE = cumulative dissipated energy; BSS = balanced salt solution. * p-values were calculated using one-way analysis of variance (ANOVA). The one-way ANOVA was used to check if there is the difference of each parameters among the five groups; Group A (n = 30): years, Group B (n = 30): years, Group C (n = 30): years, Group D (n = 30): years, Group E (n = 30): years. Table 4. Postperative clinical characteristics of each group (postoperative day #2 months) UCVA (log MAR) 0.06 ± 0.01 * 0.09 ± ± ± ± 0.03 BCVA (log MAR) 0.03 ± ± ± ± ± 0.01 ECD loss (%) ± * ± 9.08 * ± * ± ± Values are presented as mean ± SD. UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; ECD = endothelial cell density. * p-values were calculated using one-way analysis of variance (ANOVA). The one-way ANOVA was used to check if there is the difference of each parameters among the five groups; Group A (n = 30): years, Group B (n = 30): years, Group C (n = 30): years, Group D (n = 30): years, Group E (n = 30): years. 내장이 2안관찰되었고수술중발생한합병증은후낭파열이 2안으로가장많았고, 홍채이완증후군 1안, 수정체전낭원형절개부위연장 (continuous curvilinear capsulorhexis [CCC] extension) 1안으로총 4안 (2.7%) 에서발생하였는데연령별로는 40대에서수정체전낭원형절개부위연장 (CCC extension), 50대와 80대에서후낭파열, 70대에서홍채이완증 후군이발생하였다 (Table 2). 수술중초음파사용시간은 40대가다른군에비해유의하게낮았고 (p<0.05), 사용한누적소비에너지량 (cumulative dissipated energy, CDE) 은 40대, 50대, 60대가 70대와 80대보다유의하게낮은결과를보였다 (p<0.05). 평형염액사용량도 40대, 50대, 60대가 70대와 80대에비해유의하게낮 1046

4 - 김민호외 : 고령에서의백내장수술의안정성 - Figure 1. Corneal endothelial cell loss. * p-values were calculated using one-way analysis of variance (ANOVA). The one-way ANOVA was used to check if there is the difference of corneal endothelial cell loss among the five groups; Group A (n = 30): years, Group B (n = 30): years, Group C (n = 30): years, Group D (n = 30): years, Group E (n = 30): years. 은결과를보였다 (p<0.05) (Table 3). 수술후 2 개월째모든연령에서나안및교정시력 (logmar) 이유의하게향상되었고 (p<0.05) 나안시력 (logmar) 은 40 대가다른군에비해유의하게가장큰호전을보였으나 (p<0.05) 교정시력 (logmar) 은모든연령에서유의한차이가없었다 (p>0.05). 각막내피세포의밀도측정에서는 40대, 50대, 60대가 70대와 80대에비해유의하게높은결과를보였다 (p<0.05). 그러나 70대이상에서도 2,000개이상의높은평균각막내피수를나타내는결과를보였다 (Table 4). 수술 2개월후의각막내피밀도감소 (%) 도 40대, 50대, 60 대가 70대와 80대보다유의하게낮은결과를보였다 (p<0.05) (Fig. 1). 고 찰 백내장은전세계에서안과질환중시력장애의가장흔한원인중하나로특히고령에있어서시력상실및이로인한삶의질을저하시킬수있는흔한원인이기도하다. 1 현재우리나라는고령화사회로인해백내장의유병률이증가하고있고의학기술의발달과건강에대한높은관심으로고령자들에대한백내장수술건수도해마다증가추세이다. 3 최근미국에서발표된연구자료에서도매년백내장수술을받는환자의비율이증가하고있으며이는백내장환자의수가증가하였고동시에백내장수술을할수있는의사및의료기관의증가로인한의료의접근성이증가하였기때문으로분석할수있으며우리나라의증가추세와일맥상통하는면이있다고하겠다. 12 특히우리나라에서과거에는많이볼수없었던 85세이상의초고령자에대한백내장수술건수가늘어나고있으며수술후시력향상이 87% 에서관찰되었다는보고가있다. 3 해외에서도 85세이상의환자들을대상으로한연구에서수술후시력향상이 84.3% 에서있었고, 그중 71.4% 에서 0.5 이상의시력호전이있었다고보고된바있고 6 70세이상의환자들을대상으로한다른연구에서는수술후시력향상이 88% 에서있었다는보고도있다. 13 하지만나이의증가가백내장수술후의시력예후에안좋은영향을끼친다는보고가있고 3 특히 88세이상의환자에서백내장수술시수술후합병증이발생할수있는위험성이 88세미만의환자에서보다증가한다는보고도있다. 14 고령의환자들은백내장의핵경화정도가심하고동공의크기가작으며수정체비늘증후군등의안과적질환이같이동반되어있는빈도가높다. 또한수술중협조가잘되지않는경우도있어이로인해수술이어려워질수있고이에따라합병증발생빈도가높아지게되며결국시력예후에좋지않은영향을미칠수있다. 6-10,15-19 따라서고령에서의백내장수술이과연효과적이고추천할만한것인가에대한질문을해볼수있겠으며본연구에서는연령별로백내장수술의결과를비교하여고령에서의백내장수술의안정성및효과를알아보고자하였다. 백내장수술시환자의나이와수술중합병증간의관련성에대해보고한바에따르면 Robbie et al 20 은나이에따른수술중합병증에관한연구에서 59세이하, 60에서 69세, 70에서 79세, 80에서 89세, 90세이상의 5군에서수술중합병증발생비율이각각 5.56%, 6.27%, 6.76%, 6.29%, 5.56% 로발생하였다고보고하여나이의증가가수술중합병증의위험성을증가시키지는않는다는주장을하였다. Celebi 21 도백내장수술중합병증발생위험이나이의증가와관련이없다는보고를하였다. 본연구에서는수술중합병증으로후낭파열, 홍채이완증후군, 수정체전낭원형절개부위연장이발생하였고총 150명의대상자중 4안 (2.7%) 에서발생하였다. 수술전섬모체소대용해가 6안, 소동공이 4안, 과성숙백내장이 2안관찰되었고이중 7안 (58%) 이 80대에서관찰되어고령에서수술중합병증발생위험성이높을것으로예측되었으나 80대의수술중합병증이 1안 (3.3%) 에서만발생하였으며전연령군에서발생한합병증의비율 (2.7%) 과큰차이를보이지는않았다. 이전의보고들에서는 Kim et al 3 이 85세이상환자 77안을대상으로한백내장수술후의합병증발생보고에서후낭파열이나섬모체소대해리등의합병증이총 16% 에서발생하였다는보고가있고 Celebi 21 가나이에따른백내장 1047

5 - 대한안과학회지 2016 년제 57 권제 7 호 - 수술시합병증이 59세이하에서 3.78%, 60에서 74세에서 5.17%, 75세이상에서 5.30% 의비율로발생하였다는보고를한바있다. 물론술자의경험및동반된안질환등이각각의수술결과에영향을미치는다른인자임을고려해보아야하겠지만본연구에서발생한합병증발생비율만으로보았을때이전의보고들과비교하여오히려합병증발생비율이줄어든결과를보였다. 고령의환자들은백내장의핵경화정도가심하고이에따라수술중초음파사용시간과누적소비에너지량 (Cumulative dissipated energy) 이증가하게되며이로인해각막내피의손상이발생하는것으로알려져있다 각막내피의손상으로내피세포밀도의감소가발생하며손상이심한경우각막부전이발생할수있고이로인해시력예후에좋지않은영향을미칠수도있다. 따라서수술시가급적초음파사용을최소화하는것이바람직하다고할수있다. 본연구에서는수술중초음파사용시간이 40대가다른군에비해유의하게낮았고, 누적소비에너지량 (CDE) 과평형염액사용량도 40대, 50대, 60대가 70대와 80대에비해유의하게낮은결과를보였다. 수술 2개월후의각막내피밀도감소 (%) 에서도 40대, 50대, 60대가 70대와 80대보다유의하게낮은결과를보여고령일수록초음파에노출되는시간이많고이에따라각막내피의손상이발생하는확률이높아짐을알수있었다. 하지만 70대이상에서도 2,000 개이상의높은평균각막내피수를나타내는결과를보였고각막부전등의각막내피세포감소로인한합병증소견은관찰되지않았다. 고령에서의시력장애는삶의질을저하시키고낙상으로인한골절, 특히고관절골절의위험성이증가하며동시에사망률을증가시킬수있는위험인자로알려져있다 따라서백내장수술후의시력호전은일상활동능력을향상시키고낙상으로인한골절의위험성도감소시킬수있어이로인해삶의질을향상시킬수있는것으로보고되고있다. 6-9,27 본연구에서는모든연령에서수술후 2개월째교정시력 (logmar) 이향상되었고연령간유의한차이가없는것으로나타나고령에서도백내장수술을시행하였을때시력의예후에있어서긍정적인시력호전을기대해볼수있고이로인한삶의질향상에도기여할수있을것으로생각된다. 고령의환자들은연령관련황반변성, 당뇨망막병증, 수정체비늘증후군, 녹내장등의안질환이동반되어있을확률이높고이로인해수술후의시력의예후에좋지않은영향을미칠수있다. 그러나 Robbie et al 20 과 Celebi 21 가나이의증가가수술중합병증의위험성을증가시키지는않는다는보고를하였다. 따라서고령에서의백내장수술은 환자에게시력예후및합병증에대한충분한설명이되어있다면권장하여시행할만하다고할수있겠다. 본연구에있어서의제한점으로는안질환이동반되어있지않고전신상태가비교적건강한사람들을조사대상으로하였다는점이다. 이는특히고령일수록동반되어있는안질환및전신질환이많다는점을고려하였을때전체인구를대상으로하는백내장수술의효과를대변하기에는한계가있다고할수있다. 또한대상환자수가 150안으로비교적적고, 경과관찰기간이 2개월로짧다는점으로인해추후더많은환자들의장기간경과관찰결과에대한보완이필요할것이다. 본연구를통해고령에서초음차유화술을이용한백내장수술은백내장의경도가높아초음파에너지사용이증가하여수술후각막내피손실도많은편이지만비교적안전하고시력교정효과가젊은사람과차이가없을정도로우수한결과를보였다. 따라서고령의환자들에게초음차유화술을이용한백내장수술을시행할경우젊은사람에비해시력향상이크지않을수있고합병증의발생빈도가증가할수있다는충분한설명이되어있다면권장하여시행할만하다고할수있겠다. REFERENCES 1) Evans JR, Fletcher AE, Wormald RP; MRC Trial of Assessment and Management of Older People in the Community. Causes of visual impairment in people aged 75 years and older in Britain: an add-on study to the MRC trial of assessment and management of older people in the community. Br J Ophthalmol 2004;88: ) Rim TH, Kim MH, Kim WC, et al. Cataract subtype risk factors identified from the Korea National Health and Nutrition Examination survey BMC Ophthalmol 2014;14:4. 3) Kim C, Kwon JW, Wee WR, et al. Factors affecting the visual outcome of cataract surgery in the very elderly. J Korean Ophthalmol Soc 2007;48: ) Mangione CM, Phillips RS, Lawrence MG, et al. Improved visual function and attenuation of declines in health-related quality of life after cataract extraction. Arch Ophthalmol 1994;112: ) Brenner MH, Curbow B, Javitt JC, et al. Vision change and quality of life in the elderly. Response to cataract surgery and treatment of other chronic ocular conditions. Arch Ophthalmol 1993;111: ) Lundström M, Stenevi U, Thorburn W. Cataract surgery in the very elderly. J Cataract Refract Surg 2000;26: ) Mönestam E, Wachmeister L. Impact of cataract surgery on the visual ability of the very old. Am J Ophthalmol 2004;137: ) Ji MJ, Kim MS, Lee SJ, Han SB. Evaluation of visual outcome after cataract surgery in patients aged 85 years or older. J Korean Ophthalmol Soc 2016;57: ) Westcott MC, Tuft SJ, Minassian DC. Effect of age on visual outcome following cataract extraction. Br J Ophthalmol 2000;84: ) Lumme P, Laatikainen LT. Factors affecting the visual outcome af- 1048

6 - 김민호외 : 고령에서의백내장수술의안정성 - ter cataract surgery. Int Ophthalmol ;17: ) Willerscheidt AB, Healey ML, Ireland M. Cataract surgery outcomes: importance of co-morbidities in case mix. J Cataract Refract Surg 1995;21: ) Gollogly HE, Hodge DO, St Sauver JL, Erie JC. Increasing incidence of cataract surgery: population-based study. J Cataract Refract Surg 2013;39: ) Applegate WB, Miller ST, Elam JT, et al. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients. JAMA 1987;257: ) Berler DK. Intraoperative complications during cataract surgery in the very old. Trans Am Ophthalmol Soc 2000;98:127-30; discussion ) Schein OD, Steinberg EP, Cassard SD, et al. Predictors of outcome in patients who underwent cataract surgery. Ophthalmology 1995; 102: ) Drolsum L, Haaskjold E. The influence of age on characteristics of cataract patients. Acta Ophthalmol (Copenh) 1994;72: ) Lundström M, Stenevi U, Thorburn W. Outcome of cataract surgery considering the preoperative situation: a study of possible predictors of the functional outcome. Br J Ophthalmol 1999;83: ) Norregaard JC, Hindsberger C, Alonso J, et al. Visual outcomes of cataract surgery in the United States, Canada, Denmark, and Spain. Report from the International Cataract Surgery Outcomes Study. Arch Ophthalmol 1998;116: ) Jay JL, Mammo RB, Allan D. Effect of age on visual acuity after cataract extraction. Br J Ophthalmol 1987;71: ) Robbie SJ, Muhtaseb M, Qureshi K, et al. Intraoperative complications of cataract surgery in the very old. Br J Ophthalmol 2006; 90: ) Celebi AR. The relationship between age and the intraoperative complication rate during phacoemulsification surgery. Aging Clin Exp Res 2014;26: ) O'Brien PD, Fitzpatrick P, Kilmartin DJ, Beatty S. Risk factors for endothelial cell loss after phacoemulsification surgery by a junior resident. J Cataract Refract Surg 2004;30: ) Hayashi K, Hayashi H, Nakao F, Hayashi F. Risk factors for corneal endothelial injury during phacoemulsification. J Cataract Refract Surg 1996;22: ) Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg 2000;26: ) Finger RP, Kupitz DG, Holz FG, et al. The impact of the severity of vision loss on vision-related quality of life in India: an evaluation of the IND-VFQ-33. Invest Ophthalmol Vis Sci 2011;52: ) Lamoureux EL, Fenwick E, Pesudovs K, Tan D. The impact of cataract surgery on quality of life. Curr Opin Ophthalmol 2011; 22: ) Brannan S, Dewar C, Sen J, et al. A prospective study of the rate of falls before and after cataract surgery. Br J Ophthalmol 2003; 87: = 국문초록 = 고령에서의백내장수술의안정성 목적 : 연령별로백내장수술의결과를비교하여고령에서의백내장수술의안정성을알아보고자한다. 대상과방법 : 2014 년 1 월부터 2015 년 5 월까지본원에내원하여백내장진단을받은총 150 명환자의 150 안을대상으로초음파유화술및인공수정체삽입술을시행하였다. 40 대부터 80 대까지연령별로 5 군으로분류하여각군당 30 명환자의 30 안을대상으로총 150 안의수술 2 개월후의교정시력, 각막내피밀도를측정하였고수술중의 ultrasound time, cumulative dissipated energy (CDE), balanced salt solution (BSS) 사용량을비교하였다. 결과 : 수술전백내장핵경화도는 40 대 (2.85 ± 1.05), 50 대 (3.20 ± 0.81), 60 대 (3.39 ± 0.67) 가 70 대 (4.23 ± 0.68) 와 80 대 (4.47 ± 0.51) 보다유의하게낮았다 (p<0.05). 수술중초음파총에너지량 (CDE) 은 40 대 (10.10 ± 3.20) 와 50 대 (11.20 ± 3.20) 및 60 대 (12.40 ± 3.50) 가 70 대 (15.10 ± 3.80) 와 80 대 (16.70 ± 3.90) 보다유의하게낮았다 (p<0.05). 수술후 2 개월째교정시력 (logmar) 은모든연령에서유의한차이가없었다 (p>0.05). 2 개월후의각막내피세포밀도감소 (%) 는 40 대 (17.94 ± 13.50) 와 50 대 (17.46 ± 9.08) 및 60 대 (19.12 ± 16.01) 가 70 대 (26.36 ± 10.82) 와 80 대 (31.80 ± 16.86) 보다유의하게낮았다 (p<0.05). 결론 : 백내장수술후교정시력은모든나이에서유의한차이가없었다. 수술전백내장의경도가유의하게높았던 70 대이상에서 60 대이하보다수술중초음파의에너지를많이썼으며, 수술후각막내피밀도감소가유의하게높았다. 고령에서초음차유화술을이용한백내장수술시백내장의경도가높아초음파에너지사용이증가하여수술후각막내피손실도많은편이지만비교적안전하고시력교정효과가우수하여권장하여시행할만하다. < 대한안과학회지 2016;57(7): > 1049

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770>

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실