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1 대한안과학회지 2018 년제 59 권제 3 호 J Korean Ophthalmol Soc 2018;59(3): ISSN (Print) ISSN (Online) Original Article 유수정체용안내렌즈삽입술후측정된생체계측값의변화 Changes in Ocular Biometrics Measured after Implantation of a Phakic Intraocular Lens 이정후 1 류규원 2 박병건 1 Jung Hoo Lee, MD 1, Gyu Won Ryu, MD 2, Byung Gun Park, MD 1 인제대학교의과대학부산백병원안과학교실 1, 누네빛안과의원 2 Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine 1, Busan, Korea Nunevit Eye Center 2, Busan, Korea Purpose: To measure changes in ocular biometrics required for calculating intraocular lens powers during cataract surgery on phakic eyes undergoing implantation of a collamer lens (AQUA ICL [STAAR Surgical Company, Monrovia, CA, USA] or an Artiflex lens [Ophtec BV, Groningen, Netherlands]) to correct myopia. Methods: A total of 45 eyes of 23 patients who underwent implantation of iris-fixated or posterior chamber phakic intraocular lenses (piols) for correction of myopia > 7D were evaluated using the euphakic mode of the IOL Master 500 (Carl Zeiss Meditec AG, Jena, Germany) prior to piol implantation. After implantation, the axial length (AL) and anterior chamber depth (ACD) were measured 1 month postoperatively using both the euphakic and pseudophakic modes of the instrument. We compared differences between predicted IOL powers calculated using the Sanders-Retzlaff-Kraff/Theoretical (SRK/T) and Haigis formulae. Results: Seventeen eyes (37.8%) receiving ICL and 28 (62.2%) Artiflex piol implants were included in the study. After piol implantation, ALs measured by the euphakic and pseudophakic modes of the IOL Master were significantly longer (p = 0.03, p < ) and ACDs significantly shorter (p < , p < , respectively) than preoperatively. The changes after surgery were less when the euphakic rather than the pseudophakic measurement mode was employed. The postoperative IOL powers predicted by the SRK/T ( 0.03D, p = 0.023) and Haigis formulae ( 0.06D, p = 0.001) were significantly lower that the preoperative values. However, the differences were small and did not influence IOL power selection. Conclusions: After piol implantation, AL changes were less when measured using the euphakic rather than the pseudophakic mode of the IOL Master. Although the ACDs differed significantly after piol implantation, the changes were too small to influence IOL power calculations. ACD measurements differed significantly from those of AL after IOL implantation. Thus, a piol implantation history may affect biometric findings during cataract surgery. J Korean Ophthalmol Soc 2018;59(3): Keywords: Anterior chamber depth, Axial length, Phakic intraocular lens Received: Revised: Accepted: Address reprint requests to Byung Gun Park, MD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: , Fax: Kkul83@hanmail.net * Conflicts of Interest: The authors have no conflicts to disclose. 최근근시교정을위한다양한수술들이시행되고있다. 각막의형태를변형시켜교정하는시술로는굴절교정레이저각막절제술 (photo refractive keratectomy, PRK) 과 laser in situ keratomileusis (LASIK), laser subepithelial keratomileusis (LASEK) 등이경도및중등도의근시환자에서활발하게시행되고있으나, 고도근시환자에서는각막조직을안전하게제거할수있는양이제한되어적응증이 c2018 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. 223

2 - 대한안과학회지 2018 년제 59 권제 3 호 - 되지못하며근시퇴행, 각막혼탁, 각막확장증등의합병증발생이보고되고있다. 1,2 유수정체안내렌즈삽입술은이와같은각막병변의합병증을피하면서심한근시환자와각막이얇은환자에서도시행할수있는수술방법으로안정성과유효성이여러연구를통해입증되었다. 1,3 하지만고도근시가백내장진행의위험요소일뿐아니라, 유수정체안내렌즈삽입술로인한백내장발병도보고되고있고, 4-6 드물게각막내피세포손상을초래하여안내렌즈제거와함께백내장수술을고려하게되는경우가있다. 이경우유수정체안내렌즈가들어있는상태에서의생체계측을정확히하여야인공수정체도수계산에오차를줄일수있을것이다. 본연구에서는 IOL master (IOL master 500, Carl Zeiss Meditec AG, Jena, Germany) 를사용하여수술전과수술후 1개월시점의안축장과전방깊이를측정하여유수정체안내렌즈삽입안에서시행된생체계측값의정확성을알아보고자하였다. 또한수술전후의 Collamer 재질의후방유수정체안내렌즈 (AQUA ICL, STAAR surgical company, Monrovia, CA, USA) 와소수성의 polysilicone 재질의홍채고정유수정체안내렌즈 (Artiflex, Ophtec BV, Groningen, Netherlangds) 를비교하여렌즈종류가생체계측값측정에영향을주는지알아보고자하였다. 대상과방법 본연구는누네빛안과의원에서유수정체안내렌즈삽입술을시행받은평균 -11.3D의고도근시환자 23명의 45안의의무기록을후향적으로조사하였다. 의무기록에대한연구는인제대학교부산백병원의연구윤리심의위원회 (institutional review board, IRB) 의승인을받았다. 유수정체안내렌즈삽입술은한명의술자에의해시행되었으며, 14명의 28안에서 Artiflex lens 삽입술을, 9명의 17안에서 Implantable collamer lens (ICL) 삽입술을시행하였다. 모든환자에서수술전에과거병력조사, 굴절률검사, 각막곡률검사, 안압검사, 나안시력및교정시력, 세극등현미경검사, 안저검사, 각막지형도검사 (Keratograph: Oculus, Jena, Germany), 각막내피세포검사를시행하였으며, IOL master 를이용하여안축장 (axial length) 과전방깊이 (anterior chamber depth) 를측정하였다. 녹내장, 각막질환, 망막의이상, 안구에영향을주는전신질환등의안과적이상이동반된경우는수술대상에서제외하였다. 또한전방깊이가 3.0 mm 이하인경우, 각막내피세포 (corneal endothelial) 가 2,000 cells/mm 2 보다적은경우도대상에서제외되었다. 모든환자에서수술후 1달째 IOL master 의유수정체안설정과인공수정체안설정두가지방법으로안축장과전방깊이를다시한번측정하여술전과술후및측정방법간의차이를비교분석하였다. 또한실제로인공수정체도수계산에술전, 술후의안축장과전방깊이측정의차이가주는영향을알아보기위해 Sanders-Retzlaff-Kraff/ Theoretical (SRK/T) 와 Haigis 두가지공식을사용하여목표굴절력을 0D로하여인공수정체도수예측값을계산하여비교분석하였다. ICL 삽입술시행군에서는술후발생할수있는동공차단녹내장을예방하기위해서 neodymium-doped yttrium aluminium garnet (Nd-YAG) 레이저를사용하여주변부홍채절개술을시행하였으며, 시술로인해발생할수있는복시, 눈부심을예방하기위하여가능한주변부에실시하였고전안부염증반응을고려해서최소렌즈삽입술 1주전에시행하였다. 수술은환자의이측방향에 3.0 mm의투명각막절개를만들고 6시, 12시방향에각막천자를시행한후점탄물질을주입하여전방을채운후절개창으로 ICL 삽입장치끝부분을넣고 ICL을주입한뒤안내갈고리를삽입하여 ICL의지지부를부드럽게홍채뒤로밀어넣은후, 후방내에수평하게위치시켰다. ICL 도수계산은제조사 (STAAR, Surgical AG, Nidau, Switzerland) 에서제공하는프로그램을이용하였고제조사의삽입장치 (STAAR ICL injector system, Surgical AG, Nidau, Switzerland) 에장착하여삽입하였다. 기계적외상을피하기위해평형염액 (BSS, Alcon, Fort Worth, TX, USA) 을전방으로부드럽게관류하여점탄물질을제거하였다. ICL이적절하게위치된것을확인한후절개창은봉합하지않고수술을마쳤다. 술후 0.5% moxifloxacin (Vigamox, Alcon, Fort Worth, TX, USA) 과 0.5% loteprednol (Lotemax, Bausch & Lomb, Salt Lake City, UT, USA) 을하루 4회씩점안하였다. Artiflex lens 삽입술에서도수술후발생할수있는동공차단녹내장을예방하기위해서최소수술 1주전에 Nd-YAG 레이저를사용하여주변부홍채절개술을시행하였다. 상측각막으로 2.8 mm 크기의절개창을만들었고, 점탄물질을주입하여전방을채운후 polysilicone 재질의 Artiflex lens 삽입한후, enclavation 바늘과고정집게 (fixation forceps) 를이용하여렌즈양측지지부를주변부홍채에고정시켰다. 안구내점탄물질을제거한후 10-0나일론으로절개창을봉합하였다. 술후 0.5% moxifloxacin 과 0.5% loteprednol을하루 4회씩점안하였다. 통계분석은 SPSS 24.0 program (IBM Corp., Armonk, NY, USA) 을이용하여분석하였으며, Paired t-test를사용 224

3 - 이정후외 : 안내렌즈삽입술후생체계측값의변화 - 하여술전과술후의생체계측치와인공수정체도수의예측값을비교분석하였다. 삽입되는유수정체안내렌즈종류에따른생체계측치의차이를알기위해 student t-test 를사용하여 ICL과 Artiflex lens를삽입한군으로나누어비교분석하였다. p-value가 0.05 미만일경우통계적으로유의하다고판단하였다. 결과 환자의나이는평균 25.48세이며여자가 16명 (32안), 남자가 7명 (13안) 이었으며, 이들의평균굴절오차는 D 였고렌즈종류에따른유의한차이는없었다 (Table 1). 유수정체안내렌즈삽입술후유수정체안설정으로측정한안축장은술전에비해통계적으로유의하게길게측정되었고 ( mm, p=0.03), 인공수정체안설정으로측정했을때역시안축장이길게측정되었다 ( mm, p<0.0001). 전방깊이는술후유수정체안설정에서유의하게짧은것으로나타났으며 ( mm, p<0.0001), 인공수정체안설정으로측정하였을때도유의하게짧게나타났다 ( mm, p<0.0001) (Table 2). 생체계측치의변화량의술후설정방법간의비교에서안축장측정값의변화는유수정체안설정이인공수정체안설정에비해유의하게차이가적었고 (p<0.0001), 전방깊이의측정값의변화에서도유수정체안설정이인공수정체안설정에비해차이가적었지만통계적으로유의하지는않았다 (p=0.228) (Table 2). 유수정체안설정으로측정한생체계측값을유수정체안내렌즈종류에따라두군으로나누어분석해보면, 안축장측정값은두군간에통계적으로유의한차이를보이지않았으며 (p=0.146, p=0.097), 측정값의변화량의차이도통계적으로유의하지않았다 (p=0.23). 전방깊이측정값은 ICL과 Artiflex lens 삽입술후모두술전보다유의하게짧게측정되었으며 (p<0.0001, p=0.01), 측정값의차이는 ICL ( mm) 이 Artiflex lens ( mm) 보다유의하게크게측정되었다 (p=0.01) (Table 3). 수술전과수술후의측정값을통한인공수정체도수계산에서예측값의차이는유수정체안설정에서 SRK/T 공식 (-0.03D, p=0.023) 과 Haigis 공식 (-0.06D, p=0.001) 모두술전에비해유의하게작게계산되었으며, 인공수정체안설정에서는 SRK/T 공식 (-0.34D, p<0.001) 과 Haigis 공식 (-0.38D, p<0.001) 에서모두유의한변화가있었을뿐아니라유수정체안설정에비교하여보다큰차이를보였다 (Table 4). 고찰 근시를교정하기위해레이저각막절삭가공성형술 (LASIK), 굴절교정레이저각막절제술 (PRK) 등엑시머레이저를이용한굴절교정수술들이경도및중등도의근시환자에서좋은치료성적을나타내고있지만각막의형태를변형시키기때문에각막확장증, 각막의혼탁등의합병증이나타날수있으며, 안전하게제거할수있는각막조직의양 Table 1. Patient characteristics of implantable collamerlens (ICL) and Artiflex groups ICL Artiflex p-value Eyes (n, %) Age (years) 17 (37.8) ± (62.2) ± Gender (male/female) 2/7 5/9 SE (D) ± ± Values are presented as mean ± SD or n (%) unless otherwise indicated. By student t-test. SE = spherical equivalent; D = diopter. Table 2. Comparision of Ocular biometry measurements and IOL master mode after phakic intraocular lens implantation Preoperative (mm) IOL master mode Postoperative (mm) Change of biometry p-value * p-value AL ± 0.99 Euphakic ± * <0.001 Pseudophakic ± <0.001 * ACD 3.81 ± 0.14 Euphakic 3.69 ± <0.001 * Pseudophakic 3.58 ± <0.001 * Values are presented as mean ± SD unless otherwise indicated. Preoperative values measured by euphakic mode. Change of ocular biometry means postoperative ocular biometry- preoperative ocular biometry. AL = axial length; ACD = anterior chamber depth. * Statistically significant difference (p < 0.05, paired t-test). Comparision of between preoperative and postopertive biometry; Statistically significant difference (p < 0.05, paired t-test). Comparision of between IOL master mode (euphakic and pseudophakic). 225

4 - 대한안과학회지 2018 년제 59 권제 3 호 - Table 3. The change of ocular biometry after ICL and Artiflex lens implantation Preoperative (mm) Postoperative (mm) p-value AL ICL ± ± Artiflex ± ± Total ± ± * ACD ICL 3.74 ± ± 0.15 <0.001 * Artiflex 3.88 ± ± * Total 3.81 ± ± 0.35 <0.001 * Values are presented as mean ± SD unless otherwise indicated. Postoperative values measured by euphakic mode. AL = axial length; ICL = implantable collamer lens; ACD = anterior chamber depth. * Statistically significant difference (p < 0.05, paired t-test). Table 4. Comparision of predicted IOL power after phakic intraocular lens implantation Preoperative predicted IOL power (D) IOL master mode Postoperative predicted IOL power (D) Change of predicted IOL power (D) p-value * p-value SRK/T ± 2.72 Euphakic ± * <0.001 Pseudophakic ± <0.001 * Haigis ± 2.72 Euphakic ± * <0.001 Pseudophakic ± <0.001 * Values are presented as mean ± SD unless otherwise indicated. Preoperative values measured by euphakic mode. Change of ocular predicted IOL power means postoperative predicted IOL power - preoperative predicted IOL power. SRK/T = Sanders-Retzlaff-Kraff/Theoretical; IOL = intraocular lens. * Statistically significant difference (p < 0.05, paired t-test). Comparision of between preoperative and postopertivepredicted IOL power; Statistically significant difference (p < 0.05, paired t-test). Comparision of between IOL master mode (euphakic and pseudophakic). 이제한되기때문에고도근시환자에서는적응증이되지못하는한계점이있다. 7 유수정체안내렌즈삽입술은이와같은각막병변의합병증을피하면서심한고도근시환자와각막이얇은환자에서도적응증이될수있어효과적으로사용되고있다. 삽입된렌즈의교환이나제거가가능하여가역성이있으며, 대비감도의저하가적고굴절률의안정화가빠르다. 이런장점을가지는유수정체안내렌즈는고정하는위치에따라 ICL과같은후방유수정체안내렌즈와 Phakic 6H lens 와같은전방각지지렌즈, Artiflex lens와 Artisan lens 같은홍채고정유수정체안내렌즈로나누어진다. 전방각지지렌즈는광학부를동공의중심에위치시키기어려운단점이있고, 녹내장, 야간눈부심, 인공수정체편위등의합병증이나타날수있다. 8.9 홍채고정유수정체안내렌즈는안정성이높아렌즈의편위가적고광학부를동공의중심에위치시키기도용이하며전방각의구조에영향을적게받는장점이있다. 8,10,11 위와같이전방에고정하는렌즈의경우각막내피와의거리가가깝기때문에내피세포에손상의위험이높으나후방유수정체안내렌즈는수정체와의접촉가능성으로인하여백내장의발생률이상대적으로높으며, 동공차단녹내장의발생빈도가더높다. 12,13 유수정체안내렌즈수술의경우심한고도근시환자에 서도적응증이될수있는장점이있지만이런근시안에서정상안에비해후낭하백내장과핵백내장의발생률이높은것으로보고되었다. 14,15 또한여러연구들에서 ICL과 Artiflex lens 삽입술후에백내장의진행이보고되었기때문에유수정체안내렌즈를삽입한고도근시안에서백내장성변화가가속화될것으로추측할수있다. 4,5,15,16 그외에도수술당시의연령이높은경우수술후홍채섬모체염과같은만성염증으로스테로이드점안제를장기간사용한경우, 유수정체안내렌즈와수정체의기계적인접촉이있는경우백내장발생의위험을높일수있다. 또수술중외상은주로후방유수정체안내렌즈에서발생할수있으며초기에발생하는백내장의가장중요한원인이되며, 수술전레이저홍채절개술에의해서도백내장을발생시킬수있다 또한유수정체안내렌즈삽입수술후각막내피손상에대해서도여러임상연구에서보고된바있다. 11,22,23 이러한원인으로는수술중각막절개에의한직접적인각막내피세포손상등의외과적인손상, 수술후인공수정체와각막내피세포간에간헐적혹은지속적인접촉에의한기계적인손상, 연령이증가함에따라수정체의두께가증가하여전방깊이가좁아져발생하는손상등을생각할수있으며, 이경우에추가적인각막내피의손상을막기 226

5 - 이정후외 : 안내렌즈삽입술후생체계측값의변화 - 위해서는유수정체안내렌즈제거가고려되어야한다. 이러한원인들로시력교정의목적으로, 또는백내장치료목적등으로유수정체안내렌즈제거와함께백내장수술을동시에시행하는것을고려할수있을것이다. 유수정체안내렌즈의제거와백내장수술함께하였을경우, 그렇지않은경우보다오차가발생할수있다는보고가있어유수정체안내렌즈삽입안에서의생체계측값으로정확한인공수정체도수결정에어려움이있을것으로예상할수있다. 6 본연구에서유수정체안내렌즈삽입술후안축장은술전에측정한값보다유수정체안과인공수정체안설정에서모두통계적으로유의하게길게측정되었으며그안축장측정값의변화량은유수정체안설정이인공수정체안설정보다유의하게작았다. IOL master 에서는각막의정점로부터망막색소상피까지의거리로안축장을측정하는데, 안축장이길게측정되는원인은정확히알수없으나, Sanders et al 28 은고도근시환자에서수술전중심와로기계의광원을정확하게주시하지못하다가술후정시에가까운시력을가지게되면서중심와로기계의광원을정확하게주시할수있게되어안축장이길게측정되었을것이라추정하였다. 인공수정체의도수계산에효과적인렌즈위치 (effective lens position) 의중요성이부각되면서최근전방깊이를고려하여계산하는 Haigis 공식을포함하여여러가지공식들이사용되고있다. 29 기존의연구결과와같이본연구에서도전방깊이의측정값이수술전과유의하게달라지는것을확인할수있었고, 30 안축장의차이보다큰차이를보여전방깊이를고려한인공수정체계산공식사용에영향을미칠것으로생각할수있다. 기존연구에서는유수정체안내렌즈삽입안의 A-scan을이용한측정보다 (-1.07~1.31 mm) IOL master 를이용한측정 (-0.05~0.08 mm) 이정확하다는보고가있었다. 16 A-scan은접촉식으로검사과정상생기는각막의함입으로비접촉식인 IOL master 보다안축장이짧게측정될수있고, 31 또안축장측정원리의차이로초음파방식생체계측은기기에의해생성된초음파가안구를통과하면서성질이다른조직의경계면에서반사되어이를탐침자를이용해수신하여측정하는원리로각막으로부터인공수정체까지의거리를계산하고 32 IOL master 는측부에서세극등현미경의광원을조사하여이미지를분석하는원리로각막으로부터수정체까지의거리를계산하기때문에 A-scan보다 IOL master 이정확히측정되는것으로생각된다. 33 A-scan보다는정확하지만 Su et al 34 은 IOL master 에서도 IOL의렌즈표면에서 light-emitting diode (LED) 관 련빛반사로인해전방깊이를각막에서부터인공수정체표면까지의거리로잘못측정하여전방깊이가짧게측정될수있다고하였다. 실제인공수정체도수계산에서는 SRK/T 공식과 Haigis 공식모두작게측정되었는데, 일반적으로인공수정체가 0.5D 간격으로사용되고있음을생각해보면유수정체안설정에서보인 D의인공수정체도수차이는임상적으로큰의미를가지지않는것으로생각할수있다. 그러나인공수정체안설정에서는그차이가 D 정도의차이를보여인공수정체도수설정에충분히영향을미칠수있으므로유수정체안내렌즈삽입안에서의생체계측값은유수정체안설정이정확하다고할수있겠다. 본연구에서실제로인공수정체도수의예측값의변화량은 SRK/T보다 Haigis 공식에서통계적으로유의하게큰차이를보였는데이는유수정체안내렌즈수술후의전방깊이의변화에의한것으로생각된다. 그러나두공식간의차이는 0.027D로임상적으로가지는의미는크지않을것으로보인다. 다만예측값의차이가 SRK/T와 Haigis 공식모두유수정체안설정이인공수정체안설정에비해유의하게차이가적었으므로유수정체안내렌즈삽입안에서는유수정체안설정으로측정하는것이오차를줄일수있음을알수있었다. 렌즈의종류에따른안축장측정값은 ICL (+0.01 mm) 이 Artiflex lens (+0.02 mm) 보다길게측정되었으나통계적으로유의한차이를보이지않았으며 (p=0.146, p=0.097) 두렌즈간의차이도통계적으로유의한차이는없었다 (p=0.23). 전방깊이측정값은 ICL과 Artiflex lens 삽입술후모두술전보다유의하게짧게측정되었으며 (p<0.0001, p=0.01), 수술전후측정값의차이는 ICL ( mm) 이 Artiflex lens ( mm) 보다유의하게큰차이를보였다 (p=0.01) (Table 3). 안축장의측정에는렌즈의종류에따른큰차이가없었으나전방깊이에서는의미있는차이를보였다. Hoffer는렌즈의재질에따라매질을통과하는속도의차이로생체계측값의차이가발생할수있다고하였으나본연구에서는고정방법과렌즈재질이모두다른 2개의렌즈를비교하였던것이제한점이다. 국내의경우 ICL 삽입술후 A-scan을이용하여안축장을측정한연구는있으나, 35 아직까지유수정체안내렌즈삽입술후생체계측에대한임상적인보고가부족하다. 본연구에서는홍채고정및후방유수정체안내렌즈삽입술후 IOL master 을사용하여수술전후및설정방법간안축장과전방깊이의차이를확인하였고이를통해실제인공수정체도수계산에서그차이가가지는의미를알수 227

6 - 대한안과학회지 2018 년제 59 권제 3 호 - 있었다. 요약하면, 유수정체안내렌즈삽입술후 IOL master 를사용하여안축장을측정할경우유수정체안설정이인공수정체안설정보다정확하며, 유수정체안내렌즈로인한생체계측의오류는임상적으로큰의미를가지지않는것으로보인다. 전방깊이측정은안축장측정에비해유수정체안내렌즈삽입술후보다많은차이를보였으나전방깊이를고려한인공수정체계산공식에서도임상적으로유의미한차이는보이지않았다. 다만유수정체안설정을사용한다면보다더정확한인공수정체도수를계산할수있었다. 유수정체안내렌즈삽입안에서백내장수술을계획하고생체계측을시행할때에는이러한차이를유념해야할것으로생각된다. REFERENCES 1) Dawson DG, Randleman JB, Grossniklaus HE, et al. Corneal ectasia after excimer laser keratorefractive surgery: histopathology, ultrastructure, and pathophysiology. Ophthalmology 2008;115: ) Geggel HS, Talley AR. Delayed onset keratectasia following laser in situ keratomileusis. J Cataract Refract Surg 1999;25: ) Guell JL, Vázquez M, Gris O. Adjustable refractive surgery: 6-mm Artisan lens plus laser in situ keratomileusis for the correction of high myopia. Ophthalmology 2001;108: ) Fernandes P, González-Méijome JM, Madrid-Costa D, et al. Implantable collamer posterior chamber intraocular lenses: a review of potential complications. 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7 - 이정후외 : 안내렌즈삽입술후생체계측값의변화 - Cataract Refract Surg 1990;16: ) Vetrugno M, Cardascia N, Cardia L. Anterior chamber depth measured by two methods in myopic and hyperopic phakic IOL implant. Br J Ophthalmol 2000;84: ) Sheng H, Bottjer CA, Bullimore MA. Ocular component measurement using the Zeiss IOLMaster. Optom Vis Sci 2004;81: ) Su PF, Lo AY, Hu CY, Chang SW. Anterior chamber depth measurement in phakic and pseudophakic eyes. Optom Vis Sci 2008; 85: ) Seok JY, Lee D, Kyung H, Kim JM. Axial length change after implantable collamer lens implantation. J Korean Ophthalmol Soc 2013;54: = 국문초록 = 유수정체용안내렌즈삽입술후측정된생체계측값의변화 목적 : 고도근시환자의근시교정을위해 Implantable collamer lens (AQUA ICL, STAAR surgical company, Monrovia, CA, USA) 및 Artiflex R lens (Artiflex, Ophtec BV, Netherlands) 삽입술을시행받은눈에서백내장수술시안내렌즈도수계산에있어필요한생체계측값의변화를알아보고자한다. 대상과방법 : -7D 이상의근시환자의교정을위해후방유수정체및홍채고정안내렌즈삽입술 (ICL 또는 Artiflex R lens) 을시행받은환자 23 명의 45 안구를대상으로안내렌즈삽입술전에 IOL master R (IOL master 500, Carl Zeiss Meditec AG, Jena, Germany) 의유수정체안설정 (euphakic mode) 으로안축장과전방깊이를측정한후, 술후한달째유수정체안설정과인공수정체안설정 (pseudophakic mode) 으로안축장과전방깊이를측정하여수술전후와측정설정간의차이를비교분석하였다. Sanders-Retzlaff-Kraff/Theoretical (SRK/T) 공식과 Haigis 공식을사용하여측정한인공수정체도수예측치의차이를비교분석하였다. 결과 : 45 안구중 17 안 (37.8%) 이 ICL 삽입술을받았고 28 안 (62.2%) 이 Artiflex R lens 삽입술을받았다. 유수정체안내렌즈삽입술후유수정체안과인공수정체안설정모두안축장이술전에비해통계적으로유의하게길게측정되었고 (p=0.03, p<0.0001), 전방깊이의측정에서도두가지설정모두에서유의하게짧은것으로나타났다 (p<0.0001, p<0.0001). 안축장과전방깊이의측정값의변화는유수정체안설정이인공수정체안설정에비해차이가적었다. 인공수정체도수의예측값 (predicted IOL power) 은 SRK/T 공식과 (-0.03D, p=0.023), Haigis 공식 (-0.06D, p=0.001) 모두술전에비해유의하게작게계산되었으나, 인공수정체도수선택에영향을주지않을정도로작은차이를보였다. 결론 : 유수정체안내렌즈삽입술후생체계측치측정에있어 IOL master R 의유수정체안설정이인공수정체안설정보다수술전과비슷하게측정되며통계적으로유의미한차이를보이나임상적으로안내렌즈도수계산에영향을미칠정도는아니었다. 전방깊이측정은안축장측정에비해안내렌즈삽입술후보다많은차이를보였다. 유수정체안내렌즈삽인안에서백내장수술시생체계측치의차이가있을수있음을유념해야할것으로생각된다. < 대한안과학회지 2018;59(3): > 229

<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