대한안과학회지 2016 년제 57 권제 12 호 J Korean Ophthalmol Soc 2016;57(12):1891-1896 ISSN 0378-6471 (Print) ISSN 2092-9374 (Online) http://dx.doi.org/10.3341/jkos.2016.57.12.1891 Original Article 일체형과삼체형인공수정체삽입시도수산출공식간의술후굴절예측의정확성비교 Accuracy of Three Intraocular Lens-power Formulas in Predicting Refractive Outcomes in Different Intraocular Lenses 강승일 1 문건 2 전종화 1 Sung Il Kang, MD 1, Kun Moon, MD 2, Jong Hwa Jun, MD, PhD 1 계명대학교의과대학안과학교실 1, 강남더밝은안과 2 Department of Ophthalmology, Keimyung University School of Medicine 1, Daegu, Korea Gang-Nam the Bright Eye Clinic 2, Seoul, Korea Purpose: To compare the accuracy of different power-calculation formulas in predicting the postoperative refraction of three-piece and one-piece intraocular lenses (IOL). Methods: We retrospectively reviewed the medical records of 74 eyes (62 patients) that had undergone cataract surgery involving implantation of one of two IOLs the SENSAR AAB00 1-Piece Acrylic IOL (44 eyes), or the Hoya VA60BB 3-Piece Acrylic IOL (30 eyes) between October 2014 and March 2015. Axial length was measured using an optical low-coherence refractometry (Lenstar ), and biometry was then calculated by the pre-installed Lenstar program, which used the SRK/II, Sanders-Retzlaff-Kraff/Theoretical (SRK/T), and Hoffer Q formulas. Mean absolute error (MAE) and mean numeric error (MNE) were measured 1 day, 1 week, 1 month, and 2 months after surgery. Results: Using the SRK/T and Hoffer Q formulas, the one-piece IOL group differed significantly from the three-piece IOL group in terms of the MNE obtained 1 month and 2 months after surgery. Across all formulas and time points, there were no significant differences between the groups in terms of MAE. Conclusions: There was no significant difference between the different power-calculation formulas. Starting 1 month after surgery, the three-piece IOL group showed myopic postoperative refraction compared to the predictive spherical equivalent using the SRK/T and Hoffer Q formulas. J Korean Ophthalmol Soc 2016;57(12):1891-1896 Keywords: Intraocular lenses, Intraocular lens power formula, Mean absolute error, Mean numeric error Received: 2016. 7. 21. Revised: 2016. 9. 16. Accepted: 2016. 11. 21. Address reprint requests to Jong Hwa Jun, MD, PhD Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-7702, Fax: 82-53-250-7705 E-mail: junjonghwa@gmail.com * This study was presented as a poster at the 114th Annual Meeting of the Korean Ophthalmological Society 2015. 백내장수술은과거, 단순히수정체의혼탁을제거하는목적에서최근에는적극적굴절교정수술로서그패러다임이변화하고있다. 백내장수술이굴절교정수술로서기능하기위해서는절개창에의해발생하는난시를최소화하기위한작은절개창과정확한인공수정체도수산출, 난시교정용인공수정체, 다초점인공수정체등이필요하게되었다. 이중에서술자의요인을배제할경우가장중요한인자는정확한술전인공수정체도수산출을통한정확한술후굴절예측이다. 1 또한인공수정체의특성을파악하여 c2016 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1891
- 대한안과학회지 2016 년제 57 권제 12 호 - 수정체낭내안정성을높이는것이술후굴절예측오차를줄이며이를통해굴절변화가작아지고환자의만족도도향상시킬수있다. 2 최근에는환자안구의해부학적특징에특성화된도수산출공식을선택하여술후굴절값을정확히예측하고또한이의오차를줄이기위한노력들이이루어지고있다. 이에따라 SRK/II, SRK/T, Hoffer Q, Haigis 등에의한도수산출과그에의한술후굴절값을서로비교하여공식간정확성을비교하는데, 정상적인안구의안축장은전방깊이와각막곡률의차이가크지않기때문에안축장의길이가 23.0 mm에서 25.0 mm 사이인눈에서는각공식간의유의한차이가없다고알려져있다. 3-7 최근까지도많이사용되고있는 Hoffer Q, SRK/T와같은 3세대회귀추정산출공식은유효렌즈위치의계산에전방깊이의실측치가아닌각막곡률치와안축장의측정치로추정하는방식을사용하고있으나아직까지임상적으로정확한예측에는한계가있다. 다만, 통상적인안축장의길이범위를벗어나는경우짧은안축장을가진환자에서는 Hoffer Q 공식이, 긴안축장을가진환자에서는 SRK/T 공식이높은예측을보인다고보고하고있다. 5,8 만약술자에의한오차가없다고가정한다면가장중요한오차를일으키는원인은인공수정체도수산출과인공수정체의선택에따른차이일것이다. 이러한이유에서본연구는삼체형과일체형단초점인공수정체를두군으로나누어인공수정체의형태에따른안정성을비교하였다. 또한 SRK/II, SRK/T, Hoffer Q 세가지공식을비교하여공식에의한도수예측의정확도와방향성을기간별비교를통하여알아보고자하였다 대상과방법 2014년 10월부터 2015년 3월까지강남더밝은안과에서한명의술자 (M.K.) 에의해백내장수술을시행한 62명 74 안을대상으로의무기록을기초로한후향적인연구를시행하였다. 대상환자들의성별, 나이, 술전측정한안축장의 길이 (mm), 각막곡률을조사하고술전, 술후 1일, 1주일, 1개월및 2개월에각각자동굴절검사기 (CANON, RK-F1, Tokyo, JAPAN) 로측정한굴절값의구면렌즈대응치를조사하였다. 각환자들의술전안축장길이와각막곡률은저간섭성반사계 (Lenstar, Haag-Streit International, Köniz, Switzerland) 를사용하여측정하였고삽입될인공수정체의도수산출은반사계에내장된인공수정체도수산출공식프로그램 (Eyesuite, Haag-Streit International, Köniz, Switzerland) 을사용하였다. 일체형인공수정체인 SENSAR (AAB00, AMO Inc., Santa Ana, CA, USA) 을사용한환자를 1군으로삼체형인 HOYA (VA60BB, Hoya Corporation Ltd., Tokyo, Japan) 를사용한환자를 2군으로설정하였고 (Table 1), 두군은각각 SRK/II (A군) 와 SRK/T (B군), Hoffer Q (C군) 의아군으로각각나누어분석하였다. A-상수는내장된인공수정체도수산출공식프로그램 (Eyesuite ) 을이용하여일체형은 118.8, 삼체형은 118.5를사용하였다. 백내장수술은 0.5% proparacaine hydrochloride (Alcaine, Alcon, Puurs, Belgium) 를이용한점안마취후점탄물질을전방내에주입한후 4.5-5.5 mm 직경의원형전낭절개술을시행하고평형염액 (BSS Plus, Alcon, Fort Worth, TX, USA) 을이용하여수력분리술과수력분층술을실시하였다. 초음파수술기구 (Legacy, Alcon Laboratories, Inc., Fort Worth, TX, USA) 를이용하여 Phaco chop 기법으로핵정복을하고수정체유화술을시행한후, 수정체낭내에인공수정체를삽입하였다. 경우에따라, 일체형인공수정체와삼체형인공수정체를삽입하였다. 이후점탄물질 (Unial inj, Unimed pharm Inc., Asan, Korea) 을관류흡인장치를통해제거하고전방을평형염액으로유지시킨후절개창의각막수화를시행한후수술을종료하였다. 수술후에는 1% Prednisolone acetate (PredForte, Allergen, Irvine, CA, USA) 와 0.5% Moxifloxacin (Vigamox, Alcon, Fort Worth, TX, USA) 을하루 4번씩한달간점안하였다. 술전굴절값 ( 구면렌즈대응치 ) 이 ±6.0D 이상이거나난시가 3.0D 이상인경우, 술전안축장이 26 mm 이상인경우, 안내수술을받은과거력이있거나각막병변, 포도막염이나안내염증의과거력이있었 Table 1. Preoperative demographic characteristics Group 1 Group 2 p-value Number of patients (eyes) 38 (44) 24 (30) Age (years) 68.66 ± 5.06 67.03 ± 6.90 0.275 * Sex (male:female) 12:32 12:18 0.314 Axial length (mm) 23.31 ± 0.72 23.25 ± 0.70 0.730 * Anterior chamber depth (mm) 3.04 ± 0.30 3.04 ± 0.39 0.974 * Preop mean K (D) 44.17 ± 1.23 44.53 ± 1.67 0.309 * Values are presented as mean ± standard deviations. Group 1: one piece lens type, Group 2: three piece lens type. * Statistical significance were tested by Independent t-test; Statistical significance were tested by Chi-square test. 1892
- 강승일외 : 인공수정체도수공식비교 - 던경우, 녹내장, 술중후낭파열이나유리체소실, 술후안내염이발생하였거나, 후낭혼탁이심하여레이저후낭절개술을받은경우는본연구에서제외하였다. 술후 1일과 1주, 1개월과 2개월째내원시각각자동굴절검사기를이용하여굴절값측정을시행하였으며, 이를바탕으로각도수산출공식의예측굴절값과술후실측치를비교하여각도수산출공식의오차를측정하였다. 도수산출공식의평균실제오차 (mean numeric error, MNE) 는각시점별자동굴절검사결과의구면렌즈대응치에서술전도수산출공식에서계산된예측굴절값을뺀값으로정의하였다. 음의실제오차는최종굴절력이예상보다근시임을, 양의실제오차는원시임을뜻한다. 평균실제오차 (MNE) = ( 각기간별 ) 실제구면렌즈대응치 술전예측굴절값평균절대오차 (mean absolute error, MAE) 는오차의절대치를계산한값들의평균으로산출하며단위는디옵터 (diopter) 를사용하였고 D로표기하였다. 본연구는인증된연구윤리심의위원회 (institutional review board, IRB) 의승인을받았고헬싱키선언 (Declaration of Helsinki) 을준수하였다. 세가지도수산출공식을일체형과삼체형간에각각아군별로 Independent T-test로비교를하였다. 각도수산출공식아군간에각각의평균절대오차 (MAE), 평균실제오차 (MNE) 를 one-way analysis of variance (ANOVA) test를통하여도수산출공식들의수술후정확도를비교하였고분석후사후검정은 Scheffe test를사용하였다. 통계분석은 SPSS 통계분석프로그램 (version 18.0, SPSS Inc., Chicago, IL,USA) 을사용하여시행하였으며, p값이 0.05 미만인경우를통계학적으로유의하다고하였다. 결과 1군은 38명 44안, 2군은 24명 30안이었고술전각군의성별비율과나이는통계적으로의미있는차이가없 었다 (p>0.05). 술전평균안축장의길이 (mm ± SD) 는 1군 23.31 ± 0.72 mm, 2군 23.25 ± 0.70 mm로통계적차이는없었다 (p>0.05). 평균전방깊이 (mm ± SD) 도 1군 3.04 ± 0.30 mm, 2군 3.04 ± 0.39 mm로두군간의유의한차이는없었고 (p>0.05), 평균각막곡률 (D) 도 1군 44.17 ± 1.36D, 2군 44.53 ± 1.57D로통계학적차이가없었다 (p>0.05) (Table 2). 인공수정체의형태에따라각아군을비교하였을때술후 1일째와 1주일째측정한평균실제오차는통계학적으로차이는없었고, 동일한인공수정체에서각 A, B, C군을비교하였을때도통계학적으로유의한차이는없었다 (p>0.05) (Table 3). 평균절대오차도각 A, B, C군을인공수정체군에따라비교시통계학적으로차이는없었고, 동일한인공수정체군에서각아군을비교시에도통계학적으로유의한차이는없었다 (p>0.05) (Table 4). 술후 1개월에평균실제오차는 A군에서 1군은 0.05 ± 0.49D, 2군은 -0.17 ± 0.45D였고통계학적으로유의한차이를보이지않았으나 (p=0.05), B군에서는 1군은 0.20 ± 0.46D, 2군은 -0.11 ± 0.39D였고통계학적으로유의한차이를보였다 (p<0.01). 또한 C군에서도 1군은 0.27 ± 0.46D, 2군은 0.03 ± 0.49D였고통계학적으로유의한차이를보였다 (p<0.05) (Table 3). 또한술후 2개월째평균실제오차도 A군에서 1군은 -0.04 ± 0.44D, 2군은 -0.22 ± 0.53D였고통계학적으로차이는없었으나 (p<0.05), B군에서는 1군은 0.12 ± 0.48D, 2군은 -0.16 ± 0.44D로통계학적으로유의한차이를보였다 (p<0.05). C군에서도 1군은 0.18 ± 0.51D, 2 군은 -0.08 ± 0.54D였고통계학적으로유의한차이를보여 (p<0.05) 1개월째에서와동일하게삼체형인공수정체삽입군에서음의값을보였다 (Table 3). 술후 1개월과 2개월에측정한평균절대오차는모든군에서통계학적으로차이가없었다 (p>0.05) (Table 4). 고찰 백내장수술시적극적인굴절교정을통하여환자의만 Table 2. Information of two intraocular lens subtypes and number of uses VA60BB AAB00 Optic type Spheric Spheric A constant 118.4 118.7 Piece(s) 1 3 Optic size (mm) 6 6 Overall length (mm) 12.5 13 Haptic angulation 5 0 Material (optic/haptic) Hydrophobic Acrylic/ Hydrophobic Acrylic Hydrophobic Acrylic/PMMA Eyes (numbers) 30 44 PMMA = Polymethyl methacrylate. 1893
- 대한안과학회지 2016 년제 57 권제 12 호 - Table 3. Comparison mean numeric errors between intraocular lens types according to intraocular lens power formulas (SRK/II, SRK/T, Hoffer Q) Group 1 (n = 44) Group 2 (n = 30) p-value * Postop 1 day (diopter) SRK/II (A) 0.34 ± 0.73 0.21 ± 0.66 0.397 SRK/T (B) 0.50 ± 0.66 0.27 ± 0.57 0.109 Hoffer Q (C) 0.56 ± 0.62 0.34 ± 0.60 0.137 p-value 0.307 0.688 Postop 1 week (diopter) SRK/II (A) -0.10 ± 0.47 0.11 ± 0.59 0.117 SRK/T (B) 0.05 ± 0.46 0.17 ± 0.59 0.387 Hoffer Q (C) 0.11 ± 0.49 0.24 ± 0.69 0.386 p-value 0.096 0.699 Postop 1 month (diopter) SRK/II (A) 0.05 ± 0.49-0.17 ± 0.45 0.050 SRK/T (B) 0.20 ± 0.46-0.11 ± 0.39 0.003 Hoffer Q (C) 0.27 ± 0.46 0.03 ± 0.49 0.011 p-value 0.093 0.496 Postop 2 months (diopter) SRK/II (A) -0.04 ± 0.44-0.22 ± 0.53 0.131 SRK/T (B) 0.12 ± 0.48-0.16 ± 0.44 0.013 Hoffer Q (C) 0.18 ± 0.51-0.08 ± 0.54 0.042 p-value 0.099 0.577 Values are presented as mean ± standard deviations unless otherwise indicated. Group 1: one piece lens type, Group 2: three piece lens type. Postop = post operation. * Statistical significance were tested by Independent t-test; Statistical significance were tested by Analysis of variance (ANOVA) test; p < 0.05. Table 4. Comparison mean absolute errors between intraocular lens types according to intraocular lens power formulas (SRK/II, SRK/T, Hoffer Q) Group 1 (n = 44) Group 2 (n = 30) p-value * Postop 1 day (diopter) SRK/II (A) 0.60 ± 0.54 0.49 ± 0.48 0.357 SRK/T (B) 0.63 ± 0.53 0.40 ± 0.48 0.060 Hoffer Q (C) 0.66 ± 0.51 0.49 ± 0.49 0.146 p-value 0.869 0.698 Postop 1 week (diopter) SRK/II (A) 0.35 ± 0.33 0.46 ± 0.37 0.182 SRK/T (B) 0.34 ± 0.32 0.34 ± 0.21 0.123 Hoffer Q (C) 0.37 ± 0.34 0.37 ± 0.32 0.120 p-value 0.934 0.798 Postop 1 month (diopter) SRK/II (A) 0.36 ± 0.33 0.37 ± 0.30 0.977 SRK/T (B) 0.39 ± 0.32 0.34 ± 0.21 0.429 Hoffer Q (C) 0.42 ± 0.32 0.37 ± 0.32 0.535 p-value 0.723 0.890 Postop 2 months (diopter) SRK/II (A) 0.35 ± 0.25 0.46 ± 0.34 0.178 SRK/T (B) 0.38 ± 0.32 0.37 ± 0.27 0.928 Hoffer Q (C) 0.42 ± 0.34 0.44 ± 0.30 0.802 p-value 0.617 0.502 Values are presented as mean ± standard deviations unless otherwise indicated. Group 1: one piece lens type, Group 2: three piece lens type. Postop = post operation. * Statistical significance were tested by Independent t-test; Statistical significance were tested by Analysis of variance (ANOVA) test. 족감을높이기위해서는정확한도수산출공식과안정적인인공수정체의선택이중요하다. 안정적인굴절값의중 요한인자인수정체낭내안정성은인공수정체형태에따라차이를보이게된다. 알려진바에의하면광학부와지지 1894
- 강승일외 : 인공수정체도수공식비교 - 부의재질의차이에의해인공수정체의수정체낭내안정성이달라질것으로예측하였고이를분석하기위한술후전방깊이와굴절값, 인공수정체에서홍채후면까지의거리등을비교한연구가있었지만장기적인수정체낭내안정성의차이는없었다. 9,10 Olsen et al 7 은인공수정체가전방으로이동하면전방깊이가얕아지면서굴절력이근시로변하고반대로전방깊이가깊어지면굴절력이원시로변한다고보고하였는데 Wirtitsch et al 11 은일체형인공수정체에비하여삼체형인공수정체가술후의전방깊이의변화가크며 1개월까지전방으로이동한다고보고하였고, Nejima et al 12 과 Behrouz et al 13 은전방깊이측정을통해삼체형이일체형에비하여유의하게전방으로이동됨을보고하였다. 국내에보고된연구에서 Son et al 10 은술후 2개월까지굴절값및전방깊이에서삼체형과일체형인공수정체간에차이가없다고하였다. Kim et al 14 은삼체형과일체형의비교에서술후 1주째에는유의하게일체형에서전방깊이가깊었고술후 1개월에삼체형인공수정체에서일체형에비해좀더유의한근시화양상을보였다. 본연구에서는술후경과관찰중에전방깊이를측정하지는못하였지만삼체형과일체형모두시간경과에따라과교정되었고 1개월과 2개월에는삼체형이일체형에비해좀더유의하게과교정되는양상을보여비슷한결과를보였다. 본연구에서는인공수정체의굴절변화의방향성을알아보기위해평균실제오차 (MNE) 를이용하였다. 평균실제오차는삼체형에서 SRK/T와 Hoffer Q 각각술후 1개월에 -0.11 ± 0.39, 0.03 ± 0.49였고술후 2개월에 -0.16 ± 0.44, -0.08 ± 0.54로유의하게일체형에비해근시화되는경향을보였다. 또한시간의흐름에따른특성을살펴보면각공식에서모두일체형에비하여삼체형인공수정체가술후 1 일째에비하여시간이경과할수록점차근시화되는경향을보였다 (Table 3). 이러한두가지결과는삼체형의경우지지부의경도가광학부에비해강하여수정체낭의협착이진행되더라도저항하는힘이강하여비교적원하는위치에있게되지만협착이진행할수록삼체형인공수정체의경우, 일체형에비해지지부의저항강도가감소하는정도가커서본래의위치에서전방으로이동하면서근시화되는경향을보이는것으로생각된다. 12,15,16 또한 SRK/II의경우 SRK/T 17 와 Hoffer Q 18 에비해전방깊이와안축장이비례하는선형관계이론을근거로만들어진 2세대공식으로 3세대와유사한근시화되는경향은보이지만통계적으로일체형과삼체형간에유의한차이는보여주지않고있다. 이것은 SRK/T와 Hoffer Q의 3세대의회귀이론에바탕을두고일정범위를벗어나는안축장과 전방깊이가곡선의관계를가진다고가정을하고술후인공수정체유효위치 (effect lens position) 를도출하였는데이러한세대간의특징에따른차이를보여주는부분이라고생각된다. 안정성과더불어정확한도수산출공식은중요하다. 도수산출공식의정확성을비교하기위하여평균절대오차를이용하였다. 술후 1개월째를비교한 Savini et al 16 은 Hoffer Q는통계적으로유의하게삼체형에서평균절대오차가작았고 SRK/T에서는차이가없다고보고하였다. 본연구의일체형과삼체형비교에서도유의한차이가없었는데일체형과삼체형인공수정체의형태에따른평균절대오차가차이가없다는다른논문들의보고와일치하였다. 10,19 또한 Kim et al 20 은술후 1개월째일체형인공수정체에서 6가지도수산출공식모두통계학적으로유의한차이를보이지않는다고하였다. 본연구에서도같은군에서세가지공식을비교하였을경우평균절대오차는유의한차이를보이지않았다 (Table 4). 이는본연구에포함된환자들의안축장이평균적인안축장범위 (23.0-25.0 mm) 에속해있고이러한경우공식간에차이가없었다는이전논문들의보고와일치하는경과였다. 8,21,22 경과관찰기간에따라삼체형이일체형에비해시간에따라과교정되는양상을보였으나일체형과삼체형모두술후 1주일이후안정적인정확도를보였고도수산출공식서로간에차이는없었다 (Table 4). 결론적으로세공식모두인공수정체의형태와관계없이평균절대오차에근거한정확도에서유의한차이를보이지않았다. 하지만 SRK/T와 Hoffer Q 공식을통해인공수정체도수를결정하였을때삼체형인공수정체를삽입한환자군에서일체형인공수정체를삽입한환자군에비하여술후 1개월이후예측굴절값에비해실제굴절값이좀더과교정된양상을보였다. REFERENCES 1) Holladay JT, Moran JR, Kezirian GM. Analysis of aggregate surgically induced refractive change, prediction error, and intraocular astigmatism. J Cataract Refract Surg 2001;27:61-79. 2) Olsen T. Prediction of the effective postoperative (intraocular lens) anterior chamber depth. J Cataract Refract Surg 2006;32:419-24. 3) Norrby S. Sources of error in intraocular lens power calculation. J Cataract Refract Surg 2008;34:368-76. 4) Olsen T, Thim K, Corydon L. Theoretical versus SRK I and SRK II calculation of intraocular lens power. J Cataract Refract Surg 1990;16:217-25. 5) Jeong JH, Kim SG, Lee HJ, et al. Theoretical and clinical comparison of the Hoffer Q and SRK/T formulas. J Korean Ophthalmol Soc 2014;55:85-92. 1895
- 대한안과학회지 2016 년제 57 권제 12 호 - 6) Moschos MM, Chatziralli IP, Koutsandrea C. Intraocular lens power calculation in eyes with short axial length. Indian J Ophthalmol 2014;62:692-4. 7) Olsen T, Corydon L, Gimbel H. Intraocular lens power calculation with an improved anterior chamber depth prediction algorithm. J Cataract Refract Surg 1995;21:313-9. 8) Steinert RF. Cataract surgery, 3rd ed. Philadelphia: Elsevier/ Saunders, 2010; 39-47. 9) Lee JM, Oh TH, Kim HS. The changes in anterior chamber depth and refractive error associated with diverse intraocular lenses. J Korean Ophthalmol Soc 2013;54:245-50. 10) Son SW, Seo JW, Shin SJ, Chung SK. Comparison of the stability between three-piece and single-piece aspheric intraocular lenses. J Korean Ophthalmol Soc 2010;51:1584-9. 11) Wirtitsch MG, Findl O, Menapace R, et al. Effect of haptic design on change in axial lens position after cataract surgery. J Cataract Refract Surg 2004;30:45-51. 12) Nejima R, Miyai T, Kataoka Y, et al. Prospective intrapatient comparison of 6.0-millimeter optic single-piece and 3-piece hydrophobic acrylic foldable intraocular lenses. Ophthalmology 2006;113:585-90. 13) Behrouz MJ, Kheirkhah A, Hashemian H, Nazari R. Anterior segment parameters: comparison of 1-piece and 3-piece acrylic foldable intraocular lenses. J Cataract Refract Surg 2010;36:1650-5. 14) Kim HS, Lee DM, Ahn JM, et al. Comparison of anterior chamber parameter and refractive change between three-piece and single-piece aspheric intraocular lenses. J Korean Ophthalmol Soc 2012;53:1789-93. 15) Lane SS, Burgi P, Milios GS, et al. Comparison of the biomechanical behavior of foldable intraocular lenses. J Cataract Refract Surg 2004;30:2397-402. 16) Savini G, Barboni P, Ducoli P, et al. Influence of intraocular lens haptic design on refractive error. J Cataract Refract Surg 2014; 40:1473-8. 17) Retzlaff JA, Sanders DR, Kraff MC. Development of the SRK/T intraocular lens implant power calculation formula. J Cataract Refract Surg 1990;16:333-40. 18) Hoffer KJ. The Hoffer Q formula: a comparison of theoretic and regression formulas. J Cataract Refract Surg 1993;19:700-12. 19) Landers J, Liu H. Choice of intraocular lens may not affect refractive stability following cataract surgery. Clin Exp Ophthalmol 2005;33:34-40. 20) Kim DY, Kim MJ, Kim JY, Tchah H. Comparison of formulas for intraocular lens power calculation installed in a partial coherence interferometer. J Korean Ophthalmol Soc 2009;50:523-8. 21) Aristodemou P, Knox Cartwright NE, Sparrow JM, Johnston RL. Formula choice: Hoffer Q, Holladay 1, or SRK/T and refractive outcomes in 8108 eyes after cataract surgery with biometry by partial coherence interferometry. J Cataract Refract Surg 2011;37: 63-71. 22) Lee AC, Qazi MA, Pepose JS. Biometry and intraocular lens power calculation. Curr Opin Ophthalmol 2008;19:13-7. = 국문초록 = 일체형과삼체형인공수정체삽입시도수산출공식간의술후굴절예측의정확성비교 목적 : 일체형과삼체형인공수정체삽입시인공수정체의형태에따라세가지인공수정체도수산출공식에의해예측된술후굴절값의정확성을비교하였다. 대상과방법 : 총 62 명 74 안을후향적으로분석하였다. 안축장은저간섭성반사계 (LENSTAR LS900 R ) 를이용하여측정하였고삽입될인공수정체도수산출은반사계에내장된프로그램을이용하여계산하였다. 백내장수술시인공수정체는일체형 (SENSAR R AAB00 1-Piece Acrylic IOL, 44 안 ) 또는삼체형 (Hoya R VA60BB 3-Piece Acrylic IOL, 30 안 ) 을삽입하였다. 각공식에의한술후굴절값예측의정확도는술후 1 일, 1 주, 1 개월및 2 개월에 SRK/II, SRK/T, Hoffer Q 공식에의해계산된예측굴절값과술후실제측정된굴절값에의한평균절대오차와평균실제오차를계산하여분석하였다. 결과 : 두가지인공수정체환자군에서술후 1 개월과 2 개월에 SRK/T 와 Hoffer Q 공식에의한예측굴절값의평균실제오차는삼체형인공수정체환자군에서일체형인공수정체환자군보다통계적으로유의한차이를보였다. 평균절대오차는세가지공식모두술후모든경과관찰기간중에유의한차이를보이지않았다. 결론 : SRK/T 와 Hoffer Q 공식을통해인공수정체도수를결정하였을때삼체형인공수정체를삽입한환자에서일체형인공수정체를삽입한환자에비하여술후 1 개월이후예측굴절값보다근시화되는경향을보인다. < 대한안과학회지 2016;57(12):1891-1896> 1896