대한안과학회지 2015 년제 56 권제 6 호 J Korean Ophthalmol Soc 2015;56(6):868-874 ISSN 0378-6471 (Print) ISSN 2092-9374 (Online) http://dx.doi.org/10.3341/jkos.2015.56.6.868 Original Article 50 세미만성인백내장환자에서연령대별야그레이저후낭절개술의빈도와위험인자 Incidence and Risk Factors of Nd:YAG Capsulotomy in Adult Cataract Patients under 50 Years of Age According to Different Age Groups 김은영 김선영 이영춘 김수영 Eun Yeong Kim, MD, Sun Young Kim, MD, Young Chun Lee, MD, PhD, Su Young Kim, MD, PhD 가톨릭대학교의과대학안과및시과학교실 Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea Purpose: To evaluate the risk factors and incidence of neodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy due to posterior capsular opacification in adult cataract patients under 50 years of age according to different age groups. Methods: We retrospectively studied 280 eyes that received phacoemulsification and intraocular lens implantation. The total observation period was 26.2 months on average. The subjects were divided into 3 different age groups, 20's, 30's and 40's to evaluate the incidence of posterior capsulotomy. Risk factors based on gender, age, type of cataract, type of intraocular lens (IOLs), axial length, existence of diabetes mellitus, history of ocular trauma, atopic dermatitis and refractive surgery were also investigated using statistical analysis. Results: The incidence of posterior capsulotomy was 13.9% (39 of 280 eyes) and statistically significant differences were not observed based on age (7.7% in the 20 s group, 13.8% in the 30 s group and 14.4% in the 40 s group, p=0.595). We divided subjects into 3 different groups based on axial length, below 22 mm, 22 to 26 mm and over 26 mm; posterior capsulotomy was performed in 0% (0/2), 7.2% (12/166) and 24.1% (27/112) of the patients, respectively, showing the longer axial length resulted in statistically significant increase in the incidence of posterior capsulotomy (p=0.036). The incidence of posterior capsulotomy was higher in females than in males (p=0.006). Correlations among posterior capsulotomy and type of cataract, type of IOLs and existence of diabetes mellitus, history of ocular trauma, atopic dermatitis and refractive surgery were not statistically significant. Conclusions: The difference in the incidence of Nd:YAG laser posterior capsulotomy according to age was not statistically significant in adult cataract patients under 50 years of age. We showed that longer axial length resulted in higher risk of posterior capsulotomy. J Korean Ophthalmol Soc 2015;56(6):868-874 Key Words: Axial length, Nd:YAG laser capsulotomy, Posterior capsular opacification Received: 2014. 11. 8. Revised: 2015. 2. 15. Accepted: 2015. 5. 6. Address reprint requests to Su Young Kim, MD. PhD. Department of Ophthalmology, The Catholic University of Korea Uijeongbu St. Mary's Hospital, #271 Cheonbo-ro, Uijeongbu 480-717, Korea Tel: 82-31-820-3587, Fax: 82-31-847-3418 E-mail: cassiopeia-su@hanmail.net * This study was presented as an e-poster at the 109th Annual Meeting of the Korean Ophthalmological Society 2013. 백내장수술후발생하는합병증은후낭혼탁, 안압상승, 포도막염, 황반부종, 모양소대및후낭파열등으로다양하다. 1-3 그중후낭혼탁은가장흔한합병증중의하나로그발생빈도는저자에따라 10-50% 로다양하게보고되고있다. 4-7 대부분의환자에서후낭혼탁발생시시력감소를유발하고눈부심을일으켜백내장수술후만족도및삶의질을떨어뜨린다. 후낭혼탁의발생빈도에영향을주는인자 c2015 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. 868
- 김은영외 : 후발백내장의빈도와위험인자 - 로는환자의나이, 당뇨등의기저질환, 백내장의형태, 백내장수술의방법, 인공수정체의재질및형태등이보고된바있다. 8 그밖에도후낭혼탁형성에영향을미치는인자로는인공수정체광학부의모양, 인공수정체의재질, 수술후염증, 각막또는공막절개부크기, 연속적원형전낭절개술, 전낭하수정체상피세포의기계적제거등이있다. 9-11 후낭혼탁발생시 neodymium-doped yttrium aluminium garnet (Nd:YAG) 레이저를이용한후낭절개술은후낭혼탁의치료에보편적이고효과적인술기로이를통해시력회복을기대할수있다. 그러나레이저치료후낭포성황반부종, 안압상승, 인공수정체패임, 망막박리와같은합병증을일으킬수있음을염두에두어야할것이다. 3 더구나최근백내장수술술기의발전은단순히백내장의제거에만그치지않고난시교정용 (Toric intraocular lens [IOL]), 이중초점 (Bifocal) 또는다중초점 (Multifocal) 렌즈등을이용한시력의질적향상에심혈을기울이고있어삽입된렌즈의 centering이더욱중요해졌으며후낭혼탁을줄이는노력은지금도중요하다. 12 여러연구들에서술후후낭혼탁발생률이수술시환자의나이에영향을받는다고보고하고있다. 8,13,14 특히아동에서의후발백내장발생률은 43.7% 에서 100% 까지높게보고되고있으며, 이는수정체상피세포의높은증식력때문으로생각되고있다. 15,16 즉수정체상피세포의증식과재생이라는관점에서보았을때젊은사람에서고령의환자에비해상대적으로세포의증식능력, 재생능력, 이동능력등의활성도가비교적높기때문에후낭혼탁이잘발생한다고생각할수있다. 따라서저자들은 50세미만의성인환자를대상으로 20 대, 30대, 40대하위그룹분석을통해젊은나이에서백내장수술후발생하는후낭혼탁의발생빈도및위험인자로서나이가어떠한관련성을가지며, 그밖에 50세미만백내장수술환자에서후낭혼탁발생에영향을주는위험요인에대해알아보고자하였다. 대상과방법 2006년 10월부터 2012년 6월까지수정체초음파유화술및인공수정체삽입술을시행받고 24개월이상의경과관찰이가능한 50세미만성인백내장환자들을대상으로후향적으로의무기록을조사하였다. 20대 (20-29세), 30대 (30-39세), 40대 (40-49세) 로연령별하위그룹을나누어분석하였으며, 백내장형태에따라피질형혼탁, 전낭하혼탁, 혼합형혼탁, 후낭하혼탁, 핵형혼탁, 과숙형혼탁으로나누었다. 삽입된인공수정체종류에따라소수성일체형아크릴인공 수정체 (One-piece hydrophobic acrylic intraocular lens), 친수성일체형아크릴인공수정체 (One-piece hydrophilic acrylic intraocular lens), 소수성삼체형아크릴인공수정체 (Three-piece hydrophobic acrylic intraocular lens) 로나누었다. 백내장수술당시의연령을기준으로하였으며당뇨병, 아토피등의동반전신질환유무와, 성별, 안축장, 굴절수술력, 안외상력, 선천백내장, 녹내장, 포도막염, 망막수술력등의과거력을확인하였다. 대상환자중수술중인공수정체를공막고정한경우, 선천백내장, 염증에의한이차성백내장, 포도막염, 녹내장, 망막수술의과거력이있는경우는제외하였다. 수술은국소점안마취하에수정체초음파유화술과인공수정체삽입술이시행되었다. 이측에서 2.8 mm의각막투명절개창을만든후수정체낭절개용포셉 (forceps) 을이용하여인공수정체광학부의가장자리보다약간작게하는것을목표로연속곡선수정체낭원형절개를시행하였다. 관류액 (Balanced salt solution, BSS, Alcon Laboratories, Fort Worth, TX, USA) 을사용하여수력분리술과수력분층술을시행하였다. 동일한기계 (INFINITI Vision System, Alcon Laboratories, Fort Worth, TX, USA) 를사용하여수정체유화술을시행하였으며, 점탄물질및잔류피질은관류흡입기 (irrigation & aspiration [I & A]) 로충분히제거함을원칙으로하였다. 주변부전낭 polishing은시행하지않았으며, 후낭 polishing 을위해관류흡인기첨단부를원형으로천천히움직여가면서잔류피질을제거하였다. 인공수정체는낭내에안전하게위치하였으며, 각막절개부위는 10-0 nylon 으로봉합하였다. 수술후 1개월동안점안항생제와스테로이드제를사용하였다. 총 280안을대상으로백내장수술후최대교정시력에서 3줄이상의시력감소를보이고, 세극등현미경검사상황반부이상소견이나타나지않으면서저명한후낭혼탁이관찰되는경우에 Nd:YAG laser 를이용한후낭절개술을시행하였다. 통계프로그램은 IBM SPSS Statistics version 22.0 (IBM Corp., Armonk, NY, USA) 을이용하였으며대응표본 t-검정, 카이제곱검정, Fisher 의정확한검정, 선형대선형결합법, 다변량 Cox의비례위험모형 (Multivariate Cox's proportional hazards regression model) 등을사용하여분석하였다. p-value <0.05인경우를통계학적으로유의한것으로간주하였다. 결과 총 280안중남자와여자의비율은 171:109였고, 평균나이는 44.50세로모두 50세미만이었으며연령별로 20대 (20-29세) 가 13명, 30대 (30-39세) 가 58명, 40대 (40-49세) 가 209명이었다 (Table 1). 대상안을백내장형태에따라나누었 869
- 대한안과학회지 2015 년제 56 권제 6 호 - Table 1. Patients clinical features and incidences of Nd:YAG capsulotomy according to multiple factors Total Non-capsulotomy Nd:YAG capsulotomy p-value Total No. 280 241 (86.1) 39 (13.9) Gender (n, %) 0.006 * Male 171 155 (87.5) 16 (9.3) Female 109 86 (78.9) 23 (21.1) Age (years) 0.595 Median 44.50 (20-49) 45 44 IQR 6.48 6.44 6.80 <30 years 13 12 (92.3) 1 (7.7) 30-39 years 58 50 (86.2) 8 (13.8) 40-49 years 209 179 (85.6) 30 (14.4) Axial length (mm) <0.001 <22 2 2 (100) 0 (0) 22-26 166 154 (92.8) 12 (7.2) >26 112 85 (75.9) 27 (24.1) Anterior chamber depth (mm) 0.114 Mean 3.23 3.22 3.34 IOL 0.126 * One-piece hydrophobic acrylic 140 126 (90.0) 14 (10.0) One-piece hydrophilic acrylic 87 70 (80.5) 17 (19.5) Three-piece hydrophobic acrylic 53 45 (84.9) 8 (15.1) Cataract type 0.057 * Cortial opacity 53 44 (83.0) 9 (17.0) Anterior subcapsular opacity 80 77 (96.3) 3 (3.7) Anterior and posterior subcapsular opacity 23 19 (82.6) 4 (17.4) Posterior subcapsular opacity 62 49 (79.0) 13 (21.0) Nucleosclerosis 52 43 (82.7) 9 (17.3) Mature cataract 10 9 (90.0) 1 (10.0) Diabetes 16 13 (81.2) 3 (18.8) 0.474 Trauma history 9 7 (77.8) 2 (22.2) 0.363 History of atopy 5 4 (80.0) 1 (20) 0.530 History of refractive surgery 20 15 (75.0) 5 (25.0) 0.172 Values are presented as n (%) unless otherwise indicated. Nd:YAG=neodymium-doped yttrium aluminium garnet; IQR=interquartile range; IOL = intraocular lens. * Pearson's chi-square test; Linear by linear association (chi-square test for trend); Independent t-test; Fisher's exact test. 을때피질형혼탁, 전낭하혼탁, 혼합형혼탁, 후낭하혼탁, 핵형혼탁, 과숙형혼탁은각각 53 (18.93%), 80 (28.57%), 23 (8.21%), 62 (22.14%), 52 (18.57%), 10 (3.57%) 안이었다. 삽입된인공수정체종류에따른분류는소수성일체형아크릴인공수정체 140안 (50%), 친수성일체형아크릴인공수정체 87안 (31.07%), 소수성삼체형아크릴인공수정체 53안 (18.93 %) 이었다 (Table 1). 50세미만성인백내장환자에서후낭혼탁이발생하여 Nd:YAG 레이저를이용하여후낭절개술을시행받은빈도는총 280안중 39안 (13.9%) 이었다. 여자의비율이 21.1% 로남자 9.3% 에비해높았으며통계적으로유의하였다 (p=0.006). 연령대별로나누어야그레이저후낭절개술의빈도를분석한결과 20대에서 7.7%, 30대에서 13.8%, 40대에서 14.4% 였으며연령대별로통계적으로유의한차이는없었다 (p=0.595). 50세미만환자들에서는안축장 26 mm 초과의근시안이 112안 (40.0%) 으로비교적많았으 며, 후낭절개술의빈도를비교해보았을때안축장 22 mm 미만, 22-26 mm, 26 mm 초과에서각각 0%, 7.2%, 24.1% 로안축장이길수록, 즉근시안일수록후낭절개술의빈도가통계적으로유의하게높았다 (p<0.001). 후낭절개술을받은경우전방깊이가긴경향은있었으나통계적으로유의하지않았다 (p=0.114, Table 1). 후낭절개술을시행받은 39안을대상으로시술전의최대교정시력은 logmar 표기법에의해 0.42 ± 0.39였고, 후낭절개술시행 1주후최대교정시력은 logmar 표기법에의해 0.15 ± 0.23 이었다. 후낭절개술직전의최대교정시력과후낭절개술시행 1주후최대교정시력비교에서통계적으로유의하게시력향상이있었다 (Paired t-test, p<0.001) (Table 1). 그밖에도백내장형태에따라서후낭절개술을받을정도의후낭혼탁발생률이차이를보였으나통계학적으로유의하지는않았다 (p=0.057) (Table 1). 삽입한인공수정체종류에따른후낭혼탁발생률 870
- 김은영외 : 후발백내장의빈도와위험인자 - Table 2. Multivariate Cox regression analysis of the factors associated with Nd:YAG capsulotomy Variable Hazard ratio 95% CI p-value Axial length 1.138 1.008-1.284 0.036 * Independent variables such as gender, age, diabetes, axial length, cataract type, and intraocular lens (IOL) type were included. Nd:YAG=neodymium-doped yttrium aluminium garnet; CI= confidence interval. * p<0.05. 은친수성일체형아크릴인공수정체에서 19.5% 로가장높고소수성일체형아크릴인공수정체그룹에서 10.0% 로가장낮았으나통계적으로유의하지않았다 (p=0.126) (Table 1). 성별, 나이, 당뇨, 안축장, 백내장형태, 인공수정체종류를독립변수로고려하였을때다변량 Cox 비례위험모형 (Multivariate Cox regression analysis) 으로분석한결과안축장이길어질수록 Nd:YAG 레이저후낭절개술의위험이 1.138 배씩증가하는것으로나타났다 (multivariate Cox regression analysis, hazard ratio [HR]=1.138; 95% confidence interval [CI]=1.008-1.284; p=0.036) (Table 2). 이밖에백내장형태, 당뇨병유무, 안외상과거력, 아토피질환력, 인공정체종류, 굴절수술력은다변량분석에서후낭혼탁의발생으로인한후낭절개술빈도와통계적으로유의한관련성이없었다. 고 찰 후낭혼탁의발생기전및이에영향을주는인자에관한연구는다양한방법으로꾸준히시행되어왔다. 여러연구에의하면후낭혼탁발생기전은백내장수술후남아있던수정체상피세포의증식 (proliferation), 재생 (regeneration), 이동 (migration) 및아형성 (metaplasia) 에기인한다고하며수술시혈액방수장벽의파괴및염증반응으로유리된인터루킨 (interleukin) 이수정체의후낭혼탁에관여한다고요약할수있다. 10,17 이러한후낭혼탁의발생기전을고려할때상대적으로세포의증식능력, 재생능력, 이동능력등의활성도가높은젊은연령에서후낭혼탁발생률도높을것으로기대할수있으며여러연구들에서도수술후후낭혼탁발생률이수술시환자의연령에영향을받는다고보고하고있다. 8,13,14 전연령대혹은노년성백내장환자를대상으로분석한후발성백내장의발생률은보고자에따라다양하다. 처음 5년동안의발생률은낭외적출술과수정체유화술모두에서 25% 이상까지보고되고있다. 4 Ursell et al 5 은경성, 연성인공수정체를각각삽입한후 2년간경과관찰시후낭혼탁의발현빈도를각각 43.65%, 33.50% 라고하였으며, Milazzo et al 7 은연성인공수정체삽입후 3년 ( 평균 20달 ) 후에 13.7%, Linnola and Holst 18 는 1년후에 11% 의후낭절개술빈도를보고하였다. 이와비교해소아에서의후발백내장발생률은상대적으로매우높은것으로알려져있다. 43.7% 에서 100% 까지높게보고되고있으며, 이는소아에서의수정체상피세포의높은증식력때문일것이라하였다. 15,16,19 하지만청장년층백내장환자를대상으로한연구는매우드물다. Jamal and Solomon 8 은수정체낭외적출술후진주형후낭혼탁발생률을 50세미만환자에서 32%, 50세이상환자에서 18% 로보고하였으며, Dholakia et al 15 은 50세미만의백내장환자 54 명에서수술후후낭혼탁발생률은 22.2% 였으며, Nd:YAG 레이저후낭절개술은 13.8% 에서시행받았다고하였다. 국내에서는 Yoo et al 20 이 50세미만성인백내장환자에서후낭절개술을받은빈도를 20.34% 로보고하였다. 저자들은후낭혼탁발생률이연령별로차이를보일것으로기대하여 50 세미만성인백내장환자에서백내장수술후후낭절개술이필요할정도의후낭혼탁이발생하는빈도를연령대별로세분화하여분석하였으며, 유의미한영향을주는위험인자또한분석하였다. 본연구에서야그레이저후낭절개술의시행빈도는 20대에서 7.7%, 30대에서 13.8%, 40대에서 14.4% 였다 (Linear by linear association [Chi-square test for trend], p= 0.595). 나이가어릴수록후낭절개술빈도가증가할것으로기대하였으나 50세미만성인환자군에서는연령과후낭절개술빈도사이에통계적으로유의한관련성이없었다. 연령이외에도후낭혼탁에영향을주는인자들에대한여러연구들이보고되어왔다. 술전백내장형태에따른후낭절개술의시행빈도차이에대한여러보고들이있으며, 과숙형백내장에서는지속적이고심하게진행한생화학적인변화들이상피세포의섬유화생 (fibrous metaplasia) 을촉진시키기때문에후낭혼탁발생률이높을것이라예상한바있다. 21,22 그러나임상적으로 Vasavada et al 23 은특징적으로 50세미만의젊은환자군에서는후낭하혼탁형 (Posterior subcapsular opacity) 과과숙형 (mature cataract) 에서후낭혼탁발생률이동일한빈도로높게나타났다고하였으며, Argento et al 24 에따르면과숙형백내장 (mature cataract) 에서후발백내장발생이오히려더낮은경향을보였다고하였다. 본연구에서는과숙형백내장보다후낭하혼탁형백내장에서후낭절개술의빈도가상대적으로높았으나통계적으로유의하지는않았다 (p=0.057). 전신질환과관련해서당뇨와후낭혼탁발생률의연관성에대해서는논란이있다. 당뇨환자에서후낭혼탁이더빈번하게발생한다는보고들이있는반면일부에서는당뇨안이비당뇨안보다후낭혼탁의발생이적다는보고도있다. 25-27 본연구에서당뇨병유무는유의한관련성이없었다 (p=0.474). 이밖에도백내장수술시삽입하게되는인공수정체의재 871
- 대한안과학회지 2015 년제 56 권제 6 호 - 질, 디자인뿐만아니라광학부의크기와모양, 지지부의특성에따라후낭혼탁의발생률이다르다고알려져있다. 28,29 인공수정체재질에따른차이에서는 Hollick et al 30 이아크릴인공수정체를삽입한경우에서실리콘과 polymethylmethacrylate (PMMA) 군에비해적은후낭혼탁및 Nd:YAG 레이저후낭절개술을보고하였다. 또한소수성인공수정체가친수성인공수정체보다, 1-piece 인공수정체가 3-piece 인공수정체보다백내장수술후후낭혼탁의발생이낮다는보고들이많았다. 31-34 50세미만환자들을대상으로한본연구에서는모두아크릴인공수정체를삽입하였으며, 통계적으로유의하진않았으나친수성일체형아크릴인공수정체가소수성일체형아크릴인공수정체에비해야그레이저후낭절개술의빈도가높은경향을보였다. 근시및긴안축장과후낭혼탁발생과의관련성에대해서는아직논란이많다. 기존연구들에서고도또는중등도근시안 (high or moderate myopia) 에서후낭혼탁발생률과 Nd:YAG 레이저후낭절개술의시행빈도가높다고보고하고있다. 35,36 반면 Hayashi et al 37 은근시및안축장은후낭혼탁의발생또는 Nd:YAG 레이저후낭절개술빈도와관련성이없다고하였다. Praveen et al 38 은젊은환자에서고도근시가백내장을발생시키는강력한위험인자라고보고하였다. 본연구에서도 50세미만백내장환자들에서안축장 26 mm 초과의근시안이 40% 이상으로비교적많았으며, 안축장이길수록백내장수술후후낭절개술의위험도가통계적으로유의미하게증가하는것으로나타났다 (HR=1.138; 95% CI 1.008-1.284; p=0.036). 근시안에서후낭혼탁발생률이높다는기존보고에서도명확한이유를제시하고있지는않았으며근시안백내장환자군이비교적나이가어린경우가많아후낭혼탁발생률이높았을것으로추측한경우가있었으나, 본연구에서 50세미만의환자들만을대상으로연령요인을보정하여분석한경우에도안축장이긴근시안에서후낭절개술빈도가증가하는것으로나타났다. 기존연구들에서전방깊이가안축장과가장긴밀한관련성이있다고알려져있다. 39,40 본논문에서도대상안의안축장과전방깊이사이의관계를 Pearson 상관분석결과통계적으로유의한양 (+) 적선형상관관계가보였다 (r=0.141, p=0.019). 그러나후낭절개술을받은경우전방깊이가긴경향은있었으나유의성은없었다 (p=0.114). 따라서근시안의경우상대적으로전방및후방깊이가깊어수술시후낭혼탁의원인이되는수정체피질이나상피세포의충분한제거가상대적으로어려워불충분한관류흡입 (I & A) 이이루어졌을가능성과함께다른요인들도복합적으로작용했을것으로생각된다. 삽입된후방인공수정체의광학부와후낭사이의접촉이수정체상피세포의증식과이동에대한물리적장벽으로작 용하여후발백내장을억제한다고알려져있다. 41 안축장이긴안구에서상대적으로수정체낭 (capsular bag) 이큰경향이있다. 42 이에축성근시안에서는상대적으로큰수정체낭 (capsular bag) 에두께가얇은낮은디옵터의렌즈가삽입됨으로인해인공수정체광학부와후낭사이의유착정도에영향을미쳐인공수정체의후낭혼탁에대한물리적방어벽으로서의역할이불충분하였을가능성을고려할수있다. 심지어고도근시안에서 Windshield-wiper syndromes 와같은인공수정체와안구크기가맞지않아일어나는인공수정체의진추운동현상도일어날수있어후낭과의유착불충분이생길수있다. 43 이밖에도축성근시안에서는섬모체소대와유리체의지지가상대적으로약하다고알려져있어이러한요인들도후낭혼탁발생에영향을미쳤을것으로생각된다. 즉, 본연구결과연령을보정함에도근시안에서후낭절개술의위험도가증가하는것으로나왔고, 일반적으로근시안일수록 Nd:YAG 레이저후낭절개술후발생가능한합병증 ( 망막박리, 안압상승, 유리체출혈등 ) 의위험성은더높아지므로후낭혼탁이생기지않도록더욱유의해야할것으로생각된다. Nd:YAG 레이저후낭절개술은외래에서간편하게시술할수있고성공률이높은실용적인술기이나, 동일질병으로이중적비용부담이라는비경제적모순과 100% 안전성을보장할수있는술기가아니라는부정적측면도적지않다. Steinert et al 1 은 Nd:YAG 레이저후낭절개술후안압상승, 망막박리, 낭포황반부종등의합병증이 0.56% 에서 1.23% 까지나타났다고보고하였으며, 인공수정체손상, 각막내피손상, 포도막염등을보고한경우도있었다. 2,3 따라서후낭혼탁은후낭절개술로쉽게해결가능한문제로간주하기보다는그발생빈도및위험인자와관련한요인들에대한세부적이고지속적인연구가필요하다하겠다. 본연구의한계점으로는 20대에속한대상안의수가적었고, 경과관찰기간이 3년이하였으며, 인공수정체재질을제외한다른조건 ( 모서리, 광학부크기등 ) 이모두동등한인공수정체간의비교가필요하다는점이다. 또한연령별시력요구도차이등을고려한다면후낭혼탁이발생하였으나 Nd:YAG 레이저치료를받지않는경우를감안하여 Pocoman software 등을이용한후발백내장의정량적인분석및 50대이상연령층과의대규모전향적비교분석을시행한다면더의미있는연구가될것으로기대한다. REFERENCES 1) Steinert RF, Puliafito CA, Kumar SR, et al. Cystoid macular edema, retinal detachment, and glaucoma after Nd:YAG laser posteri- 872
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- 대한안과학회지 2015 년제 56 권제 6 호 - implantation in high myopia. J Korean Ophthalmol Soc 1998;39: 1427-32. 40) Gavin EA, Hammond CJ. Intraocular lens power calculation in short eyes. Eye (Lond) 2008;22:935-8. 41) Peng Q, Visessook N, Apple DJ, et al. Surgical prevention of posterior capsule opacification. Part 3: Intraocular lens optic barrier effect as a second line of defense. J Cataract Refract Surg 2000;26: 198-213. 42) Koeppl C, Findl O, Kriechbaum K, et al. Change in IOL position and capsular bag size with an angulated intraocular lens early after cataract surgery. J Cataract Refract Surg 2005;31:348-53. 43) Fava GE, Kline OR Jr. Decentration of posterior chamber lenses. Am Intra-Ocular Implant Soc J 1982;8:247-50. = 국문초록 = 50 세미만성인백내장환자에서연령대별야그레이저후낭절개술의빈도와위험인자 목적 : 50 세미만성인백내장환자에서후낭혼탁의발생으로인한후낭절개술의위험인자를분석하였고연령대별로시행률을비교하였다. 대상과방법 : 수정체초음파유화술과인공수정체삽입술을시행받은 280 안을후향적으로조사하였다. 총경과관찰기간은평균 26.2 개월이다. 20 대, 30 대, 40 대로나누어연령대별후낭절개술시행의빈도를분석하였고성별, 연령, 백내장형태, 인공수정체종류, 안축장, 당뇨, 안외상과거력, 아토피질환력과근시교정술시행여부에따른통계적분석으로위험인자를알아보았다. 결과 : 후낭절개술의시행빈도는총 280 안중 39 안 (13.9%) 이었으며연령대별로는 20 대에서 7.7%, 30 대에서 13.8%, 40 대에서 14.4% 로통계적으로유의한차이는없었다 (p=0.595). 안축장 22 mm 미만, 22-26 mm, 26 mm 초과에서후낭절개술의빈도는각각 0% (0/2), 7.2% (12/166), 24.1% (27/112) 로안축장이길수록후낭절개술의빈도가통계적으로유의하게높았다 (p=0.036). 남자에비해여자에서빈도가높았다 (p=0.006). 백내장형태, 인공수정체종류, 당뇨유무, 안외상과거력, 아토피질환력, 근시교정술시행여부는후낭혼탁의발생과통계적으로유의하게관련이없었다 (p>0.05). 결론 : 50 세미만성인백내장환자에서 20 대, 30 대, 40 대연령별야그레이저후낭절개술의빈도는통계적으로유의한차이가없었으며, 안축장이길수록후낭절개술의위험이증가함을알수있었다. < 대한안과학회지 2015;56(6):868-874> 874