대한안과학회지 2015 년제 56 권제 11 호 J Korean Ophthalmol Soc 2015;56(11):1671-1676 ISSN 0378-6471 (Print) ISSN 2092-9374 (Online) http://dx.doi.org/10.3341/jkos.2015.56.11.1671 Original Article 굴절교정수술전후의망막이상과술전시행한망막레이저치료빈도 Incidence of Retinal Lesions before and after Refractive Surgery and Preoperative Prophylactic Laser Treatment 김민교 1,2 이훈 1 이형근 1 서경률 1 김응권 1 김태임 1 Min Kyo Kim, MD 1,2, Hoon Lee, MD 1, Hyung Keun Lee, MD 1, Kyoung Yul Seo, MD, PhD 1, Eung Kweon Kim, MD, PhD 1, Tae Im Kim, MD, PhD 1 연세대학교의과대학안과학교실시기능개발연구소 1, 실로암안과병원 2 The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine 1, Seoul, Korea Siloam Eye Hospital 2, Seoul, Korea Purpose: We investigated the incidence of retinal lesions before and after surgery and the percentage of preoperative prophylactic laser treatment in patients who underwent corneal refractive surgery or phakic intraocular lens implantation (pioli). Methods: The medical records of patients who underwent refractive surgery from January 2005 to June 2013 were reviewed retrospectively. We investigated the incidence and type of retinal lesions identified during the preoperative examination. Additionally, the percentage of preoperative prophylactic laser treatment and the incidence of postoperative newly developed retinal lesions were analyzed. Results: A total of 894 eyes of 466 subjects (laser in situ keratomileusis [LASIK] 225 eyes, 117 subjects; laser-assisted subepithelial keratectomy [LASEK] or photorefractive keratectomy [PRK] 450 eyes, 231 subjects; pioli 219 eyes, 121 subjects) were enrolled in the present study. Retinal lesions were found in 268 eyes (29.98%) and of those, 144 eyes (16.11%) received prophylactic laser treatment. Postoperative newly developed retinal lesions were detected in 8 cases (LASEK or PRK, 5 cases; pioli, 3 cases) during the follow-up period. There was a significant correlation between preoperative spherical equivalent and the presence of retinal lesions. Conclusions: The patient population of refractive surgery is largely myopic and thus particularly vulnerable to retinal lesions. Additionally, a considerable number of patients required preoperative prophylactic laser treatment. Therefore, both surgeons and patients should be aware of the risks of developing postoperative retinal lesions. J Korean Ophthalmol Soc 2015;56(11):1671-1676 Key Words: Myopia, Phakic intraocular lens implantation, Prophylactic laser treatment, Refractive surgery, Retinal lesion Received: 2015. 3. 13. Revised: 2015. 7. 5. Accepted: 2015. 9. 4. Address reprint requests to Tae Im Kim, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: taeimkim@gmail.com * This study was presented as a narration at the 111th Annual Meeting of the Korean Ophthalmological Society 2014. 현재널리시행되고있는굴절수술은 1974년 Fyodorov에의해방사상각막절개술 (Radial keratectomy) 이개발된이후, 1983년 Trokel이굴절교정레이저각막절제술 (Photorefractive keratectomy, PRK) 을소개하였으며, 1990년 Pallikaris가레이저각막절삭가공성형술 (Laser in situ keratomileusis, LASIK) 을, 1999년 Camellin에의해레이저각막상피절제술 (Laser-assisted subepithelial keratectomy, LASEK) 이소개되어지금까 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. 1671
- 대한안과학회지 2015 년제 56 권제 11 호 - 지시행되고있으며, 지속적으로새로운수술방법이개발되고있다. 그러나이술법들은각막확장증, 각막혼탁, 근시퇴행등의부작용발생가능성으로인해고도근시환자에서시행하기에는한계가있다. 1-4 이러한고도근시환자에서의한계점을극복하기위해유수정체안내렌즈삽입술이개발되었으며, 홍채고정알티산렌즈 (Artisan lens, Ophtec, Groningen, Netherlands) 나후방렌즈인 ICL (Implantable Collamer lens, STAAR Surgical Company, Monrovia, CA, USA) 등이사용되고있다. 이러한굴절수술의주요대상환자군은대부분근시환자며이들에게서격자형망막변성, 망막원공, 망막열공등의망막이상이더잘발견된다는것은잘알려져있는데, 5 이에대한국내연구는부족한실정으로본저자들은본원에서일정기간동안굴절수술을받은전체근시환자에서술전후에관찰된망막이상과술전레이저치료를시행한빈도에대해알아보고자하였다. 대상과방법 본원에서 2005년 1월부터 2013년 6월까지세명의술자 (T.I.Kim, K.Y.Seo, E.K.Kim) 에게각막굴절교정 ( 라식, 라섹, 엑시머레이저 ) 혹은유수정체안내렌즈삽입술 (Implantable Collamer lens, ICL; Artisan lens) 을시행받은굴절교정수술환자를대상으로술전나안및교정시력, 안압, 동공크기, 중심각막두께, 자동굴절검사 CT-80 (Topcon, Tokyo, Japan) 등을측정하고세극등검사를시행하였다. 0.5% tropicamide (Mydrin-P, Santen, Osaka, Japan) 와 1% cyclopentolate hydrochloride (Ocucyclo, Samilallegan, Seoul, Korea) 를 10분간격으로 3번점안후 1시간경과후조절마비굴절검사를시행하였으며, 이후안저검사를시행하여망막의이상여부를확인하였다. 조절마비굴절검사를시행후최소 1주이상경과후에조절마비회복후굴절검사를시행하였으며, ORB scan (Bausch & Lomb Inc., Rochester, NY, USA), Pentacam (Oculus Inc., Wetzlar, Germany), i-trace (Tracey technology Inc., Houston, TX, USA), Wavescan (AMO Inc., Santa Ana, CA, USA) 검사를시행하였다. 안저검사상발견된망막이상의종류와빈도및이에대해장벽레이저광응고술을시행한빈도를조사하였다. 레이저광응고술의적응증은망막열공, 비문증, 광시증등의증상이있는경우, 유리체망막견인이존재하는경우, 열공편이존재하면서원공경계부에유리체유착이있는경우, 반대쪽의망막박리과거력, 망막박리의가족력이있을때등망막박리의위험성이높은경우로정하였다. 6,7 수술후 1년이후부터는해마다추적관찰을권유하고시행하였으며그기간이아니더라도환자가시력저하, 비문 증, 광시증등을경험하게되는경우바로병원으로내원할것을안내하였다. 모든환자는산동후안저검사를시행하였으며술전에관찰되지않던, 새로이발생한망막질환의종류와빈도를의무기록조사를통해분석하였다. 라식, 표면연마 ( 라섹및엑시머레이저 ), 유수정체안내렌즈삽입술의세군간나이, 구면렌즈대응치, 전방깊이의차이에대한분석에는일원배치분산분석 (One-way ANOVA) 을, 성비, 망막병변의유무의차이에는카이제곱검정법을이용하였다. 수술전후의망막병변의유무와나이, 성별, 구면렌즈대응치, 전방깊이, 수술법차이와의관계를분석하기위해서는로지스틱회귀분석법을사용하였다. 전체환자를구면렌즈대응치별로군을나누어망막병변이관찰되는빈도의변화가관찰되는구간을찾는데에는각군별로독립표본 t검정 (independent t-test) 을이용하여분석하였다. 통계적인분석에는 SPSS ver 20.0 (SPSS Inc., Chicago, IL, USA) 를사용하였고, p값이 0.05 미만인경우통계학적으로유의한것으로평가하였다. 결과 총 466명 894안이대상이되었으며평균 27.24 ± 6.25세였고남자 142명, 여자 324명이포함되었다. 이들중 268안 (29.98%) 에서술전안저검사에서망막이상이발견되었다. 라식, 표면연마 ( 라섹, 엑시머레이저 ), 유수정체안내렌즈삽입술의세군으로나누어분석하였을때각군간평균나이, 성별비는통계적으로유의한차이를보이지않았으며 (p=0.09, 0.95), 구면렌즈대응치, 전방깊이, 술전발견된망막이상비율은통계적으로유의하게나타났다 (p<0.05) (Table 1). 로지스틱회귀분석법을이용하여수술전후망막병변의유무와나이, 성별, 구면렌즈대응치, 전방깊이, 그리고수술법차이와의상관관계를분석하였을때구면렌즈대응치만수술전후망막병변의유무와통계학적으로유의하게나타났으며 (p<0.05), 각막굴절수술과유수정체안내렌즈삽입술간의수술법차이, 나이, 성별, 전방깊이는통계학적으로유의하게나타나지않았다 (p=0.67, 0.46, 0.69, 0.31) (Table 2). 구면렌즈대응치별로군을나누어각군별로수술전후망막병변이관찰되는빈도를비교해보았을때구면렌즈대응치가증가할수록망막병변이관찰되는빈도는증가하는양상이었으며, 특히 -8디옵터 ~-9디옵터군과 -7디옵터 ~-8디옵터군을비교했을때유의한빈도의증가를나타냈고, 또한 -12디옵터 ~-13디옵터군과 -11디옵터 ~-12디옵터군을비교했을때유의한빈도의증가를보였다 (p<0.05, <0.05) (Fig. 1). 1672
- 김민교외 : 굴절교정수술전후의망막이상 - Table 1. Characteristics of patients based on different type of surgery LASIK LASEK or PRK pioli Total p-value Eyes (subjects, n) 225 (117) 450 (231) 219 (121) 894 (466) Age (years) 26.76 ± 6.16 26.92 ± 6.30 28.32 ± 6.16 27.24 ± 6.25 0.09 * Men:women 34:82 71:158 37:84 142:324 0.95 SE (D) -5.49 ± 2.17-5.18 ± 1.96-10.78 ± 3.33-6.61 ± 3.42 <0.05 * ACD (mm) 3.43 ± 0.36 3.14 ± 0.27 3.47 ± 0.37 3.29 ± 0.36 <0.05 * Retinal lesions (n, %) 40 (17.78) 129 (28.67) 99 (45.21) 268 (29.98) <0.05 Values are presented as mean ± SD unless otherwise indicated. LASIK = laser in situ keratomileusis; LASEK = laser-assisted subepithelial keratectomy; PRK = photorefractive keratectomy; pioli = phakic intraocular lens implantation; SE = spherical equivalent; ACD = anterior chamber depth. * One-way ANOVA; Chi-square test. Table 2. The correlation between characteristics of patients and presence of pre- and postoperative retinal lesions Presence of pre- and postoperative retinal lesions OR 95% CI p-value * Age 1.01 0.98-1.03 0.54 Sex Men vs. women 0.92 0.66-1.27 0.61 Type of surgery Corneal refractive surgery vs. pioli 0.97 0.60-1.56 0.89 SE 0.83 0.78-0.88 <0.05 ACD 0.79 0.51-1.23 0.31 OR = odds ratio; CI = confidence interval; pioli = phakic intraocular lens implantation; SE = spherical equivalent; ACD = anterior chamber depth. * Logistic regression. Figure 1. Changes in prevalence of pre- and postoperative retinal lesions according to spherical equivalent. * p < 0.05 compared with previous subgroup, independent t-test. 발견된망막이상의종류로는격자형망막변성 172안, 망막박화 (retinal thinning) 20안, 격자형망막변성과망막원공이함께존재했던경우 28안, 후유리체박리 2안, 망막 원공단독으로존재한경우 13안, 망막열공 8안이었으며, 기타병변으로는낭포망막술 (cystic retinal tuft), 위축성반흔 (atrophic scar), 근시성망막변성, 망막전막, 선천성망막색소상피비대증등이관찰되었다 (Table 3). 망막이상이발견된경우에서술전예방적레이저장벽광응고술을시행한경우는총 144안으로 LASIK군에서 29 안 (72.5%), LASEK 및 PRK군에서 29안 (40.31%), pioli군에서 64안 (64.64%) 이해당되었다. 망막병변의종류별로예방적레이저광응고술을시행한경우는격자형망막변성 93안, 망막박화 3안, 격자형망막변성과망막원공이함께존재한경우 26안, 망막원공단독으로존재한경우 12안, 망막열공 8안, 기타망막병변은위축성반흔 1안, 낭포망막술 1안이었다 (Table 4). 술후추적관찰기간동안새로이망막이상이발견된경우는총 8안 ( 라섹및엑시머레이저군 5안, 유수정체안내렌즈삽입술군 3안 ) 이었으며, 망막병변의종류별로는격자형망막변성 4안 (50%, 라섹및엑시머레이저군 3안, 유수정체안내렌즈삽입술군 1안 ), 망막박화 1안 (12.5%, 라섹및엑시머레이저군 1안 ), 후유리체박리 1안 (12.5%, 라섹및엑시머레이저군 1안 ), 기타망막병변 2안 (25%, 유수정체안내렌즈삽입술군 2안 ) 이었으며, 기타망막병변은다발성소실성백반증후군 1안, 근시성맥락막신생혈관 1안이었다. 1673
- 대한안과학회지 2015 년제 56 권제 11 호 - Table 3. Type of preoperative retinal lesions Types of lesion (n) No. of eyes LASIK LASEK or PRK pioli Total Lattice degeneration 28 87 57 172 Retinal thinning 3 12 5 20 Lattice with retinal hole 3 7 18 28 PVD 1 1 2 Retinal hole 1 4 8 13 Retinal tear 4 4 8 Other retinal lesions 4 * 14 7 25 Total 40 129 99 268 LASIK = laser in situ keratomileusis; LASEK = laser-assisted subepithelial keratectomy; PRK = photorefractive keratectomy; pioli = phakic intraocular lens implantation; PVD = posterior vitreous detachment. * Cystic retinal tuft, atrophic scar, previous laser scar; Cystic retinal tuft, myopic degeneration, vitreous opacity, previous scleral encircling, previous laser scar; Cystic retinal tuft, atrophic scar, disc coloboma, epiretinal membrane, congenital retinal pigment epithelial hypertrophy, previous scleral encircling, previous laser scar. Table 4. The number of eyes with preoperative prophylactic laser treatment and the ratio of that to the number of retinal lesions Types of lesion (n) No. of eyes (%) LASIK LASEK or PRK pioli Total Lattice degeneration 23 36 34 93 (54.07) Retinal thinning 1 1 1 3 (15) Lattice with retinal hole 3 6 17 26 (92.86) PVD 0 0 0 0 Retinal hole 1 3 8 12 (92.31) Retinal tear 0 4 4 8 (100) Other retinal lesions 1 * 1 0 2 (8) Total 29 (72.5) 52 (40.31) 64 (64.64) 144 (53.73) LASIK = laser in situ keratomileusis; LASEK = laser-assisted subepithelial keratectomy; PRK = photorefractive keratectomy; pioli = phakic intraocular lens implantation; PVD = posterior vitreous detachment. * Atrophic scar; Cystic retinal tuft. 이들중레이저장벽광응고술을시행받은경우는 3안 ( 라섹및엑시머레이저군 2안, 유수정체안내렌즈삽입술군 1안 ) 으로모두격자형망막변성이었다. 기타망막병변중근시성맥락막신생혈관 1안은유리체강내 bevacizumab (Avastin, Genentech Inc., South San Francisco, CA, USA) 주사술을시행하였다. 고찰 굴절교정술을받는환자는대부분근시이며, 이들은정상인과비교해대체로긴안구축장을가지고있고, 이로인해격자형망막변성등의주변부망막이상이발견될가능성이높아진다는것은기존여러연구를통해잘알려져있다. 8 1989년 Burton 9 은근시값이높아질수록격자형망막변성의유병률이더높아지며, 망막박리의유병률도이와같은양상임을발표하였다. 또한굴절교정술이후발생하는망막열공등의망막관련합병증에대한여러보고도있다. 10-15 Arevalo et al 10 의라식후발생한후극부의합병증에대한연구에따르면 20안에서후극부합병증이관찰되 었으며, 그중에는망막열공, 망막박리등이있었다. 또한엑시머레이저후망막박리가발생한 11안 10명의환자가보고된바있으며, 13 국내에서는 Lee et al 16 의보고에서라식및엑시머레이저후발생한망막박리 15안의환자를보고한바있다. 라식후장기간추적관찰을한국내연구에서는수술후 1안의열공성망막박리가관찰되었다. 17 또다른연구에서는유수정체전방렌즈삽입술을시행받은 263 안중 8안에서망막박리가발생하였으며, 14 유수정체후방렌즈삽입술을시행받은 34안중 1안의망막박리발생이보고된바있다. 15 본연구결과에서는수술전후검사에서망막박리가관찰된환자는없었으나망막병변의유무와구면렌즈대응치, 성별, 나이와의관계를분석하였을때, 구면렌즈대응치만이망막병변의유무와 p<0.05로유의한관계를보이고, 구면렌즈대응치가 1D 증가할수록 0.832배만큼망막이상이발생할확률이감소하는것으로나타났다. 이는근시환자에서정상인에비해망막이상이발견될확률이높으며, 근시정도가심할수록망막이상이발생하기쉽다는이전연구결과와일치하는바이다. 1674
- 김민교외 : 굴절교정수술전후의망막이상 - 이처럼굴절교정수술후새로이발생하는망막이상에대한보고는많이이루어져있다. 엑시머레이저는음향충격파를발생시키는것으로알려져있는데 Seiler and McDonnell 18 은각막절제술시행시발생하는이러한음향충격파로인해근시안과같은망막이상발생에취약한조건에서망막박리를유발하거나더악화시키는것으로생각하였다. 그러나음향충격파의안구후극부에대한영향력은그연구에제한이있어 in vitro 연구로만추정할뿐이며, 19 최근에는그영향력이망막에손상을줄정도는아니라는연구결과도있다. 20 수술과정중흡입고리를사용할때발생하는안압상승과기계적인유리체견인으로인해망막박리가발생할것이라는제안이있었는데, 11 굴절교정수술후발생하는망막관련합병증에대한여러연구에서보이는망막박리의유병률이굴절교정수술을받지않은일반근시환자에서의망막박리유병률과큰차이가없다는연구결과에서미루어볼때굴절교정수술자체가망막박리등의망막이상이발생하는데에독립변수로작용하는지단정하기는어렵다. 9,12 흔히시행되는백내장수술과같은안구내수술은망막박리의위험인자이고, 21 유수정체안내렌즈삽입술역시안구내수술로서망막손상의위험인자로작용할수있다. 그러나유수정체전방안내렌즈삽입술의경우망막박리의유병률이수술을받지않은근시환자군의망막박리유병률과큰차이를보이지않았다는연구결과가있다. 22 유수정체후방안내렌즈삽입술의경우이에대한연구가잘이루어져있지않은데, 선행연구에따르면유수정체후방안내렌즈삽입술역시망막박리의위험을더증가시킨다고보기는어렵다고하였다. 23 하지만이는대조군연구가아니었기때문에명확한정립을위해서는후속연구가더필요하겠다. 본연구결과에서는수술방법의적응증에차이가있기때문에안내렌즈삽입술군에서각막굴절교정술을받았던다른두군과비교해서유의하게근시가더심했으며, 구면렌즈대응치가높은고도근시일수록망막박리의위험인자로작용하였다. 로지스틱회귀분석상에서도구면렌즈대응치가망막이상의존재여부와유의한관계가있었을뿐각막굴절교정술또는안내렌즈삽입술의수술법차이는망막이상의여부와유의한관계를보이지않았다. 또한기존연구 24 에서안축장길이와유의한양의상관관계, 구면렌즈대응치의증가와유의한음의상관관계를보이는것으로알려진전방깊이는본연구에서도구면렌즈대응치와유의한음의상관관계를보이는것으로나타났지만 (r=-0.174, p<0.05), 망막이상의유무와는통계학적으로유의한관계를보이지않았다. 망막병변이발견되는빈도의유의한변화를보이는구면 렌즈대응치의구간을찾기위해구면렌즈대응치별로군을나누어각군에서의빈도를분석한결과 -8디옵터, -12디옵터를넘어가는구간에서그이전구간에서보다망막병변의빈도가유의하게증가하였다. 따라서 -8디옵터이상의근시환자, 특히 -12디옵터이상의초고도근시환자의경우굴절교정수술전안저검사를면밀히시행하여야할것이며, 수술후에도정기적인안저검사를시행해야할것이다. 본연구는지금까지국내에서보고되지않았던굴절교정수술을받은환자에서술전후망막이상이발견되는빈도와이에대한예방적레이저치료를시행하는빈도를조사하고자하였다. 이를통해망막이상을유발하는독립변수를찾고자하였으며, 단일기관에서다수의환자를대상으로하였다는데에그의의가있다. 그러나굴절교정수술을받은환자군만을대상으로하여충분한대조군이설정되지않았다는것과, 수술후의망막이상의경우모든환자를대상으로한검사가아니라경과관찰을위해환자가내원하였거나이상을호소하여내원한경우에시행된검사만이대상이되었다는점에서한계가있으며항후모든환자를일정한기간동안검사한후속연구가필요할것이다. 본연구결과근시교정술을시행한환자중 276안 (30.83%) 에서망막이상이발견되었고, 적응증에따라 125안 (13.96%) 에서레이저치료를시행하였다. 이처럼술전후 19.66% 에서발견된격자형망막변성은망막원공, 열공등열공성망막박리를일으킬수있는원인병소를동반하거나진행할수있고, 망막박리는시력예후에영향을미칠수있기때문에미리발견하고예방적치료를시행하여야한다. 따라서망막이상의주요위험인자중하나인근시환자가대상이되는굴절교정수술을시행하기전산동후정밀한안저검사가필요하며, 수술후추적관찰기간중에도정기적인검사가요구되고증상이발생하는경우에는산동후안저검사가반드시이루어져야겠다. 참고문헌 1) Trokel SL, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol 1983;96:710-5. 2) Knorz MC, Liermann A, Seiberth V, et al. Laser in situ keratomileusis to correct myopia of -6.00 to -29.00 diopters. J Refract Surg 1996;12:575-84. 3) Ambrósio R Jr, Wilson S. LASIK vs LASEK vs PRK: advantages and indications. Semin Ophthalmol 2003;18:2-10. 4) Pallikaris IG, Papatzanaki ME, Stathi EZ, et al. Laser in situ keratomileusis. Lasers Surg Med 1990;10:463-8. 5) Curtin BJ. The Myopias: Basic Science and Clinical Management, 1st ed. Philadelphia: Harpercollins College Division, 1985; 333-48. 6) Wilkinson CP. Evidence-based analysis of prophylactic treatment 1675
- 대한안과학회지 2015 년제 56 권제 11 호 - of asymptomatic retinal breaks and lattice degeneration. Ophthalmology 2000;107:12-5; discussion 15-8. 7) Wilkinson C. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev 2005;(1):CD003170. 8) Karlin DB, Curtin BJ. Peripheral chorioretinal lesions and axial length of the myopic eye. Am J Ophthalmol 1976;81:625-35. 9) Burton TC. The influence of refractive error and lattice degeneration on the incidence of retinal detachment. Trans Am Ophthalmol Soc 1989;87:143-55; discussion 155-7. 10) Arevalo JF, Ramirez E, Suarez E, et al. Incidence of vitreoretinal pathologic conditions within 24 months after laser in situ keratomileusis. Ophthalmology 2000;107:258-62. 11) Ozdamar A, Aras C, Sener B, et al. Bilateral retinal detachment associated with giant retinal tear after laser-assisted in situ keratomileusis. Retina 1998;18:176-7. 12) Ruiz-Moreno JM, Pérez-Santonja JJ, Alió JL. Retinal detachment in myopic eyes after laser in situ keratomileusis. Am J Ophthalmol 1999;128:588-94. 13) Charteris DG, Cooling RJ, Lavin MJ, McLeod D. Retinal detachment following excimer laser. Br J Ophthalmol 1997;81:759-61. 14) Alió JL, de la Hoz F, Pérez-Santonja JJ, et al. Phakic anterior chamber lenses for the correction of myopia: a 7-year cumulative analysis of complications in 263 cases. Ophthalmology 1999;106: 458-66. 15) Pesando PM, Ghiringhello MP, Tagliavacche P. Posterior chamber collamer phakic intraocular lens for myopia and hyperopia. J Refract Surg 1999;15:415-23. 16) Lee SG, Hwang BN, Her J, Yun IH. Clinical analysis of rhegmatougenous retinal detachment after laser refractive surgery. J Korean Ophthalmol Soc 2003;44:2769-74. 17) Han HS, Song JS, Kim HM. Long-term results of laser in situ keratomileusis for high myopia. Korean J Ophthalmol 2000;14:1-6. 18) Seiler T, McDonnell PJ. Excimer laser photorefractive keratectomy. Surv Ophthalmol 1995;40:89-118. 19) Gobbi PG, Carones F, Brancato R, et al. Acoustic transients following excimer laser ablation of the cornea. Eur J Ophthalmol 1995;5:275-6. 20) Krueger RR, Seiler T, Gruchman T, et al. Stress wave amplitudes during laser surgery of the cornea. Ophthalmology 2001;108: 1070-4. 21) Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol 1982;100:289-92. 22) Ruiz-Moreno JM, Alió JL, Pérez-Santonja JJ, de la Hoz F. Retinal detachment in phakic eyes with anterior chamber intraocular lenses to correct severe myopia. Am J Ophthalmol 1999;127:270-5. 23) Martinez-Castillo V, Boixadera A, Verdugo A, et al. Rhegmatogenous retinal detachment in phakic eyes after posterior chamber phakic intraocular lens implantation for severe myopia. Ophthalmology 2005;112:580-5. 24) Hosny M, Alio JL, Claramonte P, et al. Relationship between anterior chamber depth, refractive state, corneal diameter, and axial length. J Refract Surg 2000;16:336-40. = 국문초록 = 굴절교정수술전후의망막이상과술전시행한망막레이저치료빈도 목적 : 근시교정을위해다양한각막굴절교정수술혹은유수정체안내렌즈삽입술을시행한환자에서수술전발견한망막이상과술전시행한예방적레이저광응고술여부, 그리고수술후발생한망막질환의빈도를알아보고자하였다. 대상과방법 : 본원에서 2005 년 1 월부터 2013 년 6 월까지시행한굴절교정수술환자를대상으로술전검사에서발견한망막이상의종류와빈도및이에대해예방적레이저광응고술을시행한비율을조사하였으며, 수술이후새로이발생한망막질환의종류와빈도를후향적의무기록조사를통해분석하였다. 결과 : 총 466 명 894 안 ( 라식군 117 명 225 안, 라섹및엑시머군 231 명 450 안, 유수정체안내렌즈삽입술군 121 명 219 안 ) 중 268 안 (29.98%) 에서술전망막이상이발견되었고, 이중 144 안 (16.11%) 에서예방적레이저광응고술을시행하였으며, 추적관찰기간중 8 안 ( 라섹및엑시머군 5 안, 유수정체안내렌즈삽입술군 3 안 ) 에서술전에관찰되지않았던망막이상이새로발견되었다. 수술전구면렌즈대응치와망막이상의유무간의유의한상관관계가관찰되었다. 결론 : 굴절교정술환자의대부분을차지하는근시환자에서망막이상의빈도는정상안보다높으며수술전망막레이저치료가필요한경우가많았다. 뿐만아니라수술후추적기간중에도망막이상이발생하는경우가있어이에대한술자와환자모두의주의가요구된다. < 대한안과학회지 2015;56(11):1671-1676> 1676