초음파 백내장쪼개기와 작은 백내장쪼개기에 의한 백내장 수술의 비교

목적 : 초음파 백내장쪼개기(Phaco Chop)와 작은 백내장쪼개기(Mini Chop) 방법으로 백내장 수술을 시행하고 유효초음파시간(Effective Phacoemulsification Time, 이하 EPT), 술후 각막부종 및 각막내피세포수에 있어서 차이가 있는지 알아보고자 하였다. 대상과 방법 : 중등도 이상의 백내장을 가진 환자를 초음파 백내장쪼개기(P군, 15안)와 작은 백내장쪼개기(M군, 13안) 방법으로 수술을 시행하였다. EPT, 각막두께(수술전, 수술직후, 1일, 1주, 1개월, 3개월) 및 각막내피세포수(수술전, 수술후 1개월, 3개월)를 측정하였다. 결과 : 양 군간 EPT는 P군과 M군 각각 5.2초, 1.0초였으며(p=0.000), 각막두께 증가는 M군이 수술후 1주째까지 통계적인 유의성은 없었으나 적은 경향을 보였다. 각막내피세포밀도는 수술후 한달째와 석달째 모두 통계적으로 유의하게 M군이 높았다. 결론 : 초음파사용을 가능한 적게 한 작은 백내장쪼개기 방식이 초음파 백내장쪼개기에 비해 내피세포의 손상을 줄이면서 초기에 술후 각막부종이 적은 경향을 보이는 수술 방법임을 알 수 있었다. Purpose: To compare effective phacoemulsification time (EPT), the severity of corneal swelling and corneal endothelial cell density after cataract surgery between the phaco chop method and the mini chop method. Methods: Cataract surgery was performed by phaco chop (15 eyes) or by mini chop (13 eyes) method in 28 eyes of 27 patients. The nuclear opacity of cataract grade was more than 5 on LOCS (Lens opacities classification system) III. EPT and the amount of irrigated BSS solution were measured during the operation. Corneal thickness (preoperative, immediate postoperative, postoperative 1 day, 1 week, 1 month, and 3 months) and corneal endothelial cell density (preoperative, postoperative 1month and 3 months) were measured. Results: The EPT of phaco chop group was 5.2 sec and that of mini chop was 1.0 sec (p=0.000). The amount of irrigated BSS was 193.7 ml and 170.4 ml in the phaco chop group and the mini chop group, respectively. The increase in corneal thickness was 3.2% and 0.9% at immediately after surgery (p=0.128), 19.0% and 10.5% at postoperative 1 day (p=0.088), 5.7% and 1.5% at postoperative 1 week (p=0.080), 0% and -1.3% at postoperative 1 month (p=0.717), and -0.4% and -0.6% at postoperative 3 months (p=0.890) in the phaco chop group and the mini chop group, respectively. Corneal endothelial cell density decreased 23.0% in the phaco chop group and 9.4% in the mini chop group at postoperative 1 month (p=0.005) and 22.9%, 12.6%, at 3 months respectively (p=0.036). Conclusions: The mini chop technique reduced permanent endothelial cell damage in comparison with the phaco chop method and might be more effective in decreasing corneal swelling during the early postoperative period than the phaco chop method. KCI Citation Count: 1