양안 후부 원추각막 환자에서 난시교정용 인공수정체 삽입 후 굴절 오차
Refractive Error after Toric Intraocular Lens Implantation in a Patient with Bilateral Posterior Keratoconus
- 대한검안학회
- Annals of optometry and contact lens
- Vol.23 No.3
- 2024.09
- 125 - 130 (6 pages)
목적: 양안 후부 원추각막 환자에서 양안 백내장 수술 및 난시교정용 인공수정체 삽입 후 목표로 한 구면 대응치 결과를 보인 증례를 보고하고자 한다. 증례요약: 64세 여자 환자가 시력 저하를 주소로 내원하였다. 세극등현미경 검사에서, 각막 전면에서는 큰 이상 소견은 없었으나 상피하혼탁과 함께 각막후면 중심부의 패임이 양안 모두에서 관찰되어 후부 원추각막으로 진단하였다. 각막단층촬영검사의 posterior axial curvature map에서 난시는 1 D 미만으로 심하지 않았고, posterior elevation map에서 작은 크기의(우안 1.5 × 1.5 mm, 좌안1.0 × 1.0 mm) 후부 각막 융기가 있었으나 난시는 없었다. 결과적으로 수술 후 우안은 교정시력 0.8 × -1.25 D Ax 10°, 좌안은 교정시력 0.7 × plano로 목표로 한 술 후 구면 대응치를 얻었다. 결론: 후부 원추각막 환자에서 백내장 수술을 시행할 때에는 각막전면의 이상 유무, 각막후면의 패임 정도 및 범위, 후면 난시를 모두 고려하여 인공수정체 도수를 결정해야 한다.
Purpose: To report a case of bilateral posterior keratoconus where a targeted spherical equivalent outcome was achieved after bilateral cataract surgery Case summary: A 64-year-old female patient presented with impaired vision. Corrected visual acuity was 0.6 × -2.50 D Ax 60° in the right eye and 0.4 × -2.50 = -2.50 D Ax 140° in the left eye. Although slit-lamp examination revealed no abnormalities on the anterior surface of the cornea, it showed subepithelial opacity and excavation in the central posterior cornea; hence, a diagnosis of posterior keratoconus was made. Corneal tomography revealed that the astigmatism was less than 1 D in the posterior axial curvature map, the size of the posterior corneal elevation was small (right eye, 1.5 mm; left eye, 1.0 mm), and there was no astigmatism in the posterior elevation map. Simulated keratometry was used for the K value, and the intraocular lens (IOLs) power was calculated using the Sanders Retzlaff Kraff/Theoretical formula. The use of toric IOLs was decided to correct anterior cornea astigmatism, and the postoperative target spherical equivalent outcome for both eyes was planned as emmetropic. Finally, the corrected visual acuity was 0.8 × -1.25 D Ax 10° in the right eye and 0.7 × plano in the left eye, resulting in the targeted postoperative spherical equivalent outcome. Conclusions: To determine the most appropriate power of the IOLs in patients with posterior keratoconus, the abnormality of the anterior corneal surface, degree and extent of posterior corneal excavation, and degree of posterior corneal astigmatism should be considered.
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