초음파수정체유화술에서 핵경화도에 따라 누적분사에너지가 각막내피세포에 미치는 영향

Effects of Cumulative Dissipated Energy on Corneal Endothelial Cells in Phacoemulsification Based on Nucleus Sclerosis

목적: 초음파수정체유화술 시행시 핵경화도에 따른 누적분사에너지(cumulative dissipated energy, CDE) 양과 그로 인한 각막내피세포(corneal endothelial cell, CEC)의 변화를 경면현미경검사를 통하여 알아보고자 하였다. 대상과 방법: 초음파수정체유화술을 받은 67안을 대상으로 수술 전, 후 각막내피세포의 변화를 분석하고자 수술 전, 수술 1개월, 3개월째 경면현미경검사 결과를 비교하였다. 결과: 수술 전과 수술 1개월째 경면현미경검사에서는 단위면적당개수(cell density, CD), 세포면적변이계수(coefficient of variation, CV)에서 유의미한 차이가 있었다(p<0.001, 0.011). 수술 1개월째 CD는 nucleus sclerosis (NS) 2부터 6으로 갈수록 감소하였다(p<0.001). NS가 증가함에 따라 CDE는 증가하였다(r=0.809, p<0.001). 같은 핵경화도 내에서는 CDE가 증가하면 CEC 감소량이 커지는 양의 상관관계를 확인하였다(r=0.559, p=0.001). 수술 3개월째 CD는 핵경화도가 증가할수록 감소하였다(p=0.010). 수술 1개월, 3개월째의 CD는 수술 전보다 감소하였으며(p<0.001, <0.001), 수술 1개월, 3개월째는 차이가 없었다. 결론: 핵경화도가 증가할수록 CDE가 증가하고 이와 각막내피세포의 손상 정도는 양의 상관관계가 있음을 확인하였다. 따라서 핵경화도가 증가할수록 CDE가 증가하지 않도록 이를 줄일 수 있는 방법으로 수술을 계획해야 한다.

Purpose: To investigate changes in corneal endothelial cell (CEC) by cumulative dissipated energy (CDE) during phacoemulsification. Methods: Based on the degree of nucleus sclerosis (NS), changes in CECs were compared preoperatively and at 1 and 3 months postoperatively in 67 eyes that underwent phacoemulsification. Results: The mean CDE used during surgery was 4.30 ± 2.31. A comparison of the surgical measurements before and 1 month after surgery revealed significant differences in the cell density (CD) and coefficient of variation (CV) (p < 0.001, 0.011, respectively). The CD showed significant differences among NS grades 2-6 (p < 0.001). The CDE increased significantly with higher NS grades (r = 0.809, p < 0.001). Within the same NS grade, there was a positive correlation between higher CDE and greater CEC loss (r = 0.559, p = 0.001). CD changes were significantly associated with increasing CDE (r = 0.612, p < 0.001). The CD loss also increased significantly from NS2 to NS6 (p < 0.001). At 3 months postoperatively, surgical measurements revealed a significant decrease in CD with increasing NS grade (p = 0.010). Conclusions: CDE increased with higher NS grades and there was a positive correlation between CDE and CEC loss. Therefore, surgeons should plan surgical techniques preoperatively to minimize CDE as NS increases. Additionally, it is important to assess CEC damage postoperatively based on surgical measurements in patients with high intraoperative CDE.