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[논문] 엑스트라 라섹의 각막 후면 고도의 안정화 (BMC Ophthalmology)

2016.08.11 8363

"엑스트라 라섹이 각막 후면 고도의 안정화를 가능하게 한다"

이미 아베드로 의학자문위원회, CXL학회에서 

엑스트라 라섹의 효용성과 안정성을 강조해 온 아이리움안과, 


2016년 8월,아이리움안과와 연세대 의과대의 공동 논문이 유명 학술지 BMC Ophthalmology에 실렸습니다. 

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Lee et al. BMC Ophthalmology (2016) 16:139 DOI 10.1186/s12886-016-0320-3

BMC Ophthalmology

RESEARCH ARTICLE Open Access

Changes in posterior corneal elevations after combined transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking: retrospective, comparative observational case series

Hun Lee1,2, David Sung Yong Kang3, Byoung Jin Ha3, Jin Young Choi3, Eung Kweon Kim2,4, Kyoung Yul Seo2 and Tae-im Kim2*

Abstract

Background
To compare the changes in anterior and posterior corneal elevations after combined transepithelial photorefractive keratectomy (PRK) and accelerated corneal collagen cross-linking (CXL) and after PRK.
Methods
Medical records of 82 eyes of 44 patients undergoing either combined transepithelial PRK and CXL (PRK-CXL group) or transepithelial PRK (PRK group) were examined retrospectively. Changes in anterior and posterior corneal elevations were calculated by fitting an 8.0-mm diameter best-fit sphere and best-fit toric ellipsoid (BFTE) to the corneal shape with a fixed eccentricity of 0.4 using Scheimpflug tomography (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany) preoperatively and 6 months postoperatively.
Results
In anterior corneal elevation, both groups demonstrated a similar trend of a forward displacement of peripheral anterior corneal surface and a backward displacement of central anterior corneal surface. In posterior corneal elevation, a forward displacement of peripheral posterior corneal surface was induced in both groups, along with a backward displacement of central posterior corneal surface, regardless of the calculation method. The magnitudes of displacement of peripheral and central posterior corneal surfaces were significantly smaller in the PRK-CXL group than in the PRK group. Moreover, the PRK-CXL group showed a backward displacement of posterior corneal surface at maximum corneal elevations when the BFTE was used as the reference surface.
Conclusions
Transepithelial PRK combined with prophylactic CXL significantly reduced the magnitudes of displacement of peripheral and central posterior corneal surfaces, with the radius of the BFTE was set to 8.0-mm on the Scheimpflug tomography system.
Keywords
Posterior corneal elevations, Transepithelial photorefractive keratectomy, Accelerated corneal collagen cross-linking, Scheimpflug tomography, Best-fit toric ellipsoid


Posterior corneal elevation values

GroupReference SurfaceMeasurement TypeValue (Estimated)
PRK-CXL groupBFTEΔpph~0.5
PRK-CXL groupBFTEΔcentral~-3.5
PRK-CXL groupBFTEΔmax~-1.3
PRK-CXL groupBFSΔpph~0.8
PRK-CXL groupBFSΔcentral~-3.8
PRK-CXL groupBFSΔmax~0.7
PRK groupBFTEΔpph~2.0
PRK groupBFTEΔcentral~-7.0
PRK groupBFTEΔmax~1.6
PRK groupBFSΔpph~2.6
PRK groupBFSΔcentral~-5.8
PRK groupBFSΔmax~2.7

Fig. 1 Comparison of changes in preoperative and postoperative corneal elevation values between eyes that underwent combined transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking and transepithelial photorefractive keratectomy alone. PRK-CXL = Combined transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking; PRK = transepithelial photorefractive keratectomy; Δ = change; pph = measurements of 6-mm and 4-mm zone; central = measurements of 2-mm zone and center; max = measurements of maximal elevation zone; BFTE = best-fit toric ellipsoid; BFS = best-fit sphere. Error bars represent standard error of the mean (*p < 0.05, **p < 0.01)



이로써, 각막 전면부에 국한된다고 여겨지던 콜라겐교차결합술의 영향이

실제로는 각막 전체에 고루 영향을 주어

각막 후면의 곡률과 각막의 고도(elevation)가 안정화 되어

각막 전체의 구조적 안정을 가능케 함을 국제적으로 입증하였습니다.

▣ 엑스트라 수술이 필요한 눈 조건, 어떻게 알 수 있을까요? 


아이리움안과는 엑스트라 수술 전, 객관적 검사 결과를 근거로

'코르비스ST를 이용한 각막강성도검사'를 필수 시행하고 검사 결과를 보여드립니다.

검사 결과가 정상인지, 수술 후에도 안전한지 알기 위해서는 각막강성도의 정상구간을 알아야 합니다.

그래야 엑스트라 수술이 필요한 눈 조건인지 알수 있습니다.

검사수치는 읽어드리는 것이 아니라 집도의가 해석하고 판단해드려야 합니다.

그래서 연세대 의과대와 공동 연구한 '각막강성도 정상범주'논문,

세계적 SCI 학술지 美 Cornea지에 채택되어 수술안전성을 더 높인 계기가 되었습니다.

관련논문: Biomechanical properties of the cornea measured with a dynamic Scheimpflug analyzer in young healthy adults


정밀하고 철저한 검사와, 객관적인 근거를 바탕으로 

안전한 수술로 보답하기 위해 항상 최선을 다하겠습니다.

 성원에 감사드립니다. 

▼미국 아베드로 아시아 유일 의학자문위원회(MAB) 소속 강성용 원장

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