각막굴절교정수술 후 각막절삭량과 안압변화의 상관관계

Correlation between Corneal Ablation Amount and Intraocular Pressure after Corneal Refractive Surgery

목적 : 각막굴절교정수술 후 각막절삭량에 따른 안압변화와 수술 전 굴절이상도에 따른 수술 후 안압 변화에 대하여 알아보고자 하였다. 방법 : 라식 각막굴절교정수술을 받은 평균연령 $37.34{\pm}7.42$세, 성인 남녀 108명(남자 48명, 여자60명)을 대상으로 선정하였다. 자동굴절검사기, 비접촉형안압계, 엑시머레이저를 이용하여 굴절이상도, 안압, 각막절삭량을 측정하였으며, p<0.05일 때 통계적으로 유의하다고 판단하였다. 결과 : 각막굴절교정수술 전 안압은 남자가 $15.08{\pm}2.60mmHg$, 여자가 $14.16{\pm}2.67mmHg$로 남자가 여자보다 높게 나타났으며, 각막굴절교정수술 후 안압 감소량은 남자가 4.22mmHg, 여자가 3.61mmHg로 나타났다. 등가구면 굴절력은 각막굴절교정 수술 전 남자 $-3.89{\pm}2.17D$, 여자 $-4.45{\pm}2.92D$에서, 각막굴절교정 수술 후 남자 $-0.10{\pm}0.46D$, 여자$-0.04{\pm}0.46D$로 나타났다. 각막굴절교정수술 후 각막절삭량은 남자 $53.95{\mu}m$, 여자 $61.26{\mu}m$로 통계적으로 유의한 차이가 있었으며, 각막절삭량과 안압의 감소량에는 유의한 상관성(r=0.2299, p<0.001)을 보였다. 성별로는 남자의 각막절삭량이 많아질수록 안압의 감소량은 유의하게 증가하는 것으로 나타났다. 굴절이상도가 증가할수록 안압의 감소량도 커져 경도의 굴절이상도에서는 $3.04{\pm}2.18mmHg$, 중등도의 굴절이상에서는 $4.10{\pm}2.16mmHg$, 고도의 굴절이상도에서는 $4.65{\pm}3.29mmHg$가 감소하는 것으로 나타났다. 결론 : 각막굴절교정수술 후 비접촉식 안압계로 측정한 안압은 감소하는 것을 알 수 있었으며, 안압측정은 녹내장 판단에 영향을 줄 수 있으므로 안압 측정시 각막굴절교정수술 여부에 대한 사전설문이 필요할 것으로 생각된다.

Purpose : The purposes of this study were to evaluate the changes of intraocular pressure according to corneal ablation amount after corneal refractive surgery and the changes of intraocular pressure according to refractive errors before corneal refractive surgery. Methods : The mean age of adults who underwent LASIK corneal refractive surgery were $37.34{\pm}7.42years$, and 108 adults(48 males, 60 females) were participated in this study. Refractive errors, intraocular pressure, and corneal ablation amount were measured using an autorefractor, a noncontact tonometer, and an excimer laser. All test values were considered statistically significant when p<0.05. Results : The mean intraocular pressure before corneal refractive surgery was $15.08{\pm}2.60mmHg$ in males and $14.16{\pm}2.67mmHg$ in females. The decrease of intraocular pressure after corneal refractive surgery were 4.22mmHg in males and 3.61mmHg in females. Spherical equivalent power were $-3.89{\pm}2.17D$ in males and $-4.45{\pm}2.92D$ in females before corneal refractive surgery, and $-0.10{\pm}0.46D$ in males and $-0.04{\pm}0.46D$ in females after corneal refractive surgery. The corneal ablation amount after corneal refractive surgery were statistically significant, with $53.95{\mu}m$ in males and $61.26{\mu}m$ in females. There was significant correlation between corneal ablation amount and decrease of intaocluar pressure(r=0.2299, p<0.001). As the growth of corneal ablation amount in males, the decrease of intraocular pressure was significantly increased. As the growth of refractive error, the amount of decrease in intraocular pressure was also significant. The decrease of intraocualr pressure were $3.04{\pm}2.18mmHg$ in low refractive error, $4.10{\pm}2.16mmHg$ in middle refractive error, and $4.65{\pm}3.29mmHg$ in high refractive error. Conclusion : We found that intraocular pressure decreased after corneal refractive surgery by noncontact tonometer and the change of intraocular pressure which is an important index for glaucoma diagnosis, may affect the judgment of eye disease. We think that a preliminary questionnaire whether corneal refractive surgery is necessary for the measurement of intraocular pressure.