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목적: 양의 수직코마를 가진 환자에서 직난시 및 도난시에 따른 상측절개 백내장수술 전후의 고위수차 변화량을 비교하고자 하였다. 대상과 방법: 양의 수직코마를 가진 환자에서 2.5 mm 상측 투명각막절개 백내장수술을 시행한 직난시군 37안과 도난시군 33안을 대상으로 수술 전 및 수술 후 1달 뒤 나안시력, 최대교정시력, 각막난시를 측정하였고, 각막 전면, 후면 및 총 수차(사축트레포일, 수평트레포일, 수직코마, 수평코마, 구면수차, 총 고위수차)를 Pentacam으로 측정하여 비교하였다. 결과: 직난시군에서는 수술 후 각막 전면, 후면 및 총 수직코마가 유의하게 감소하였고(p<0.05), 도난시군에서는 후면 수직코마에서 유의한 감소를 보였으나(p=0.008), 총 수직코마에서는 유의한 변화를 보이지 않았다. 사축트레포일은 두 군 모두에서 유의한 증가를 보였고, 수평트레포일은 도난시군에서 유의한 감소를 보였다(p<0.05, respectively). 구면수차는 도난시군의 전면 각막수차에서 유의한 감소를 보였고(p<0.001), 총 고위수차는 직난시군의 전면과 후면, 도난시군의 후면수차에서 유의한 증가를 보였다(p<0.05, p=0.001). 수평코마와 각막난시는 두 군에서 수술 전후로 유의한 변화를 보이지 않았다. 결론: 상측절개 백내장수술에서 수직코마는 난시축에 영향을 받아 직난시군에서 유의한 감소를 보였고, 각막 난시는 수술 전후로 유의한 변화를 보이지 않았다.
Purpose: The purpose of this study was to compare changes in higher-order aberrations after superior-incision cataract surgery between eyes with a within-the-rule (WTR) astigmatism and an against-the-rule (ATR) astigmatism in patients with positive vertical coma. Methods: This study included patients who presented with positive vertical coma and who underwent cataract surgery through a 2.5 mm superior clear corneal incision. The eyes included in this study were divided into two groups (37 eyes with WTR astigmatism and 33 eyes with ATR astigmatism), and uncorrected visual acuity, best corrected visual acuity, and corneal astigmatism were measured before and after surgery. In addition, anterior, posterior, and total aberrations (i.e., oblique trefoil, horizontal trefoil, vertical coma, horizontal coma, spherical aberration, and total higher-order aberrations) were measured using a Pentacam. Results: In the WTR astigmatism group, anterior/posterior corneal aberrations and total aberrations were significantly decreased after surgery (p < 0.05). However, in the ATR astigmatism group, a significant decrease in the posterior vertical coma (p = 0.008) was observed, although there was no change in total vertical coma. A significant increase in oblique trefoil was observed in both groups, while a significant decrease in horizontal trefoil was found in the ATR astigmatism group (all p < 0.05). For spherical aberration, the ATR astigmatism group showed a significant decrease in anterior cornea aberrations (p < 0.001). For total higher- order aberrations, the WTR astigmatism group showed a significant increase in anterior and posterior aberrations, while the ATR astigmatism group showed a significant increase in posterior aberrations (p < 0.05, p = 0.001, respectively). In the case of horizontal coma and corneal astigmatism, both groups exhibited no significant changes after surgery. Conclusions: When superior-incision cataract surgery was performed, vertical coma was affected by the axis of astigmatism, resulting in a significant decrease in the WTR astigmatism group. However, no significant changes in corneal astigmatism were observed before and after surgery.
