고도 축성 근시에서 시신경 형태의 다양성과 녹내장과의 연관성
Variability in Optic Nerve Head Morphology in High Axial Myopia and Its Association with Glaucoma
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목적: 고도 축성 근시안에서 시신경유두 형태의 다양성을 확인하고, 빛간섭단층촬영을 통한 시신경 깊은 층의 구조를 분석하여 고도 축성 근시가 있는 눈에서 시신경유두 형태 변화 정도와 녹내장과의 연관성을 확인하고자 하였다. 대상과 방법: 안축장이 26 mm 이상 27 mm 미만인 고도 축성 근시가 있는 69안(정상안 33안, 녹내장 36안)의 의무기록을 후향적으로 분석하였다. 안저사진에서 확인한 시신경 유두의 기울기 정도에 따라(기울기=1.3) 두 그룹으로 나누어 사상판 깊이, 시신경 유두주위 위축 너비, 브루크막 개방 넓이를 포함한 시신경 유두 깊은 층의 형태학적 특징을 비교하고, 녹내장성 손상 정도와 연관이 있는 인자를 분석하였다. 결과: 전체 대상안의 평균 시신경유두 기울기는 1.31 ± 0.23이었다. 기울기가 큰 군(≥1.3, 30안)에서 작은 군(<1.3, 39안)에 비해 녹내장 빈도가 높았고(p=0.035), 심한 시야결손(p<0.001), 얇은 망막신경섬유층 두께(p=0.046), 넓은 감마 시신경 유두주위 위축 너비(p<0.001)를 보였다. 시신경 유두 기울기는 시야결손 정도와 연관된 인자 분석에서 통계적으로 유의한 관련이 있었지만(p=0.018), 망막신경섬유층의 두께 감소와는 유의한 관련이 없었다(p=0.203). 결론: 비슷한 정도의 안축장을 가진 고도 축성 근시안에서 시신경유두 기울기는 다양할 수 있으며, 기울기가 클수록 심한 시야결손을 보였다. 이는 근시의 진행에 따른 시신경유두 형태 변화의 양상에 따라 녹내장 손상의 정도에 영향을 줄 수 있다는 것을 시사한다.
Abstract
Purpose: To investigate optic disc morphology in high axial myopia and its associations with the deep-layer structure of the optic disc using optical coherence tomography and glaucoma. Methods: We retrospectively reviewed the medical records of 69 eyes (33 normal and 36 glaucomatous eyes) with an axial length of 26-27 mm. The eyes were categorized into two groups based on the optic disc tilt ratio (≥ 1.3 or < 1.3). Characteristics of optic disc morphology, including lamina cribrosa depth, peripapillary atrophy width, and Bruch’s membrane opening area, were compared between the two groups. Furthermore, factors related to mean deviation and global retinal nerve fiber layer (RNFL) thickness were analyzed. Results: The mean optic disc tilt ratio was 1.31 ± 0.23. Eyes with a tilt ratio ≥ 1.3 (30 eyes) had a higher likelihood of glaucoma (p = 0.035) and severe visual field (VF) defects (p < 0.001), a thinner global RNFL thickness (p = 0.046), and larger gamma peripapillary atrophy width (p < 0.001) compared to eyes with a tilt ratio < 1.3 (39 eyes). Linear regression analysis revealed that the optic disc tilt ratio was significantly associated with VF loss (p = 0.018) but not with global RNFL thinning (p = 0.203). Conclusions: Variations in optic disc morphology are observed in eyes with similar axial lengths, and a higher optic disc tilt ratio is associated with more severe VF defects. These findings suggest the potential influence of optic disc morphological changes due to axial elongation on the severity of glaucomatous damage.
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