시신경유두함몰비가 큰 미숙아의 선천 녹내장 발생 위험
Risk of Developing Congenital Glaucoma in Premature Infants with Large Cup/Disc Ratio
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목적: 시신경유두함몰비가 큰 미숙아의 장기적인 경과 관찰 결과를 분석하여 선천 녹내장의 발생 위험을 확인하고자 하였다. 대상과 방법: 시신경유두함몰비가 0.3 이상인 미숙아의 의무기록을 후향적으로 분석하였다. 초진 시와 마지막 추적 관찰 시 시신경유두함몰비의 변화를 분석하였으며, 이와 연관된 임상인자를 분석하였다. 결과: 74명이 분석에 포함되었으며, 교정 연령을 기준으로 33.96 ± 19.86개월까지 추적 관찰하였다. 초진 시 안압은 17.12 ± 4.01 mmHg였으며, 수평각막직경은 10.34 ± 0.83 mm였다. 시신경유두함몰비는 초진 시 0.54 ± 0.14였으며, 마지막 추적 관찰 시 0.57 ± 0.14로 유의하게 증가하였다(p<0.001). 초진 시 시신경유두함몰비가 작은 것이 시신경유두함몰비의 증가와 관련된 임상인자로 나타났으며(regression coefficient, β=-0.111, p=0.028), 이외 재태연령, 출생 체중, 안압, 각막직경은 유의한 연관성은 없는 것으로 나타났다. 선천 녹내장으로 진단된 경우는 없었다. 결론: 미숙아에서 시신경유두함몰비가 0.3 이상이더라도 안압이 높지 않은 경우 녹내장의 발생 위험이 높지는 않은 것으로 보인다.
Abstract
Purpose: To investigate the risk of congenital glaucoma development in premature infants with large cup/disc ratios: a long-term follow-up study. Methods: The medical records of premature infants with cup/disc ratios of at least 0.3 were retrospectively reviewed. Ophthalmic examinations, including measurements of intraocular pressure (IOP) corneal diameter, and dilated fundoscopy, were periodically performed. Changes in the cup/disc ratio from the first examination to the last follow-up were sought, and clinical factors associated with such changes were analyzed. In addition, glaucoma development was investigated. Results: Seventy-four patients were included; they were monitored for up to 33.96 ± 19.86 months (based on corrected age). At first examination, the mean IOP was 17.12 ± 4.01 mmHg and the horizontal corneal diameter 10.34 ± 0.83 mm. The mean cup/disc ratio was 0.54 ± 0.14 at the first visit and increased significantly to 0.57 ± 0.14 at the last follow-up (p < 0.001). A small baseline cup/disc ratio was associated with a greater change in the cup/disc ratio (regression coefficient β = -0.111, p = 0.028). We found no significant association of such change with gestational age, birth weight, IOP, or corneal diameter. We encountered no case of congenital glaucoma. Conclusions: Even if the cup/disc ratio is at least 0.3 in premature infants, the risk of glaucoma does not seem to be high if the IOP is not high. Prospective studies on more patients are needed.
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