손상 정도가 다른 양안 정상안압녹내장 환자에서 두 눈의 사상판 깊이 비교
Inter-eye Comparison of the Lamina Cribrosa Depth in Patients with Bilateral Normal-tension Glaucoma with Asymmetrical Damage
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목적: 정상안압녹내장 환자에서 시신경 손상의 중등도와 사상판 깊이와의 상관성을 알아보고자 하였다. 대상과 방법: 손상 정도가 다른 양안 정상안압녹내장 환자에서 양안의 optic nerve head (ONH) horizontal B-scan 영상을 얻었다. ONH의 수직 거리가 동일한 3개의 위치에서 사상판 깊이를 측정하였다. 시야결손 중등도에 따라 결손이 심한 눈 군과 결손이 경한눈 군으로 나누어 두 군의 LCD를 비교 분석하였다. 조건부 로지스틱 회귀분석을 이용하여 녹내장 예후와 관련된 인자를 분석하였다. 결과: 환자 52명, 총 104안이 포함되었다. 평균 연령은 66.0 ± 15.0세였고, 남자 31명, 여자 21명이었다. 시야결손이 심한 눈은 반대눈보다, 기저안압이 높고(p＜0.001), 망막신경섬유층 두께가 얇고(p＜0.001), 시야검사의 mean deviation 값이 낮고(p＜0.001), pattern standard deviation이 컸다(p＜0.001). 양안의 구면대응수치 및 안축장 길이의 차이는 없었으나, 시야결손이 심한 눈의 사상판 깊이가 반대 눈보다 컸다(529.4 ± 116.7 vs. 482.9 ± 107.5 μm, p＜0.001). 조건부 로지스틱 회귀분석에서 기저안압이 높을수록(p=0.006), LCD가 클수록(p=0.003) 녹내장이 심할 위험이 높았다. 결론: 양안 정상안압녹내장 환자에서, 시신경 손상이 더 심한 눈의 LCD가 더 컸다. 이는 정상안압녹내장 환자에서도 사상판의 변형이시신경 손상과 관련이 있을 것임을 시사한다.
Abstract
Purpose: To evaluate the association between lamina cribrosa depth (LCD) and the severity of glaucomatous damage in patients with normal-tension glaucoma (NTG). Methods: The optic nerve heads (ONHs) of patients with bilateral NTG showing asymmetrical damage were scanned using spectral-domain optical coherence tomography. LCDs were measured on ONH horizontal B-scan images at three locations equidistant across the vertical optic disc diameter and compared between the more damaged and contralateral eyes. Conditional logistic regression analysis was performed to identify ocular risk factors associated with more severe damage between the eyes. Results: One hundred and four eyes of 52 patients with bilateral NTG were included. The mean age was 66.0 ± 15.0 years; there were 31 males and 21 females. The more damaged eyes exhibited a higher baseline intraocular pressure (IOP) (p < 0.001), a thinner global retinal nerve fiber layer thickness (p < 0.001), and worse visual field mean deviation (p < 0.001) and a pattern standard deviation (p < 0.001), than the contralateral eyes. In contrast, we found no significant inter-eye difference in either the spherical equivalent or the axial length. The average LCD was significantly larger in the more damaged eyes (529.4 ± 116.7 vs. 482.9 ± 107.5 μm, p < 0.001). On conditional logistic regression analysis, the higher the baseline IOP (p = 0.006) and the larger the LCD (p = 0.003), the higher the risk of having more severe damage compared to the contralateral eye under similar systemic conditions. Conclusions: The LCD was significantly larger in the more damaged eyes of patients with bilateral NTG, suggesting that LC deformation might be associated with glaucomatous ONH damage in NTG eyes.
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