프로스타글란딘의 Benzalkonium Chloride 보존제가 각막지각에 미치는 영향
Effect of the Preservative Benzalkonium Chloride in Prostaglandin Analogues on Corneal Sensitivity
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목적: 프로스타글란딘 제제에서 보존제 benzalkonium chloride (BAK)의 포함 여부가 각막지각에 미치는 영향을 비교해 보고자 하였다. 대상과 방법: 프로스타글란딘 단독 제제로 치료를 시작한 정상안압녹내장과 원발개방각녹내장 환자의 단안에서 Cochet-Bonnet 지각계로 중심각막의 지각을 측정하였다. 각막지각의 측정은 치료 시작 전과 치료 후 1개월, 3개월에 실시하였다. 결과: 정상안압녹내장 52안, 원발개방각녹내장 32안에서 3개월간 전향적으로 각막지각을 측정하였다. BAK가 포함되지 않은 프로스타글란딘 제제는 45안, 포함된 프로스타글란딘 제제는 39안에서 사용되었다. 각막지각은 BAK가 포함되지 않은 프로스타글란딘 제제를 사용한 경우 치료 전과 1개월, 3개월째에 각각 58.22 ± 3.56 mm, 57.77 ± 4.59 mm, 56.33 ± 5.47 mm였으며, BAK가 포함된경우 치료 전과 1개월, 3개월째에 각각 58.20 ± 4.51 mm, 56.31 ± 6.22 mm, 55.52 ± 6.23 mm였다. 치료 3개월째에 BAK가 함유된프로스타글란딘 제제를 사용한 경우 유의하게 각막지각이 감소하였으며(p=0.033), 이때 함께 사용한 인공누액 제제는 이러한 각막지각의 저하에 유의한 영향을 미치지 않았다. 결론: 보존제로 BAK가 포함된 프로스타글란딘 제제는 각막지각의 저하를 유발하며, 인공누액 제제를 함께 사용하더라도 각막지각의 저하에 영향을 미치지 않았다. 따라서 BAK가 포함된 녹내장 약물을 장기간 사용할 경우 각막지각을 저하시킬 수 있으며 이에 따른 부작용도 고려하여야 할 것이다.
Abstract
Purpose: To investigate the effect of a prostaglandin (PG) analogue with or without preservative benzalkonium chloride (BAK) on corneal sensitivity. Methods: Central corneal sensitivity was measured prospectively with a Cochet–Bonnet esthesiometer in patients with normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) before and 1 and 3 months after treatment. All patients began treatment with PG monotherapy with or without BAK preservative. Results: The study enrolled 84 patients: 52 NTG and 32 POAG. The treatment was PG with BAK preservative in 45 eyes and without BAK preservative in 39 eyes. Without BAK, the mean corneal sensitivity was 58.22 ± 3.56, 57.77 ± 4.59, and 56.33 ± 5.47 mm before and after 1 and 3 months, respectively; with BAK the mean corneal sensitivity was 58.20 ± 4.51, 56.31 ± 6.22, and 55.52 ± 6.23 mm. Corneal sensitivity was reduced significantly in patients using PG with the preservative BAK after 3 months (p = 0.033). Co-administration of artificial tears did not affect this reduction in corneal sensitivity. Conclusions: PG with the preservative BAK reduced corneal sensitivity and artificial tears did not improve this reduction. Reduced corneal sensitivity and accompanying side effects should be considered in the long-term use of PG with the preservative BAK.
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