개방각 녹내장 환자에서 편측 및 양측 반구 시야결손 환자의 임상적 특징 비교
Structural Features of Optic Nerve Head in Glaucoma with Single-hemispheric and Bi-hemispheric Visual Field Defects
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목적: 중등도의 시야결손을 가진 한국인 개방각 녹내장 환자에서 시야결손이 편측 반구에 국한된 경우와 양측 반구에 있는 경우의 시신경유두의 구조적 특징을 비교하고자 하였다. 대상과 방법: Mean deviation이 -12 dB 이상이며 -6 dB보다 낮은 중등도의 시야결손을 가진 개방각 녹내장 환자의 의무기록을 후향적으로 분석하여 연속적으로 등록하였다. 시야결손이 편측 반구에 국한된 군과 양측 반구 모두에 있는 군으로 대상안을 분류하였으며 사상판 두께, 이측 βPPA+ B M와 βPPA-B M의 길이, 유두주위 망막신경섬유층 두께를 포함한 구조적인 특징을 빛간섭단층촬영을 통해 분석하고 비교하였다. 결과: 분석에 포함된 137명 137안 중 80안은 편측 반구에 시야결손이 국한되어 있었고, 57안은 양측 반구에 시야결손이 있었다. 양측 반구 시야결손 군에서 편측 반구 시야결손 군에 비해 안축장이 더 길었고(p=0.038) 중심각막두께가 더 얇았으며(p=0.003) 사상판두께가 더 얇고(p<0.001) 이측 βPPA+ B M width가 더 컸다(p=0.002). 결론: 양측 반구에 시야결손이 있는 군에서 편측 반구에 시야결손이 국한된 군보다 구조적으로 시신경유두가 더 취약하였으며, 안축장이 길거나 중심각막두께가 얇은 경우, 사상판 두께가 얇고 이측 βPPA+ B M width가 큰 경우가 이에 해당하였다. 본 연구는 구조적으로 취약한 시신경유두를 가진 녹내장 환자에서 양측 반구에 시야결손이 발생하기 더 쉽고, 더 나아가 녹내장 환자를 지켜보는 데 있어 시신경유두를 평가하는 것의 중요성을 강조한다.
Abstract
Purpose: To compare the structural features of the optic nerve head (ONH) in moderate glaucoma patients with single-hemispheric and bi-hemispheric visual field (VF) defects. Methods: Patients with open-angle glaucoma (OAG) and a VF mean deviation between -6 and -12 dB were retrospectively enrolled. Based on VF defect patterns, eyes were classified into two groups: those with single-hemispheric VF defects and those with bi-hemispheric VF defects. Structural features analyzed included Bruch’s membrane opening area, lamina cribrosa (LC) thickness, temporal β-zone parapapillary atrophy with and without Bruch's membrane (βPPA+BM, βPPA-BM, respectively), and peripapillary retinal nerve fiber layer thickness using spectral-domain optical coherence tomography. Results: Out of 137 eyes from 124 patients, 80 eyes had single-hemispheric VF defects and 57 eyes had bi-hemispheric VF defects. The bi-hemispheric group exhibited longer axial length (p = 0.038), thinner central corneal thickness (p = 0.003), thinner LC (p < 0.001), and larger temporal βPPA+BM (p = 0.002) compared to the single-hemispheric group. Conclusions: Among Korean OAG patients with moderate VF defects, those with bi-hemispheric VF defects showed more structurally vulnerable optic discs characterized by longer axial lengths, thinner central corneal thickness, thinner LC, and larger β PPA+BM compared to those with single-hemispheric VF defects. These findings underline the importance of evaluating ONH structures in monitoring glaucoma progression particularly in patients with extensive VF damage.
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