빛간섭단층촬영으로 측정한 시신경유두 및 황반부 구조 분석에 백내장이 미치는 영향
Effects of Cataract on Optic Nerve Head and Macular Analysis Using Optical Coherence Tomography
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목적: 녹내장 및 대조군에서 시신경유두지표(시신경유두 면적, 시신경테 면적, 평균유두함몰비, 수직유두함몰비, 유두함몰 용적), 시신경유두 주위 망막신경섬유층 두께, 황반부 신경절세포-내망상층 두께에 대한 백내장의 영향을 평가하고자 한다. 대상과 방법: 2021년 1월부터 12월까지 백내장수술을 받은 정상, 녹내장 의증, 녹내장 환자 총 44명 63안의 환자의 의무기록을 후향적으로 분석하였다. 스펙트럼영역 빛간섭단층촬영(spectral-domain optical coherence tomography)을 사용하여 백내장수술 전과 후에 시신경유두지표, 시신경유두 주위 망막신경섬유층 두께, 황반부 신경절세포-내망상층 두께를 측정하였다. 수술 전후 지표들의 변화 및 수술 전 분할 오류(segmentation error)와 관련된 요인을 분석하였다. 결과: 녹내장 환자에서 수술 후 시신경유두 주위 망막신경섬유층 평균 두께(p=0.002)는 증가하고, 시신경유두지표와 황반부 신경절세포-내망상층 평균 두께는 수술 전후 유의한 변화가 없었다(all p>0.05). 반면, 대조군에서는 일부 구역별 황반부 신경절세포-내망상층 두께가 술 후 증가하였다(p<0.05). 다변량 회귀분석에서 녹내장 환자의 수술 전 시신경유두 주위 망막신경섬유층, 황반부 신경절세포-내망상층 평균 두께가 얇을수록 수술 후 평균 두께가 증가하였다(각각 p<0.001, p=0.008). 결론: 녹내장 환자에서 백내장으로 인한 두께 감소는 시신경유두 주위 망막신경섬유층에서 나타나지만, 시신경유두지표는 백내장의 영향을 상대적으로 적게 받아 백내장과 녹내장이 동시에 진행된 환자에서 유용하게 활용될 수 있다.
Abstract
Purpose: To assess the impact of cataract on optic nerve head (ONH) parameters (disc area, rim area, average cup/disc ratio, vertical cup/disc ratio, cup volume), peripapillary retinal nerve fiber layer (pRNFL) thickness, and macular ganglion cell-inner plexiform layer (mGC-IPL) thickness in patients with glaucoma and in a control group. Methods: A retrospective analysis was conducted on medical records from January to December 2021 for individuals undergoing cataract surgery. This group included normal, glaucoma suspects, and glaucoma patients, totaling 44 individuals and 63 eyes. Measurements of ONH parameters, pRNFL thickness, and mGC-IPL thickness were taken using spectral-domain optical coherence tomography before and after surgery. We analyzed postoperative changes in these parameters and related factors to preoperative segmentation errors. Results: In glaucoma patients, a significant increase in the average thickness of the pRNFL (p = 0.002) was observed after surgery, while no significant changes were seen in ONH parameters and the average thickness of the mGC-IPL (all p > 0.05). Conversely, the control group showed an increase in some areas of mGC-IPL thickness after surgery (p < 0.05). Multivariate regression analysis indicated that in glaucoma patients, thinner preoperative pRNFL and mGC-IPL thickness were predictors of increased average thickness after surgery (p < 0.001 and p = 0.008, respectively). Conclusions: Cataract significantly impacts the pRNFL and mGC-IPL thickness in glaucoma patients, with less effect on ONH parameters. These findings suggest that ONH parameters can be more reliable for monitoring patients undergoing cataract surgery and assessing glaucoma progression simultaneously.
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