얇은 중심각막두께를 가진 정상안압녹내장 환자에서 중심각막두께 보정 안압의 임상적 의의
Implications of Central Corneal Thickness-corrected Intraocular Pressure in Normal-tension Glaucoma with Reduced Central Corneal Thickness
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목적: 얇은 중심각막두께를 가지고 있는 정상안압녹내장 환자에서 중심각막두께로 보정한 안압의 임상적 의의를 알아보고자 하였다. 대상과 방법: 후향적 의무기록을 분석을 통해 정상안압녹내장 환자 187명 187안을 연구에 포함하였다. 얇은 중심각막두께는 양안 모두500 μm 미만인 경우로 정의하였다. 개방각이며 중심각막두께로 보정한 치료 전 안압이 20 mmHg 미만인 경우만을 연구에 포함하였다. 골드만안압계로 측정한 안압과 중심각막두께로 보정한 안압 CCT-corrected IOP (ccIOP)를 분석에 활용하였다. 전체 대상군을진행군과 안정군으로 나눠 분석하였다. 결과: 전체 대상자의 평균 중심각막두께는 481.2 ± 17.5 μm이고, 경과 관찰 기간은 6.3 ± 2.5년이었다. 초기 안압은 13.7 ± 2.4 mmHg, 초기 ccIOP는 16.6 ± 2.5 mmHg였으며 평균 시야 진행 속도는 -0.79 ± 1.26 dB/yr이었다. 전체 대상자 중 진행군은 47안, 안정군은 140안이었다. 진행군은 안정군에 비해 나이가 많고 초기 ccIOP가 높았다. 또한 인공수정체안의 비율이 높았다. 다변량 분석에서 초기 ccIOP만이 진행에 대한 유의한 인자로 확인되었다. 결론: 얇은 각막두께를 갖는 정상안압녹내장 환자의 전반적인 녹내장의 진행 속도는 비교적 안정적이었다. 얇은 중심각막두께를 갖는정상안압녹내장 환자에서 고령, 백내장수술력, 높은 초기 안압이 녹내장 진행과 연관성을 보였다. ccIOP가 녹내장 진행에 연관된 유의한 인자로 확인되었다. 따라서 얇은 중심각막두께의 정상안압녹내장 환자에서 중심각막두께로 보정한 안압을 확인하는 것이 임상적으로 중요하다.
Abstract
Purpose: Reduced central corneal thickness (CCT) is a risk factor for glaucoma progression and can impact intraocular pressure (IOP) measurement. Therefore, we investigated the glaucoma progression pattern and associated risk factors among individuals with normal-tension glaucoma (NTG) and reduced CCT. Methods: This retrospective study enrolled 187 eyes of 187 NTG patients with an open angle and a baseline IOP < 20 mmHg, adjusted for CCT. Reduced CCT was defined as < 500 μm thickness in both eyes. Patients with a history of corneal disease or surgery affecting CCT were excluded. We used Goldmann tonometry to measure baseline and CCT-corrected IOP (ccIOP; [IOP - [CCT - 545]/50 × 2.5]). The participants were divided into progressing and stable subgroups. Results: The mean CCT was 481.2 ± 17.5 μm and the mean follow-up period was 6.3 ± 2.5 years. The baseline IOP and ccIOP were 13.7 ± 2.4 and 16.6 ± 2.5 mmHg, respectively. The average visual field progression rate was -0.79 ± 1.26 dB/yr. Of the participants, 47 (26.6%) and 140 (73.4%) were in the progressing and stable group, respectively. Participants in the progressing group were older, had a higher baseline ccIOP, and had a higher proportion of pseudophakia than those in the stable group. Multivariate analysis showed that baseline ccIOP was a significant risk factor. Conclusions: Individuals presenting with NTG and reduced CCT had a relatively stable glaucoma progression rate. However, glaucoma progression was associated with old age, pseudophakia, and high baseline IOP in individuals with reduced CCT. In particular, the only significant factor associated with glaucoma progression was ccIOP. Therefore, ccIOP is a clinically significant factor in individuals with NTG and reduced CCT.
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