본태눈꺼풀연축 환자에서 보툴리눔독소 주사 후 각막형태검사 변화
Corneal Topographic Changes after Botulinum Toxin-A Injection in Patients with Essential Blepharospasm
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목적: 본태눈꺼풀연축 환자의 보툴리눔독소 주사 전후 각막형태검사 변화를 비교하고자 한다. 대상과 방법: 2015년 9월부터 2020년 12월까지 본원에서 본태눈꺼풀연축으로 진단받은 총 20명의 환자 40안을 대상으로 하였다. 나보타®를 이용한 보툴리눔독소 주사 전과 주사 후 1, 3개월에 iTrace®를 이용한 각막형태검사를 실시하였으며, 각막 중심부로부터1 mm, 3 mm 영역에서 상측, 하측, 비측, 이측 지점의 각막굴절력을 측정하였다. 또한 가파른 각막곡률값과 편평한 각막곡률값, 난시의 변화 양상도 측정하였다. 결과: 주사 후 1개월에 1 mm 영역의 상측, 하측 지점에서만 각막굴절력이 유의하게 감소하였다(p=0.038, p=0.042). 3 mm 영역의모든 지점에서는 각막굴절력의 변화는 없었다. 주사 후 1개월에 가파른 각막곡률값만 유의하게 감소하였으며(p=0.046), 직난시가 감소하고 도난시가 증가하였다. 주사 3개월 후에는 각막곡률값과 난시가 주사 전으로 다시 회복하였다. 결론: 나보타® 주사 후 1개월에 1 mm 영역의 수직 방향 경선의 각막 중심부가 일시적으로 편평화되었으며, 가파른 각막곡률값만 유의하게 변화하였다. 주사 후 3개월에는 보툴리눔독소의 작용 효과 감소로 각막의 형태학적인 변화는 다시 주사 전의 상태로 회복되었다.
Abstract
Purpose: To compare the corneal topographic change before and after botulinum toxin A injection in patients with essential blepharospasm. Methods: From September 2015 to December 2020, we enrolled total 20 patients, 40 eyes diagnosed with essential blepharospasm. We estimated the corneal refractive power and astigmatism before and after Nabota® (Daewoong Co. Ltd, Seoul, Korea) botulinum toxin injection at 1 and 3 months using iTrace® Topography (Software version 4.2.1., Tracey technology Inc., Houston, TX, USA). Corneal refractive power was analyzed in superior, inferior, nasal and temporal location at 1 mm, 3 mm zone. Also, steep and flat keratometry, astigmatism was measured by topography. Results: Corneal refractive power showed significant difference in superior and inferior location of 1 mm zone at 1 month after botulinum toxin injection (p = 0.038, p = 0.042). There was no significant difference in all four locations of 3 mm zone. At 1 month after toxin injection, steep keratometry was only significant reduced (p = 0.046) and with-the-rule astigmatism was shifted to against-the-rule astigmatism. At 3 months after toxin injection, keratometry and astigmatism was resolved to before toxin injection. Conclusions: At 1 month after Nabota® (Daewoong Co. Ltd) botulinum toxin injection, corneal refractive power at vertical axis was flattened and steep keratometry was significantly reduced. At 3 months after toxin injection, corneal topographic change was changed to before toxin injection.
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