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마이봄샘기능장애를 동반한 쇼그렌증후군 환자에서 펄스광선조사기의 임상적 효과

Efficacy of Intense Pulsed Light Treatment in Patients with Sjögren’s Syndrome Associated with Meibomian Gland Dysfunction

윤현정|윤경철|문자영
대한안과학회 (The Korean Ophthalmological Society)|2021.12|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제62권 제12호|pp. 1581-1591

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참고문헌

키워드

Sjögren’s syndromeIntense pulsed lightMeibomian gland dysfunction
주제분류안과학

초록

목적: 마이봄샘기능장애를 동반한 쇼그렌증후군 환자에서 펄스광선조사 치료의 임상적 효과에 대해 알아보고자 하였다. 대상과 방법: 쇼그렌증후군 환자들 중 마이봄샘기능장애가 동반된 43명을 펄스광선조사 치료와 마이봄샘 압출을 함께 시행받은 복합치료군(22명)과 마이봄샘 압출만 시행 받은 단독치료군(21명)으로 분류하였다. 치료는 3주 간격으로 총 3회에 걸쳐 시행되었으며 치료 종료 6주 후 한 번 더 내원하였다. 내원 시마다 안구표면질환지수, 형광 및 비침습눈물막파괴시간, 눈물띠 높이, 쉬르머검사, 안구표면염색 점수, 마이봄샘 질 및 배출 점수, 마이봄 점수 평가를 시행하였으며 복합치료군에서는 추가적으로 눈물막지질층을 평가하였다. 결과: 복합치료군에서 안구표면질환지수, 형광 및 비침습눈물막파괴 점수, 각막표면염색 점수, 마이봄 질 점수, 마이봄 점수와 눈물막지질층 등급은 치료 전에 비하여 통계적으로 유의한 호전을 보였고, 복합치료군과 단독치료군 모두에서 마이봄 배출 점수의 호전을 보였다(p＜0.05). 결막표면염색 점수, 쉬르머검사, 눈물띠 높이는 두 치료군 모두 치료 전과 후의 차이를 보이지 않았다. 치료 종료 후 복합치료군이 단독치료군에 비하여 안구표면질환지수, 각막염색 점수, 마이봄 질 및 배출 점수는 유의하게 낮았고, 형광 눈물막파괴시간은 높게 나타났다(p＜0.05). 결론: 마이봄샘기능장애를 동반한 쇼그렌증후군 환자에서 펄스광선조사 치료와 마이봄샘 압출 복합치료는 눈물막 및 안구표면지표의 개선뿐만 아니라 마이봄샘의 기능호전에도 효과가 있다.

Abstract

Purpose: To investigate the efficacy of intense pulsed light (IPL) treatment in patients with meibomian gland dysfunction (MGD) associated with Sjögren’s syndrome. Methods: This study included 43 patients with MGD and Sjögren’s syndrome. Patients received either IPL with meibomian gland expression (IPL/MGX) (n = 22) or MGX only (n = 21). Treatments were administered three times at a 3-week interval. Patients were followed up 6 weeks after the end of the treatment. Ocular Surface Disease Index (OSDI), tear film breakup time with fluorescein dye (FBUT), non-invasive tear breakup time, tear meniscus height (TMH), Schirmer test, SICCA ocular surface staining score, meibum quality score (MQS), and meibum expression score (MES) were evaluated at each visit. Meibomian gland dropouts (meiboscore) and tear film lipid layer grade were measured using keratography. Results: OSDI, FBUT, corneal surface staining score, MQS, meiboscore, and tear film lipid layer grade improved after IPL/MGX treatment (p < 0.05). In both treatment groups, MES significantly improved (p < 0.01 and p < 0.05 for IPL/MGX and MGX groups, respectively). The Schirmer test score, conjunctival surface staining score, and TMH after treatment were not significantly different between the groups. After treatment, the IPL/MGX group had significantly lower OSDI, FBUT, corneal staining score, MQS, and MES, but higher FBUT, compared with the MGX group (p < 0.05). Conclusions: IPL treatment effectively improved tear film, ocular surface parameters, meibomian gland function, and lipid layer grade in patients with Sjögren’s syndrome and MGD.

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