본문 바로가기
KERD
논문KCI 등재

치료받지 않은 단안 개방각녹내장 환자에서의 양안의 유두주위 맥락막두께 비교

Inter-eye Comparison of Peripapillary Choroidal Thickness in Patients with Treatment-naïve Unilateral Open-angle Glaucoma

신민철|김정아|이진호|이영복|김원준
대한안과학회 (The Korean Ophthalmological Society)|2020.10|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제61권 제10호|pp. 1203-1211

1

조회

0

다운로드

0

인용

0

참고문헌

키워드

Open-angle glaucomaOptic nerve headPeripapillary choroid
주제분류안과학

초록

목적: 개방각녹내장 환자에서 시신경손상과 유두주위 맥락막두께와의 관련성을 알아보고자 하였다. 대상과 방법: 안압하강 치료를 받은 병력이 없는 단안의 개방각녹내장 환자에서 스펙트럼영역 빛간섭단층촬영술로 측정한 양안의 유두주위 맥락막두께를 비교하고, 녹내장 발생과의 관련성을 분석하였다. 결과: 안압하강 치료 병력이 없는 단안의 개방각녹내장 환자 총 39명, 78안이 포함되었다. 녹내장안은 정상안에 비해 안압이 높고(16.7 ± 3.9 mmHg vs. 15.4 ± 2.6 mmHg, p=0.005), 각막두께(523.8 ± 32.5 μm vs. 527.6 ± 35.0 μm, p=0.030), 망막신경섬유층 두께(72.2 ± 13.7 μm vs. 89.3 ± 13.1 μm, p<0.001) 및 유두주위 맥락막두께(133.2 ± 52.1 μm vs. 144.1 ± 53.0 μm, p<0.001) 측정치가 통계적으로 유의하게 낮았다. 조건부 로지스틱 회귀분석에서 안압이 높을수록(odds ratio [OR] 3.368, 95% confidence interval [CI] 1.285-8.828, p=0.014), 맥락막두께가 얇을수록(OR 0.910, 95% CI 0.834-0.993, p=0.035) 녹내장 발생의 위험은 높았다. 결론: 단안 개방각녹내장 환자에서 안압과 유두주위 맥락막두께는 녹내장 발생과 유의한 연관성을 보였다. 본 연구 결과는 개방각녹내장 환자에서 안압에 의한 시신경의 기계적인 스트레스와 시신경 주변의 관류 부전이 녹내장 발생과 관련이 있을 것임을 시사한다.

Abstract

Purpose: We investigated the relationship between optic nerve damage and peripapillary choroidal thickness in patients with treatment-naïve primary open-angle glaucoma. Methods: Peripapillary choroidal thicknesses of 78 eyes of 39 patients with primary open-angle glaucoma were measured on 360° scans of enhanced-depth optical coherence tomography images using the inbuilt manual segmentation function. Inter-eye peripapillary choroidal thicknesses were compared and factors associated with glaucoma were analyzed. Results: Eyes with primary open-angle glaucoma exhibited thinner peripapillary choroidal thickness (133.2 ± 52.1 vs. 144.1 ± 53.0 μm; p < 0.001), higher intraocular pressure (16.7 ± 3.9 vs. 15.4 ± 2.6 mmHg; p = 0.005), thinner corneal thickness (523.8 ± 32.5 vs. 527.6 ± 35.0 μm; p = 0.030), and thinner retinal nerve fiber layer (72.2 ± 13.7 vs. 89.3 ± 13.1 μm; p < 0.001), compared with healthy fellow eyes. On multivariate, conditional, logistic regression analysis, thinner peripapillary choroidal thickness (odds ratio [OR] 0.910, 95% confidence interval [CI] 0.834-0.993; p = 0.035) and higher intraocular pressure (OR 3.368, 95% CI 1.285-8.828; p = 0.014) were significantly associated with glaucoma. Conclusions: Thinner peripapillary choroid and higher intraocular pressure were significantly associated with glaucoma in patients with unilateral primary open-angle glaucoma, suggesting that poor perfusion around the optic nerve head may be associated with glaucoma pathogenesis.

참고문헌 (45)

  1. Hyman L, "Prevalence and causes of visual impairment in The Barbados Eye Study", Ophthalmology, 108, pp.1751~1756 (2001)
  2. Quigley HA, "The number of people with glaucoma worldwide in 2010 and 2020", Br J Ophthalmol, 90, pp.262~267 (2006)
  3. Flammer J, "The impact of ocular blood flow in glaucoma", Prog Retin Eye Res, 21, pp.359~393 (2002)
  4. Hayreh SS, "Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc", Br J Ophthalmol, 53, pp.721~748 (1969)
  5. Duijm HF, "Choroidal haemodynamics in glaucoma", Br J Ophthalmol, 81, pp.735~742 (1997)
  6. Grunwald JE, "Optic nerve and choroidal circulation in glaucoma", Invest Ophthalmol Vis Sci, 39, pp.2329~2336 (1998)
  7. Nickla DL, "The multifunctional choroid", Prog Retin Eye Res, 29, pp.144~168 (2010)
  8. Onda E, "Microvasculature of the human optic nerve", Am J Ophthalmol, 120, pp.92~102 (1995)
  9. Hayreh SS, "The blood supply of the optic nerve head and the evaluation of it-myth and reality", Prog Retin Eye Res, 20, pp.563~593 (2001)
  10. Kubota T, "Decreased choroidal thickness in eyes with secondary angle closure glaucoma. An aetiological factor for deep retinal changes in glaucoma?", Br J Ophthalmol, 77, pp.430~432 (1993)
  11. Lee KM, "Juxtapapillary choroid is thinner in normal-tension glaucoma than in healthy eyes", Acta Ophthalmol, 94, pp.e697~e708 (2016)
  12. Karahan E, "Correlation of peripapillary choroidal thickness and retinal nerve fiber layer thickness in normal subjects and in patients with glaucoma", Semin Ophthalmol, 32, pp.602~606 (2017)
  13. Park HY, "Analysis of macular and peripapillary choroidal thickness in glaucoma patients by enhanced depth imaging optical coherence tomography", J Glaucoma, 23, pp.225~231 (2014)
  14. Li L, "Peripapillary choroidal thickness in both eyes of glaucoma patients with unilateral visual field loss", Am J Ophthalmol, 156, pp.1277.e1~1284.e1 (2013)
  15. Suh W, "Evaluation of peripapillary choroidal thickness in unilateral normal-tension glaucoma", Jpn J Ophthalmol, 58, pp.62~67 (2014)
  16. Kwon J, "Choroidal microvasculature dropout is associated with parafoveal visual field defects in glaucoma", Am J Ophthalmol, 188, pp.141~154 (2018)
  17. Lee EJ, "Parapapillary deep-layer microvasculature dropout in glaucoma : topographic association with glaucomatous damage", Invest Ophthalmol Vis Sci, 58, pp.3004~3010 (2017)
  18. Shin JW, "Choroidal microvasculature dropout is not associated with myopia, but is associated with glaucoma", J Glaucoma, 27, pp.189~196 (2018)
  19. Lee SH, "Topographic correlation between juxtapapillary choroidal thickness and parapapillary deep-layer microvasculature dropout in primary open-angle glaucoma", Br J Ophthalmol, 102, pp.1134~1140 (2018)
  20. Suh MH, "Deep retinal layer microvasculature dropout detected by the optical coherence tomography angiography in glaucoma", Ophthalmology, 123, pp.2509~2518 (2016)
  21. Li XQ, "Subfoveal choroidal thickness in relation to sex and axial length in 93 Danish University students", Invest Ophthalmol Vis Sci, 52, pp.8438~8441 (2011)
  22. Saeedi O, "Change in choroidal thickness and axial length with change in intraocular pressure after trabeculectomy", Br J Ophthalmol, 98, pp.976~979 (2014)
  23. Fard MA, "Peripapillary choroidal thickness in nonarteritic anterior ischemic optic neuropathy", Invest Ophthalmol Vis Sci (2015)
  24. 진상욱, "RTVue 빛간섭단층촬영기로 측정한 맥락막 두께와 연관인자에 관한 연구", 대한안과학회지, 56(7), pp.1065~1074 (2015), 대한안과학회
  25. Chakraborty R, "Diurnal variations in axial length, choroidal thickness, intraocular pressure, and ocular biometrics", Invest Ophthalmol Vis Sci, 52, pp.5121~5129 (2011)
  26. Luksch A, "Effects of systemic NO synthase inhibition on choroidal and optic nerve head blood flow in healthy subjects", Invest Ophthalmol Vis Sci, 41, pp.3080~3084 (2000)
  27. Polak K, "Altered nitric oxide system in patients with open-angle glaucoma", Arch Ophthalmol, 125, pp.494~498 (2007)
  28. Reitsamer HA, "Dopaminergic vasodilation in the choroidal circulation by d1", d5 receptor activation, 2004, pp.45, 900~905
  29. Galassi F, "Ocular hemodynamics and glaucoma prognosis : a color Doppler imaging study", Arch Ophthalmol, 121, pp.1711~1715 (2003)
  30. Nicolela MT, "Scanning laser Doppler flowmeter study of retinal and optic disk blood flow in glaucomatous patients", Am J Ophthalmol, 122, pp.775~783 (1996)
  31. Hirooka K, "Evaluation of peripapillary choroidal thickness in patients with normal-tension glaucoma", BMC Ophthalmol, 12, pp.29~ (2012)
  32. Usui S, "Evaluation of the choroidal thickness using high-penetration optical coherence tomography with long wavelength in highly myopic normal-tension glaucoma", Am J Ophthalmol, 153, pp.10.e1~16.e1 (2012)
  33. Zhang Z, "Choroidal thickness and open-angle glaucoma : a meta-analysis and systematic review", J Glaucoma, 25, pp.e446~e454 (2016)
  34. Ehrlich JR, "Peripapillary choroidal thickness in glaucoma measured with optical coherence tomography", Exp Eye Res, 92, pp.189~194 (2011)
  35. 김지원, "스펙트럼영역 빛간섭단층촬영으로 측정한 녹내장 환자의 맥락막 두께 분석", 대한안과학회지, 55(6), pp.868~876 (2014), 대한안과학회
  36. Wang W, "Biometric differences between unilateral chronic primary angle closure glaucoma and fellow non-glaucomatous eyes", Semin Ophthalmol, 33, pp.595~601 (2018)
  37. Mwanza JC, "Choroidal thickness in unilateral advanced glaucoma", Invest Ophthalmol Vis Sci, 53, pp.6695~6701 (2012)
  38. Kadziauskiene A, "Changes in choroidal thickness after intraocular pressure reduction following trabeculectomy", Acta Ophthalmol, 94, pp.586~591 (2016)
  39. 김인혜, "녹내장수술 후 안압하강에 따른 맥락막두께의 장기 변화", 대한안과학회지, 61(1), pp.69~77 (2020), 대한안과학회
  40. Vetrugno M, "Latanoprost 0.005% in POAG: effects on IOP and ocular blood flow", Acta Ophthalmol Scand Suppl, (227), pp.40~41 (1998)
  41. Boltz A, "Effect of latanoprost on choroidal blood flow regulation in healthy subjects", Invest Ophthalmol Vis Sci, 52, pp.4410~4415 (2011)
  42. Kim M, "Association between choroidal thickness and ocular perfusion pressure in young, healthy subjects : enhanced depth imaging optical coherence tomography study", Invest Ophthalmol Vis Sci, 53, pp.7710~7717 (2012)
  43. Maul EA, "Choroidal thickness measured by spectral domain optical coherence tomography : factors affecting thickness in glaucoma patients", Ophthalmology, 118, pp.1571~1579 (2011)
  44. Hood DC, "Glaucomatous damage of the macula", Prog Retin Eye Res, 32, pp.1~21 (2013)
  45. Ho J, "Analysis of normal peripapillary choroidal thickness via spectral domain optical coherence tomography", Ophthalmology, 118, pp.2001~2007 (2011)

관련 논문AI추천

스펙트럼영역 빛간섭단층촬영으로 측정한 녹내장 환자의 맥락막 두께 분석김지원, 류진영, 최규룡대한안과학회 · 대한안과학회지2014 · 제55권 제6호진행된 녹내장 환자에서의 맥락막두께박도희, 박상우, 성미선대한안과학회 · 대한안과학회지2021 · 제62권 제12호정상안과 녹내장안의 맥락막혈관지수 비교나정호, 서민희, Rupesh Agrawal대한안과학회 · 대한안과학회지2022 · 제63권 제4호RTVue 빛간섭단층촬영기로 측정한 맥락막 두께와 연관인자에 관한 연구노세현, 노승수, 서홍융, 진상욱, 최우석대한안과학회 · 대한안과학회지2015 · 제56권 제7호녹내장수술 후 안압하강에 따른 맥락막두께의 장기 변화구원모, 김인혜, 정아름, 차순철대한안과학회 · 대한안과학회지2020 · 제61권 제1호손상 정도가 다른 양안 정상안압녹내장 환자에서 두 눈의 사상판 깊이 비교권성옥, 김정아, 이재연, PAYAM HOSSEINZADEHKA대한안과학회 · 대한안과학회지2022 · 제63권 제5호

이 간행물의 다른 논문 (19건)

갑상샘눈병증에서 갑상샘자극호르몬수용체 자가항체가 망막 및 맥락막혈관에 미치는 영향김유철, 박지웅, 이동철pp. 1121-1128국내 각막굴절교정술과 관련된 의료소송 분석김태훈, 한경은pp. 1129-1134능동적 수정체유화 역동학과 하방경사 첨단부를 이용한 백내장수술의 각막내피세포에 대한 안정성이한민, 김창식, 김경남, 구형문, 이성복pp. 1135-1142백내장수술 시 0.25디옵터 단위로 생산되는 인공수정체의 굴절력 정확도박규홍, 최진석, 박세영, 곽주영, 정성근, 조민수pp. 1143-1148드루젠 환자에서 망막전막수술 후 드루젠의 변화 관찰방종욱, 이민수, 전혜민, 방찬우, 윤희성pp. 1149-1155
원문 보기