건성안증후군 환자의 주관적 증상 중증도와 관련있는 객관적 지표들
Objective Parameters Associated with Subjective Symptom Severity in Dry Eye Syndrome Patients
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목적: 건성안증후군 환자의 증상 중증도 질문지 중 하나인 ocular surface disease index (OSDI) 점수와 객관적인 지표 사이의 상관관계를 알아보고, OSDI 중증군에 영향을 주는 생활환경요소 위험인자에 대해 알아보고자 한다. 대상과 방법: 본원에서 처음으로 건성안증후군 진단을 받은 총 30명(30안)을 대상으로 후향적 연구를 하였다. 쉬르머검사, 각막 및 결막염색검사, 눈물막파괴시간검사, 마이봄의 질(Quality of Meibum)검사와 OSDI 설문조사를 하였다. 또한 결막측정장치인 Lipiview®를 사용하여 눈물지질층두께, 부분눈깜빡임횟수를 측정하였으며, 하안검판 마이봄샘촬영 후 Image J® 프로그램을 이용하여 하안검판에서 마이봄샘이 차지하는 백분율을 측정하였다. 각각의 안구지표들과 OSDI 점수 사이에 Pearson 상관분석, 다중선형회귀분석을 하였다. OSDI 중증군의 생활환경요소 위험인자에 대해 알아보고자, 성별과 함께 환자의 생활환경요소인 불면증, 컴퓨터사용력, 각막관련수술, 냉난방환경노출 유무에 대해 로지스틱회귀분석을 하였다. 결과: Pearson 상관분석 결과, 마이봄의 질과 나이, 결막염색점수, 부분눈깜빡임횟수, 각막염색점수 순으로 OSDI와 높은 상관관계를 보였으며, 다중선형회귀분석 결과, 마이봄의 질과 나이가 OSDI에 영향을 주는 인자로 나타났다. 로지스틱회귀분석 결과, 4시간 이상 컴퓨터 사용군(교차비 7.43, p-value=0.02)이 유의한 생활환경요소 위험인자로 작용하였다. 결론: 중증 건성안증후군 환자 치료 시 마이봄샘기능부전, 나이 요소가 주관적 안구불편함의 중증도와 관련이 크다는 점과 증상이 심한 군에서는 장기간의 컴퓨터사용과 같은 생활환경인자 교정이 중요하다는 점에 대한 인지가 필요하다.
Abstract
Purpose: To evaluate the correlation between the ocular surface disease index (OSDI score) and objectively quantifiable parameters in dry eye syndrome patients, and to assess environmental and lifestyle risk factors in severe OSDI patients. Methods: The present study was retrograde and included 30 patients (30 eyes) diagnosed with dry eye syndrome at Ilsan Paik Hospital for the first time. Shirmer’s test, corneal staining, and conjunctiva staining were assessed, and tear break-up time, meibum quality, and OSDI questionnaires were performed. We measured the lipid layer thickness in tear meniscus and counted the amount of partial eyelid blinking using Lipiview®. Moreover, we modified images of the lower lid meibography and calculated the percentage of meibomian glands outside the lower tarsal plate using the ImageJ® software. We analyzed the Pearson’s correlation and performed a multiple linear regression analysis between the test values and OSDI. In addition, logistic regression analysis was used to determine the risk factors of the severe OSDI group, such as insomnia, level of computer use, and exposure to fully air-conditioned indoor environments. Results: According to the Pearson’s correlation analysis, quality of the meibum showed the highest statistically significant correlation with OSDI, followed by age, conjunctiva staining score, counts of partial blinking, and corneal staining score. The multiple linear regression analysis revealed that quality of the meibum and age were statistically significant factors affecting the OSDI score. Based on the logistic regression analysis, using a computer for more than 4 hours at a time exhibited a 7.43-fold odds ratio for severe OSDI (p-value = 0.029). Conclusions: Meibomian gland dysfunction and age should be considered to be important factors, especially in treating dry eye syndrome patients who complain severely. Moreover, we should also consider environmental factors such as long-term computer use for the treatment of dry eye syndrome patients with severe symptoms.
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