수성 눈물 부족 건성안 환자에서 수술적 눈물점 폐쇄의 효과 평가
The Effects of Surgical Punctual Occlusion on Patients with Aqueous Deficient Dry Eye
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목적: 수성 눈물 생성이 부족한 건성안 환자에서 소작기를 이용해 눈물점 폐쇄술을 시행한 후 건성안 소견의 호전 정도를 평가하고, 이차 전신 질환 유무가 수술 결과에 미치는 영향에 대해 알아보고자 하였다. 대상과 방법: 쉬르머 검사상 5 mm 이하이며, 이전에 눈물점 마개 삽입술을 시행 받았으나 합병증이 있었던 환자들 중, 눈물점 폐쇄술을 시행 받은 쇼그렌 증후군 환자 4명, 류마티스 관절염 환자 1명, 이식편대 숙주병 환자 1명 및 이차 전신 질환이 없는 건성안 환자 2명, 총 8명, 15안에 대해 수술 전 및 수술 한 달째의 logMAR 시력, 주관적 증상, 각막염색점수, 눈물막 파괴시간을 비교하였고, 이차전신 질환이 수술 전후 증상에 미치는 영향에 대해서 비교 분석하였다. 또한 수술 후 눈물점 폐쇄의 성공 결과에 대해 평가하였다. 결과: 전체 환자의 수술 전 시력, 주관적 증상, 각막염색점수, 눈물막 파괴시간은 호전되어 통계적으로 유의한 차이를 보였다. 류마티스 관련 질환이 있는 경우에는 수술 후 증상이 호전되는 결과를 보였다. 수술 후 눈물점 폐쇄는 완전 폐쇄 성공률 80%, 부분 재개통 20.0%의 결과를 보였다. 결론: 수술적 눈물점 폐쇄는 수성 눈물 생성이 부족한 건성안 환자 중 눈물점 마개의 빈번한 소실이나 합병증으로 눈물점 마개를 유지하기 어려운 환자에서 효과적인 대안으로 시도해 볼 수 있겠다.
Abstract
Purpose: To analyze the improvement of symptoms and signs of dry eye after surgical punctual occlusion and to evaluate the effects of secondary systemic disease in dry eye patients. Methods: From March 2011 to July 2014, 15 eyes of 8 dry eye patients with a history of punctal plug insertion underwent surgical punctal occlusion. Schirmer test was measured based on mean 2.9 mm. The patients consisted of 4 dry eye patients with Sjogren’s disease, 1 with rheumatoid arthritis, 1 with graft-versus-host disease (GVHD), and 2 with no secondary systemic disease. Preoperative and postoperative ophthalmic examinations of log MAR visual acuity, subjective symptoms, corneal staining (National Eye Institute [NEI] score), and tear break-up time (BUT) were performed and the effects of secondary systemic disease in dry eye patients were evaluated. The results of surgical punctual occlusion were analyzed. Results: All patients showed a statistically significant improvement of log MAR visual acuity, subjective symptoms, corneal staining (NEI score), and tear BUT. The patients with rheumatoid-related diseases showed improved symptoms after surgery, but the patient with GVHD showed no significant improvement after surgery. Among the study patients, 80.0% showed completely closed punctum and 20.0% showed partial recanalization. Conclusions: Surgical punctal occlusion is an effective alternative in patients with severe aqueous deficient dry eye who show recurrent punctal plug loss or complications associated with punctal plugs.
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