마이봄샘 기능 이상 환자에서 빛간섭단층촬영을 이용한 눈물띠 분석
Tear Meniscus Evaluation Using Optical Coherence Tomography in Meibomein Gland Dysfunction Patients
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목적: 마이봄샘 기능 이상 건성안 환자에서 푸리에도메인 빛간섭단층촬영(Fourier-domain optical coherence tomography, FD-OCT) 을 이용한 눈물띠 수치를 정상안 및 눈물분비 부족 건성안과 비교하고자 한다. 대상과 방법: 정상 대조군 33안, 눈물분비 부족 건성안(aqueous tear deficient, ATD) 79안, 마이봄샘 기능 이상 건성안(meibomein gland dysfunction, MGD) 48안을 대상자로 하여 FD-OCT를 이용하여 눈물띠의 높이(tear meniscus height, TMH), 깊이(tear meniscus depth, TMD), 넓이(tear meniscus area, TMA)를 측정하고, 쉬르머검사, 눈물막 파괴시간, 플루오레신 각막염색을 시행하여 집단 간 수치를 비교하였다. 결과: TMH, TMD, TMA의 평균은 정상안에서 각각 295.58 ± 58.36 μm, 166.67 ± 30.43 μm, 0.0360 ± 0.01100 mm2, 눈물분비부족 건성안에서 226.43 ± 42.18 μm, 147.44 ± 38.38 μm, 0.0209 ± 0.01015 mm2, 마이봄샘 기능이상 건성안에서 272.81 ± 64.21 μm, 159.37 ± 44.05 μm, 0.0295 ± 0.01271 mm2였다. 세 군을 비교해 보았을 때 눈물분비 부족 건성안에서 눈물띠 수치가 가장감소되었고 TMH, TMD, TMA 수치 모두 통계적으로 유의하였다. 마이봄샘 기능 이상 건성안 군의 눈물띠 수치는 눈물분비 부족 건성안의 수치보다는 높았으나 정상안의 수치보다는 낮았고, 그중 TMA만 통계적으로 유의하였다. 결론: 마이봄샘 기능 이상 건성안 환자의 FD-OCT를 이용한 눈물띠 수치들은 눈물생성부족 건성안 환자의 수치보다는 높은 경향을보이며, 정상안과 유의한 차이를 보이지 않았다. 이는 마이봄샘 기능 이상 건성안의 병태생리에 의한 것으로, 건성안의 기전이 다름에따라 눈물띠 수치도 다른 경향을 나타내는 것을 고려하여 진단 및 치료 결정에 참고하여야 할 것이다.
Abstract
Purpose: This study compared tear meniscus parameters between normal control, aqueous tear deficient dry eye, and meibomein gland dysfunction groups using Fourier-domain optical coherence tomography (FD-OCT). Methods: This study included 33 normal eyes, 79 aqueous tear-deficient dry eyes (ATD), and 48 meibomein gland dysfunction dry eyes (MGD). Following routine examination including Schirmer test, tear break-up time, corneal staining, and tear meniscus parameters such as tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were obtained using FD-OCT. The differences among groups were assessed. Results: The averages of TMH, TMD, and TMA were 295.58 ± 58.36 μm, 166.67 ± 30.43 μm, and 0.0360 ± 0.01100 mm2 in normal eyes, respectively, 226.43 ± 42.18 μm, 147.44 ± 38.38 μm, and 0.0209 ± 0.01015 mm2 in ATD, respectively, 272.81 ± 64.21 μm, 159.37 ± 44.05 μm, and 0.0295 ± 0.01271 mm2 in MGD, respectively. Tear meniscus parameters were significantly lower in ATD. Tear meniscus parameters in MGD were higher than ATD and lower than normal eyes, but the TMA was the only statistically significant value. Conclusions: Although tear meniscus parameters in MGD were higher than ATD, they could not be distinguished from normal eyes. Tear meniscus evaluation using FD-OCT could be a useful measurement system in classification and treatment choice for dry eye patients.
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