당뇨환자에서 각막생체역학인자의 변화
Change in Corneal Biomechanical Parameters in Diabetes Mellitus
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 당뇨환자에서 각막생체역학인자의 변화를 알아보고자 하였다. 대상과 방법: 당화혈색소(HbA1c)가 7% 이하인 군 25안, 7% 초과인 군 25안을 포함한 총 50안의 당뇨환자군과 정상군 80안을 대상으로 안구반응분석기(ocular response analyzer, ORA)를 이용하여 각막생체역학인자를 측정하였다. 정상군과 당뇨환자군, 당화혈색소7% 이하인 군과 7% 초과인 군 간의 각막생체역학인자의 차이를 각각 비교하였다. 결과: 이력현상(corneal hysteresis, CH), 저항인자(corneal resistance factor, CRF), 중심각막두께(central corneal thickness, CCT)는정상군에 비해 당뇨환자군에서 유의하게 높았다. 또한 골드만압평안압(GAT), 비접촉성안압계의 안압측정치(NCT), Goldmann-correlatedIOP (IOPg)는 당뇨환자군에서 유의하게 높게 측정되었지만 Corneal compensated IOP (IOPcc)는 두 군 간에 유의한 차이를 보이지않았다. 당화혈색소 7% 이하인 군과 7% 초과인 군 간의 비교에서는 당뇨안과 정상안 사이에 유의한 차이를 보였던 모든 인자들이유의한 차이를 보이지 않았다. 결론: 당뇨안에서 각막의 성질이 정상안과 차이가 있다는 점을 고려할 때 ORA로 측정한 IOPcc는 안압측정 시 보정해야 할 인자인중심각막두께 및 안구의 생체역학적 요소를 반영하고 있어 당뇨 환자에서 임상적으로 안압측정에 유용할 것으로 생각하며 당뇨환자군에서 나타난 각막생체역학인자의 변화는 단기간의 혈당조절보다는 장기간의 혈당조절과 연관성이 있을 것이라고 생각한다.
Abstract
Purpose: In this study, we examined the changes in corneal biomechanical parameters in patients with diabetes mellitus (DM). Methods: Fifty patients with DM were divided into 2 subgroups, 25 diabetic patients with glycated hemoglobin (HbA1c ≤ 7% and25 diabetic patients with HbA1c > 7%) and compared with the eyes of 80 healthy subjects. Corneal biomechanical parameterswere measured using ocular response analyzer (ORA). Differences in corneal biomechanical properties between healthy subjectsand diabetic patients were compared. Additionally, differences in corneal biomechanical properties between diabetic patientswith HbA1c ≤ 7% and diabetic patients with HbA1c > 7% were compared. Results: Corneal hysteresis, corneal resistance factor and central corneal thickness (CCT) were statistically significantly higherin patients with diabetes compared to healthy subjects. Goldmann tonometer, non-contact tonometer and Goldmann-correlatedintraocular pressure (IOPg) were statistically significantly higher in patients with DM compared to healthy subjects, but cornealcompensated IOP (IOPcc) was not statistically significantly different between healthy subjects and diabetic patients. However,corneal biomechanical parameters, which were statistically significantly different between healthy subjects and DM patients,were not statistically significantly different between diabetic patients with HbA1c ≤ 7% and diabetic patients with HbA1c > 7%. Conclusions: Considering that corneal properties are different between diabetic patients and healthy subject, IOPcc measuredwith ORA is considered clinically useful for measuring IOP as it reflects CCT and biomechanical properties that should berevised. In diabetes, changes in corneal biomechanical properties depend on long-term glucose control rather than short-termglucose control.
참고문헌 (22)
- 전자영, "Prevalence of Diabetes and Prediabetes according to Fasting Plasma Glucose and HbA1c", Diabetes and Metabolism Journal, 37(5), pp.349~357 (2013), 대한당뇨병학회[DOI]
- Hager A., "Changes of extracellular matrix of the cornea in diabetes mellitus", Graefes Arch Clin Exp Ophthalmol, 247, pp.1369~1374 (2009)
- Goldich Y., "Effect of diabetes mellitus on biomechanical parameters of the cornea", J Cataract Refract Surg, 35, pp.715~719 (2009)
- Sahin A., "Corneal biomechanical changes in diabetes mellitus and their influence on intraocular pressure measurements", Invest Ophthalmol Vis Sci, 50, pp.4597~4604 (2009)
- Terai N., "Identification of biomechanical properties of the cornea : the ocular response analyzer", Curr Eye Res, 37, pp.553~562 (2012)
- Scheler A., "Effect of diabetes mellitus on corneal biomechanics and measurement of intraocular pressure", Acta Ophthalmol, 90, pp.e447~e451 (2012)
- 조가은, "Ocular Response Analyzer의 재현성 및 골드만압평안압, 비접촉안압과의 비교", 대한안과학회지, 53(9), pp.1311~1317 (2012), 대한안과학회
- 박종혁, "정상안압녹내장의 시야손상 진행과각막생체역학인자의 관련성", 대한안과학회지, 54(11), pp.1757~1766 (2013), 대한안과학회[DOI]
- Lee JS., "Differences in corneal thickness and corneal endothelium related to duration in diabetes", Eye(Lond), 20, pp.315~318 (2006)
- Reddy GK., "Glucose-mediated in vitro glycation modulates biomechanical integrity of the soft tissues but not hard tissues", J Orthop Res, 21, pp.738~743 (2003)
- Wollensak G., "Stress-strain measurements of human and porcine corneas after riboflavin-ultraviolet-A-induced cross-linking", J Cataract Refract Surg, 29, pp.1780~1785 (2003)
- Sady C., "Advanced Maillard reaction and crosslinking of corneal collagen in diabetes", Biochem Biophys Res Commun, 214, pp.793~797 (1995)
- Brandt JD., "Central corneal thickness in the Ocular Hypertension Treatment Study(OHTS)", Ophthalmology, 108, pp.1779~1788 (2001)
- Nemesure B., "Corneal thickness and intraocular pressure in the Barbados eye studies", Arch Ophthalmol, 121, pp.240~244 (2003)
- Su DH., "Diabetes, hyperglycemia, and central corneal thickness: the Singapore Malay Eye Study", Ophthalmology, 115, pp.964~968.e1 (2008)
- Seiler T., "Manifest diabetes and keratoconus : a retrospective case-control study", Graefes Arch Clin Exp Ophthalmol, 238, pp.822~825 (2000)
- Kuo IC., "Is there an association between diabetes and keratoconus?", Ophthalmology, 113, pp.184~190 (2006)
- Shah S., "Assessment of the biomechanical properties of the cornea with the ocular response analyzer in normal and keratoconic eyes", Invest Ophthalmol Vis Sci, 48, pp.3026~3031 (2007)
- Tielsch JM., "Diabetes, intraocular pressure, and primary open-angle glaucoma in the Baltimore Eye Survey", Ophthalmology, 102, pp.48~53 (1995)
- Dielemans I., "Primary open-angle glaucoma, intraocular pressure, and diabetes mellitus in the general elderly population. The Rotterdam Study", Ophthalmology, 103, pp.1271~1275 (1996)
- Matsuoka M., "Intraocular pressure in Japanese diabetic patients", Clin Ophthalmol, 6, pp.1005~1009 (2012)
- Broman AT., "Influence of corneal structure, corneal responsiveness, and other ocular parameters on tonometric measurement of intraocular pressure", J Glaucoma, 16, pp.581~588 (2007)