유병기간이 짧은 눈물길 협착 환자에서 점안 스테로이드제의 효과에 관한 연구
The Effectiveness of Topical Steroid Instillation in Patients with Recently Developed Nasolacrimal Drainage Stenosis
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목적: 최근 발생한 눈물흘림을 주소로 내원한 환자에서 눈물길 협착이 진단된 경우에 점안 스테로이드제의 효과 및 이에 미치는 요인들을 알아보고자 한다. 대상과 방법: 2010년 1월부터 2013년 6월까지 3개월 내에 발생한 눈물흘림을 주소로 내원하여 눈물길 협착으로 진단받고 점안 스테로이드제를 점안한 56명 108눈의 환자들의 의무기록을 후향적으로 분석하였다. 안약 점안 후 1개월, 3개월, 6개월에 외래 추적관찰하였으며, 매 방문 시마다 환자의 주관적인 증상을 물어보고, 눈물띠 높이, 플루오레세인 염색소실검사를 시행하였으며 필요에 따라 눈물소관 관류 검사, 눈물소관 탐침술을 시행하여 결과를 비교 분석하였다. 결과: 1, 3개월에 누적 호전율은 각각 42.0%, 51.0%였으며, 증상이 호전된 기간은 평균 3.8 ± 1.9주(범위, 3-12)였다. 최종 관찰 시까지 총 108안 중 56안(51.9%)에서 증상의 호전을 보였고, 눈물길 협착의 원인이 명확하지 않은 환자의 63% (12/19안), 도세탁셀(Docetaxel)에 의해 유발된 환자의 100% (10/10안), S-1에 유발된 환자에서 43% (34/79안)의 호전을 보였다. 결론: 최근에 발생한 눈물흘림을 주소로 내원한 눈물길 협착 환자에서 점안스테로이드 제제의 사용이 효과적일 수 있으며, 침습적인시술 전에 점안스테로이드의 사용을 우선 시도해 볼 수 있겠다.
Abstract
Purpose: To evaluate the effectiveness of topical steroid instillation and associated factors in patients with recently developednasolacrimal drainage stenosis. Methods: The medical records of 108 eyes of 56 patients who received topical steroid for nasolacrimal drainage stenosis betweenJanuary 2010 and June 2013 and who developed epiphora of a three-month duration were retrospectively reviewed. Evaluations were performed at 1, 3, and 6 months after instillation of topical steroid. Subjective symptoms, tear meniscus height,and fluorescein dye disappearance test results were noted at every follow-up visit; nasolacrimal irrigation and canalicular probingwere also performed as needed. Results: The cumulative improvements were 42.0% at 1 month and 51.0% at 3 months after treatment, and the mean period ofsymptomatic improvement was 3.8 ± 1.9 weeks (range, 3-12 weeks). At the final follow-up visit, 56 (51.9%) of 108 eyes showedimproved epiphora. Final improvement was observed in 63% (12 of 19 eyes) of idiopathic nasolacrimal drainage stenosis patients,in 100% (10 of 10 eyes) of docetaxel-treated patients, and in 43% (34 of 79 eyes) of S-1-treated patients. Conclusions: Instillation of topical steroids can be effective for nasolacrimal drainage stenosis and may prevent the need for invasivesurgical treatment.
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