당뇨병 환자에서 당뇨망막병증 중증도에 따른 눈물막의 변화
The Change of Tear Film in Classification of Diabetic Retinopathy
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목적: 당뇨병 환자에서 당뇨망막병증의 중증도에 따른 눈물막의 변화를 알아보았다. 대상과 방법: 2012년 1월부터 2012년 7월까지 본원에서 제2형 당뇨병으로 진단받은 환자 117명을 대상으로 하여 ETDRS를 기준으로당뇨망막병증을 분류하고 범망막광응고술과 인슐린 치료의 유무, 당뇨병의 유병기간, 당화혈색소를 측정하였다. 눈물막의 진단검사는눈물막 파괴시간, 쉬르머 I검사, 안구표면의 진단적 형광염색법을 시행하였고 각막지각도는 Cochet-Bonnet 각막지각계로 측정하였다. 결과: 당뇨망막병증의 중증도가 진행할수록 안구표면의 형광염색정도는 유의하게 증가하였다. 당뇨병의 유병기간, 인슐린 치료유무와눈물막의 변화 사이에는 큰 연관성을 보이지 않았다. 당화혈색소가 높은 경우에 눈물막 파괴시간은 유의하게 감소하였고 형광염색정도는 유의하게 증가하였다. 범망막광응고술을 받은 환자에서도 눈물막 파괴시간과 형광염색정도에서 유의한 변화를 보였다. 결론: 당뇨병 환자 중 당뇨망막병증 중증도가 진행한 경우, 혈당조절이 잘 안된 경우(당화혈색소가 높은 경우), 범망막광응고술을 받은환자에서 눈물막 기능이 악화되어 안구표면 이상이 호발하는 환경을 제공하므로 세심한 주의가 필요하다.
Abstract
Purpose: To determine the relationship between changes in the tear film according to the classification of diabetic retinopathy inpatients with diabetes. Methods: A total of 117 newly detected diabetic patients were included in this study. The classification of diabetic retinopathywas performed based on the Early Treatment Diabetic Retinopathy Study (ETDRS). The duration of diabetes and HbA1c werealso investigated in patients who had undergone panretinal photocoagulation or insulin treatment. To examine the tear film function,we performed the tear break-up time test, the Schirmer I test, and the diagnostic fluorescein staining test of the ocularsurface. The Cochet-Bonnet esthesiometer was also employed to examine the corneal sensitivity. Results: As the severity of diabetic retinopathy progressed, the degree of ocular surface fluorescein staining increasedsignificantly. There was no relationship between the duration of diabetes and the results of the tear film function test. Patientswho had high blood HgA1c levels showed significant increases in tear break-up time and degree of ocular surface fluoresceinstaining. The patients who had undergone panretinal photocoagulation showed significant differences in tear break-up time anddegree of ocular surface fluorescein staining. Conclusions: The diabetic patients with progressed diabetic retinopathy, uncontrolled blood HgA1c levels and who had previouslyundergone panretinal photocoagulation should be managed more carefully since those patients are more susceptible toocular surface disorder with aggravation of tear film function.
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