녹내장환자에서 중심각막내피세포 검사의 중요성
The Importance of Evaluation of Corneal Endothelial Cell Count in Glaucoma Patients
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 백내장 수술을 위해 내원한 녹내장 환자에서 중심각막내피세포의 감소 유무와 이의 원인, 치료를 포함한 여러 인자와의 관련성에 대해 알아보고자 하였다. 대상과 방법: 항녹내장 점안제로 치료 중인 60안, 레이저홍채절개술 및 섬유주절제술을 시행한 30안과 대조군 60안을 대상으로 안압및 녹내장 유병기간, 평균 항녹내장 안약 점안횟수, 수술 전 중심각막내피세포에 대해 후향적으로 분석하였다. 결과: 중심각막내피세포수는 약물치료군 2681.30 ± 355.33개/mm2, 수술치료군 2435.57 ± 646.81개/mm2, 대조군 2822.08 ±330.17개/mm2로 약물치료군과 수술치료군이 대조군에 비해 통계적으로 유의하게 감소해 있었고(p=0.026, p=0.010) 유병기간에 따른중심각막내피세포의 수는 유병기간이 길수록, 평균 항녹내장 점안횟수가 많을수록 감소하는 것으로 나타났다(p=0.003, p=0.010). 결론: 녹내장 환자에서는 수술, 레이저, 장기간 또는 다수의 항녹내장 점안제사용 등으로 각막내피세포의 감소가 더 빨리 진행할 수있으므로 각막내피세포 검사가 필수적이다.
Abstract
Purpose: To evaluate the possible causes of decreased central corneal endothelial cell count in glaucoma patients and to acknowledge the importance of central corneal endothelial cell count evaluation. Methods: This retrospective case-control study included 60 glaucomatous eyes that were being treated with topical anti-glaucoma drugs, 30 eyes that underwent laser iridotomy or trabeculectomy, and 60 control eyes. Intraocular pressure,duration of topical anti-glaucoma medications, mean number of topical anti-glaucoma drugs, and preoperative central corneal endothelial cells were analyzed. Results: The numbers of central corneal endothelial cells in the topical anti-glaucoma medication group, the surgical group and the control group were 2681.30 ± 355.33, 2435.57 ± 646.81 and 2822.08 ± 330.17 cells/mm2, respectively. The numbers in the topical anti-glaucoma medication group and the surgical group were significantly lower than that of the control group. The number of central corneal endothelial cells was significantly low in patients with longer duration of disease and in those taking a greater number of topical anti-glaucoma drugs (p = 0.003, p = 0.010). Conclusions: In glaucoma patients, corneal endothelial cell count is decreased by glaucoma surgery, laser therapy,long-term or multiple topical anti-glaucoma medications. When performing cataract surgery in glaucoma patients, preoperative corneal endothelial evaluation is essential.
참고문헌 (28)
- Shaffer RN, "Comparison of cataract incidence in normal and glaucomatous population", Am J Ophthalmol, 69, pp.368~371 (1970)
- Sugar J, "Endothelial trauma and cell loss from intraocular lens insertion", Arch Ophthalmol, 96, pp.449~450 (1978)
- Sugar J, "The effect of phacoemulsification on corneal endothelial cell density", Arch Ophthalmol, 96, pp.446~448 (1978)
- Na HK, "Change of the corneal endothelial cell density in postoperative", J Korean Ophthalmol Soc, 22, pp.17~24 (1981)
- Gwin RM, "Effects of phacoemulsification and extracapsular lens removal on corneal thickness and endothelial cell density in the dog", Invest Ophthalmol Vis Sci, 24, pp.227~236 (1983)
- Jacobi PC, "Primary phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma", Ophthalmology, 109, pp.1597~1603 (2002)
- Khokhar S, "Phacoemulsification in filtered chronic angle closure glaucoma eyes", Clin Experiment Ophthalmol, 30, pp.256~260 (2002)
- Lai JS, "The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series", J Glaucoma, 15, pp.47~52 (2006)
- Itoi M, "Specular microscopic studies of the corneal endothelia of Japanese diabetics", Cornea, 8, pp.2~6 (1989)
- Larsson LI, "Structure and function of the corneal endothelium in diabetes mellitus type I and type II", Arch Ophthalmol, 114, pp.9~14 (1996)
- Lass JH, "A morphologic and fluorophotometric analysis of the corneal endothelium in type I diabetes mellitus and cystic fibrosis", Am J Ophthalmol, 100, pp.783~788 (1985)
- Schultz RO, "Corneal endothelial changes in type I and type II diabetes mellitus", Am J Ophthalmol, 98, pp.401~410 (1984)
- Straatsma BR, "Diabetes mellitus and intraocular lens implantation", Ophthalmology, 90, pp.336~343 (1983)
- Whikehart DR, "Alteration of ATPase activity and duplex DNA in corneal cells grown in high glucose media", Cornea, 12, pp.295~298 (1993)
- Kim KS, "Morphometric analysis of the corneal endothelial cells in normal Korean", J Korean Ophthalmol Soc, 33, pp.320~325 (1992)
- Markowitz SN, "The endothelium in primary angle-closure glaucoma", Am J Ophthalmol, 98, pp.103~104 (1984)
- Waltman SR, "Corneal endothelial changes with long-term topical epinephrine therapy", Arch Ophthalmol, 95, pp.1357~1358 (1977)
- Koo BS, "The effect of extracapsular cataract extraction in patients with chronic angle-closure glaucoma combined with cataract", J Korean Ophthalmol Soc, 37, pp.1045~1053 (1996)
- Nishida T, "Basic science: Cornea, sclera, ocular adnexa anatomy, physiology and pathophysiologic responses, In Cornea" (2011), Elsevier
- Park WT, "The changes of ultrastructure and function of the corneal endothelial cell caused by benzalkonium chloride", J Korean Ophthalmol Soc, 40, pp.2423~2430 (1999)
- Meyer KT, "Corneal endothelial damage with neodymium:YAG laser", Ophthalmology, 91, pp.1022~1028 (1984)
- Kaji Y, "Effect of shear stress on attachment of corneal endothelial cells in association with corneal endothelial cell loss after laser iridotomy", Cornea, 24, pp.55~58 (2005)
- Hahn YH, "Toxicity of benzalkonium chloride on corneal endothelium of rabbits", J Korean Ophthalmol Soc, 36, pp.1155~1161 (1995)
- Kerr Muir MG, "Damage to the corneal endothelium during Nd", YAG photodisruption, 1985, pp.69, 77~85
- Olsen T., "The endothelial cell damage in acute glaucoma. On the corneal thickness response to intraocular pressure", Acta Ophthalmol (Copenh), 58, pp.257~266 (1980)
- Traverso C, "Central corneal endothelial cell density after argon laser trabeculoplasty", Arch Ophthalmol, 102, pp.1322~1324 (1984)
- Dragon DM, "Neodymium:YAG laser iridotomy in the cynomolgus monkey", Invest Ophthalmol Vis Sci, 26, pp.789~796 (1985)
- Bigar F, "Corneal endothelial changes in primary acute angle-closure glaucoma", Ophthalmology, 89, pp.596~599 (1982)