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근시의 정도에 따른 안압, 뇌척수압 및 사상판경유압력차의 관계

The Relationships of Intraocular Pressure, Cerebrospinal Fluid Pressure, and Trans-lamina Cribrosa Pressure Differences with Myopia

이시형|김찬윤|온영훈|나승관
대한안과학회 (The Korean Ophthalmological Society)|2018.06|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제59권 제6호|pp. 527-536

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MyopiaIntraocular pressureOpen-angle glaucomaCerebrospinal fluid pressure
주제분류안과학

초록

목적: 한국인에서 근시와 안압, 뇌척수압, 사상판경유압력차 간의 관계를 알아보고자 하였다. 대상과 방법: 본 연구는 2008년부터 2012년까지 시행한 국민건강영양조사자료를 바탕으로 19세 이상의 성인 6,933안을 대상으로 젊은 연령군(19-49세, Group 1)과 고령군(≥50세, Group 2)으로 분류하였다. 추정뇌척수압은 ‘cerebrospinal fluid pressure (mmHg)=0.44×신체비만지수(kg/m2)+0.16×이완기혈압(mmHg)-0.18×나이(years)-1.91’ 공식을 사용하였다. 사상판경유압력차는 안압에서 추정뇌척수압수치를 제하여 구하였다. 결과: 전체 환자군에서, 평균추정뇌척수압은 13.7 ± 0.1 mmHg (Group 1: 14.2 ± 0.1 mmHg, Group 2: 11.5 ± 0.1, p<0.01)였고 평균안압은 14.0 ± 0.1 mmHg (Group 1: 14.0 ± 0.1 mmHg, Group 2: 14.1 ± 0.1, p=0.724)였으며, 평균사상판경유압력차는 0.7 ± 0.1 mmHg (Group 1: 0.3 ± 0.1 mmHg, Group 2: 3.0 ± 0.2, p<0.001)였다. 혼란변수를 보정한 후 시행한 다중선형회귀분석에서 근시의정도와 추정뇌척수압 간의 양의 상관관계를 가졌으며(p<0.001; β: 0.12, spherical equivalent [SE]: 0.03), 이는 안압에서도 마찬가지였다(p<0.001; β: 0.29, SE: 0.05). 결과적으로 근시가 심할수록 높은 사상판경유압력차와 연관이 있었다(p=0.002; β: 0.18, SE: 0.06). Group 1과 Group 2로 나눠 시행한 분석에서 Group 1은 비슷한 연관성을 보였으나(추정뇌척수압: p<0.001; β: 0.12, SE: 0.03; 안압: p<0.001; β: 0.28, SE: 0.05; 사상판경유압력차: p=0.005; β: 0.17, SE: 0.06), Group 2에서는 사상판경유압력차와 근시의 정도와의 관계가 통계적으로 유의하지 않았다(p=0.274; β: 0.18, SE: 0.16). 결론: 한국인에서 공식으로 계산한 사상판경유압력차는 근시의 정도와 연관이 있으며, 이는 근시가 녹내장의 발병과 진행에 영향을 미치는 병리기전에 사상판경유압력차 증가가 기여할 수 있음을 나타낸다.

Abstract

Purpose: To investigate the relationships between myopia and the three parameters of intraocular pressure (IOP), estimated cerebrospinal fluid pressure (CSFP), and the trans-lamina cribrosa pressure difference (TLCPD). Methods: A total of 6,933 adults (≥19 years of age) who participated in the Korea National Health and Nutrition Examination Survey (2008–2012). These subjects were divided into two groups: young age group (19–49 years of age) and old age group (≥ 50 years of age). The estimated CSFP was calculated as CSFP (mmHg) = 0.44 body mass index (kg/m2) + 0.16 diastolic blood pressure (mmHg) - 0.18 age (years) - 1.91. The TLCPD was calculated by subtracting the CSFP from the IOP. Results: The mean estimated CSFP in the total population was 13.7 ± 0.1 mmHg (young, 14.2 ± 0.1 mmHg; old, 11.5 ± 0.1; p < 0.01), the mean IOP in the total population was 14.0 ± 0.1 mmHg (young, 14.0 ± 0.1 mmHg; old, 14.1 ± 0.1; p = 0.724), and the mean TLCPD in the total population was 0.7 ± 0.1 mmHg (young, 0.3 ± 0.1 mmHg; old, 3.0 ± 0.2; p < 0.001). After adjusting for confounding factors, multivariate linear regression analyses revealed significant positive associations between the degree of myopia and the estimated CSFP (p < 0.001; β, 0.12; spherical equivalent [SE], 0.03), as well as IOP (p < 0.001; β, 0.29; SE, 0.05). As a result, a higher TLCPD also showed a significant association with more myopic refractive error (p=0.002; β, 0.18; SE, 0.06). In subgroup analyses, a similar association was shown only in the young age group (estimated CSFP, p < 0.001; β, 0.12; SE, 0.03; IOP, p < 0.001; β, 0.28; SE, 0.05; TLCPD, p = 0.005; β, 0.17; SE: 0.06), while the old age group did not show a significant association between TLCPD and the degree of myopia (p = 0.274; β, 0.18; SE, 0.16). Conclusions: The calculated TLCPD showed an association with high myopia. It was consistent with the potential role of high myopia in the pathogenesis of open-angle glaucoma.

참고문헌 (36)

  1. Crawford Downs J, "Glaucomatous cupping of the lamina cribrosa: a review of the evidence for active progressive remodeling as a mechanism", Exp Eye Res, 93, pp.133~140 (2011)[DOI]
  2. Wu HM, "Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore", Optom Vis Sci, 78, pp.234~239 (2001)
  3. Tomlinson A, "Ratio of optic cup to optic disc. In relation to axial length of eyeball and refraction", Br J Ophthalmol, 53, pp.765~768 (1969)[DOI]
  4. Bellezza AJ, "The optic nerve head as a biomechanical structure: initial finite element modeling", Invest Ophthalmol Vis Sci, 41, pp.2991~3000 (2000)
  5. Chihara E, "Atypical nerve fiber layer defects in high myopes with high-tension glaucoma", Arch Ophthalmol, 108, pp.228~232 (1990)[DOI]
  6. Dichtl A, "Histomorphometry of the optic disc in highly myopic eyes with absolute secondary angle closure glaucoma", Br J Ophthalmol, 82, pp.286~289 (1998)[DOI]
  7. Cahane M, "Axial length and scleral thickness effect on susceptibility to glaucomatous damage: a theoretical model implementing Laplace's law", Ophthalmic Res, 24, pp.280~284 (1992)[DOI]
  8. Quigley HA, "Reappraisal of the mechanisms of glaucomatous optic nerve damage", Eye (Lond), 1, pp.318~322 (1987)[DOI]
  9. Avetisov ES, "Some features of ocular microcirculation in myopia", Ann Ophthalmol, 9, pp.1261~1264 (1977)
  10. Shih YF, "Ocular pulse amplitude in myopia", J Ocul Pharmacol, 7, pp.83~87 (1991)[DOI]
  11. To'mey KF, "Ocular pulse in high myopia: a study of 40 eyes", Ann Ophthalmol, 13, pp.569~571 (1981)
  12. Perkins ES, "The ocular pulse", Curr Eye Res, 1, pp.19~23 (1981)[DOI]
  13. Lutjen-Drecoll E, "Ultrahistochemical studies on tangential sections of the trabecular meshwork in normal and glaucomatous eyes", Invest Ophthalmol Vis Sci, 21, pp.563~573 (1981)
  14. Curtin BJ, "Normal and staphylomatous sclera of high myopia. An electron microscopic study", Arch Ophthalmol, 97, pp.912~915 (1979)[DOI]
  15. Hammond CJ, "Genes and environment in refractive error: the Twin Eye Study", Invest Ophthalmol Vis Sci, 42, pp.1232~1236 (2001)
  16. Stone EM, "Identification of a gene that causes primary open angle glaucoma", Science, 275, pp.668~670 (1997)[DOI]
  17. Mutti DO, "Myopia. The nature versus nurture debate goes on", Invest Ophthalmol Vis Sci, 37, pp.952~957 (1996)
  18. Morgan WH, "The influence of cerebrospinal fluid pressure on the lamina cribrosa tissue pressure gradient", Invest Ophthalmol Vis Sci, 36, pp.1163~1172 (1995)
  19. Ren R, "Cerebrospinal fluid pressure in glaucoma: a prospective study", Ophthalmology, 117, pp.259~266 (2010)[DOI]
  20. Marek B, "Cerebrospinal fluid pressure and glaucoma: regulation of trans-lamina cribrosa pressure", Br J Ophthalmol, 98, pp.721~725 (2014)[DOI]
  21. Xie X, "Noninvasive intracranial pressure estimation by orbital subarachnoid space measurement: the Beijing Intracranial and Intraocular Pressure (iCOP) Study", Crit Care, 17, pp.R162~ (2013)[DOI]
  22. Choi JA, "Age-related association of refractive error with intraocular pressure in the Korea National Health and Nutrition Examination Survey", PLoS One, 9, pp.e111879~ (2014)[DOI]
  23. Mitchell P, "The relationship between glaucoma and myopia: the Blue Mountains Eye Study", Ophthalmology, 106, pp.2010~2015 (1999)[DOI]
  24. Xu L, "High myopia and glaucoma susceptibility the Beijing Eye Study", Ophthalmology, 114, pp.216~220 (2007)[DOI]
  25. Marcus MW, "Myopia as a risk factor for open-angle glaucoma: a systematic review and meta-analysis", Ophthalmology, 118, pp.1989~1994 (2011)[DOI]
  26. Shim SH, "The Prevalence of Open-Angle Glaucoma by Age in Myopia: The Korea National Health and Nutrition Examination Survey", Curr Eye Res, 42, pp.65~71 (2017)[DOI]
  27. Berdahl JP, "Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma", Ophthalmology, 115, pp.763~768 (2008)[DOI]
  28. Berdahl JP, "Intracranial pressure in primary open angle glaucoma, normal tension glaucoma, and ocular hypertension: a case-control study", Invest Ophthalmol Vis Sci, 49, pp.5412~5418 (2008)[DOI]
  29. Lee SH, "Estimated Trans-Lamina Cribrosa Pressure Differences in Low-Teen and High-Teen Intraocular Pressure Normal Tension Glaucoma: The Korean National Health and Nutrition Examination Survey", PLoS One, 11, pp.e0148412~ (2016)[DOI]
  30. Killer HE, "Cerebrospinal fluid exchange in the optic nerve in normal-tension glaucoma", Br J Ophthalmol, 96, pp.544~548 (2012)[DOI]
  31. Linden C, "Normal-tension glaucoma has normal intracranial pressure: a prospective study of intracranial pressure and intraocular pressure in different body positions", Ophthalmology, 125, pp.361~368 (2018)[DOI]
  32. Fan H, "Associated factors for visibility and width of retrobulbar subarachnoid space on swept-source optical coherence tomography in high myopia", Sci Rep, 6, pp.36723~ (2016)[DOI]
  33. Jonas JB, "Histological changes of high axial myopia", Eye (Lond), 28, pp.113~117 (2014)[DOI]
  34. Fleischman D, "Analysis of cerebrospinal fluid pressure estimation using formulae derived from clinical data", Invest Ophthalmol Vis Sci, 57, pp.5625~5630 (2016)[DOI]
  35. Jonas JB, "Intraocular pressure and associated factors: the Central India Eye and Medical Study", J Glaucoma, 20, pp.405~409 (2011)[DOI]
  36. 김윤경, "개방각녹내장과 뇌척수압 및 사상판경유압력차의 관계: 제5기 국민건강영양조사 자료", 대한안과학회지, 57(9), pp.1392~1399 (2016), 대한안과학회

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