흡수눈물점플러그 사용 후 Keratograph를 이용한 안구 표면의 변화 연구
The Use of Keratography to Study Changes on the Ocular Surface after Absorbable Plug Insertion
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목적: 안구건조증 환자를 대상으로 Collagen absorbable plug를 사용하여 눈물점 폐쇄 전과 후의 Keratograph를 이용한 단기간 안구표면 변화에 대하여 알아보고자 한다. 대상과 방법: 안구건조증 환자 20명 20안을 대상으로 Collagen absorbable plug인 UltraPlug™ (Surgical Specialties Corporation, Reading, PA, USA)를 사용하기 전과 일주일 후에 각각 교정시력, Ocular Surface Disease Index (OSDI) score, Keratograph (K5M; Oculus Optikgerate GmbH, Wetzlar, Germany)를 통한 눈물띠 높이 및 눈물막파괴시간, 형광색소 염색을 이용하여 측정한 눈물막파괴시간 및 각막상피병증검사, 쉬르머검사를 비교해 보았다. 결과: 흡수성 눈물점마개를 통한 눈물점 폐쇄 전후에 형광색소 염색을 이용하여 측정한 각막상피병증검사, OSDI score에 있어서 유의한 차이를 보였으나(p-value=0.006, p-value=0.001, 각각), 형광색소 염색을 이용하여 측정한 눈물막파괴시간, 쉬르머검사, Keratograph 를 이용한 눈물띠 높이 및 눈물막파괴시간 결과에서는 유의한 차이가 없었다(p-value ＞0.05). 결론: 각막상피병증검사 결과 및 OSDI score가 유의하게 호전된 것을 통해 흡수성 눈물점마개는 안구건조증 증상 호전에 있어 효과가 있는 것으로 보인다. 그러나 이번 연구에서 알아보고자 했던 주요 관심사 중 하나인 Keratograph를 이용해 측정한 눈물띠 높이 및 눈물막파괴시간을 통해서는 유의하게 호전된 것을 확인할 수 없었다. 추후 더 많은 환자들의 장기간 경과 관찰을 통해 결과에 대한 보완이 필요할 것으로 보인다.
Abstract
Purpose: The aim of our study was to evaluate short-term changes in corneal surface status via Keratography in dry eye patients after placement of an absorbable collagen plug (UltraPlug™; Surgical Specialties Corporation, Reading, PA, USA). Methods: Patients (n = 20 eyes, 20 subjects) diagnosed with dry eye were recruited for this prospective, 1-month clinical trial. The lacrimal puncta were blocked using absorbable collagen plugs. We evaluated clinical parameters and symptoms 1 month later. We assessed visual acuity, the score on the Ocular Surface Disease Index (OSDI) questionnaire, and keratographic tear meniscus height (TMH) and tear break-up time (TBUT) (K5M; Oculus Optikgerate GmbH, Wetzlar, Germany). We also measured TBUT classically, the corneal fluorescein staining score, and the Schirmer test result. Results: Significant improvements in the corneal staining and OSDI scores were observed 1 month after treatment (p = 0.006, p = 0.001, respectively), but no significant differences in the keratographic TMH and TBUT, the classical TBUT, or the Schirmer test data was observed (all p > 0.05). Conclusions: Blocking of the lacrimal punctum with an absorbable collagen plug effectively improved clinical symptoms and objective indicators in dry eye patients, the corneal staining score and OSDI scores improved significantly. However, no significant improvements in keratographic TMH and TBUT were observed; this was of concern. Longer-term studies with more patients are required.
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