백내장 수술 후 발생하는 안구건조증의 임상양상 및 영향을 미치는 요인에 대한 분석
Changes in Clinical Manifestations of Dry Eye Syndrome after Cataract Surgery and the Affecting Factors
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목적: 백내장수술 후 발생하는 안구건조증과 관련된 임상양상의 변화를 살펴보고 술 후 사용한 인공눈물의 보존제 유무, 각막절개창위치에 따라 비교하였다. 대상과 방법: 2009년 5월부터 7월까지 백내장 수술을 시행 받은 17명 24안을 대상으로 전향적으로 연구하였다. 술 후 0.1% sodium hyaluronate 인공눈물의 보존제 유무에 따라 보존제 군과 무보존제 군으로 무작위로 분류하였고 무보존제 군은 난시에 따라 절개위치를 이측 또는 상측으로 결정하였다. 수술 전, 후 1, 2, 6개월째 눈물막 파괴시간 검사, 쉬르머 검사, 각막 지각 검사, 각막미란 정도,안구 건조증 증상 설문조사를 시행하였다. 또한 수술 전, 후 1, 6개월째 각막 공초점현미경으로 각막신경을 분석하였다. 결과: 무보존제 군에서 보존제 군에 비해 수술 6개월째 눈물막 파괴시간이 길고(p=0.010) 주관적 증상 점수가 낮았으며(p=0.007), 무보존제 군에서 각막절개창 위치에 따라서는 임상양상의 유의한 차이가 발견되지 않았다. 결론: 보존제가 함유되지 않은 인공눈물을 사용하는 것이 보존제가 함유된 인공눈물을 사용하는 것보다 백내장 술 후 발생한 안구건조증의 회복 및 증상완화에 도움이 되었다.
Abstract
Purpose: To evaluate the changes in the clinical signs and symptoms of dry eye syndrome before and after cataract surgery according to the main incision location and the type of artificial tears. Methods: Twenty-four eyes of 17 patients who underwent phacoemulsification and posterior chamber lens insertion from May 2009 to July 2009 were enrolled in the present study prospectively. The main incision location (temporal or superior incision) was determined according to the axis of astigmatism and the postoperative artificial tears (sodium hyaluronate with or without preservatives) were determined randomly. The tear film break-up time (TF-BUT), Schirmer test, esthesiometer,corneal surface grading with Oxford system and ocular surface disease index (OSDI) questionnaire before and 1,2 and 6 months after surgery were evaluated. The corneal nerve was also analyzed using corneal confocal microscopy (Confoscan 4, Nidek, Italy) before, and 1 and 6 months after surgery. Results: The TF-BUT was significantly longer (p = 0.010) and the OSDI score was significantly lower (p = 0.007) in the patient group with preservative-free sodium hyaluronate than the group with sodium hyaluronate containing preservatives at 6 months after cataract surgery. There were no statistically significant differences according to the main incision location in the sodium hyaluronate without preservatives group. Conclusions: Symptoms and several signs of dry eye syndrome triggered by cataract surgery decreased with preservative-free artificial tears compared to tears with preservatives.
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