자가면역 연관 주변부각막궤양의 임상양상 및 예후인자 분석
The Clinical Manifestations and Prognostic Factors of Autoimmune-Related Peripheral Corneal Ulcers
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목적: 자가면역 연관 주변부각막궤양의 예후인자를 발굴하고자 하였다. 대상과 방법: 1999년 11월부터 2010년 8월까지 서울대학교병원에서 자가면역 연관 주변부각막궤양으로 진단받은 18명 19안 대해 의무기록을 후향적으로 분석하였다. 결과: 진단 시 나이는 평균 64.6세로 여성(66.7%)에 흔하였으며, 주로 단안(94.4%)에 발생하였다. 무렌각막궤양(53.6%) 및 류마티스관절염(26.3%)이 주요 병인이었다. 절반 이상(57.9%)에서 궤양의 깊이가 각막 두께의 75% 이상이었고, 궤양의 크기는 평균 69.5o이었다. 치료 전후 시력차이는 없었으며(p=0.789), 병인 및 치료방법에 따른 치료결과의 차이는 없었다. 재발(p=0.048) 및 치료에 실패하였던 경우(p=0.005)가 최종시력이 좋지 않았으며, 궤양이 깊을수록 치료실패가 증가하였다(p=0.037). 최종시력은 초진시력과 양의상관관계(p=0.031), 재발횟수와 음의 상관관계를 보였다(p=0.042). 결론: 자가면역 연관 주변부 각막궤양의 예후인자로 초진시력 및 궤양의 깊이를 도출하였으며, 이는 궤양의 깊이에 따른 단계적인 치료적 접근을 시도하는 데에 도움을 줄 것으로 생각한다.
Abstract
Purpose: To investigate clinical manifestations and prognostic factors of autoimmune-related peripheral corneal ulcers. Methods: Nineteen eyes in 18 patients who were diagnosed with autoimmune-related peripheral corneal ulcer from November 1999 to August 2010 were enrolled in the present study. Clinical manifestations and treatment results were investigated retrospectively. Results: The average age at presentation was 64.6 years with female (66.7%) and unilateral (94.4%) dominance. The main etiologies were Mooren’s ulcer (53.6%) and rheumatoid arthritis (26.3%). The ulcer depth was greater than 75% of the corneal thickness in more than half of the cases (57.9%) and the mean extent of the ulcer was 69.5°. There were no significant improvements in visual acuity after treatment (p = 0.789) and no significant differences in treatment outcomes among etiologies or treatment modalities. The patients who underwent ulcer recurrence (p = 0.048) or treatment failure (p = 0.005) had poorer final visual acuity than those patients who did not. The ulcer depth correlated with treatment failure (p = 0.037). The final visual acuity showed positive correlations with visual acuity at presentation (p = 0.031) and negative correlations with the number of recurrences (p = 0.042). Conclusions: The visual acuity at presentation and ulcer depths were significant prognostic factors. These factors appeared to be helpful in the treatment of marginal keratitis depending on the depth of the ulcer.
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