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0.1% 사이클로스포린 양이온 나노 에멀젼의 점안감 및 순응도에 미치는 영향력 인자 분석

Contributing Factors Affecting Ocular Discomfort on Instillation and Compliance of 0.1% Cyclosporine A Cationic Nanoemulsion

전연숙|김경우|이원준
대한안과학회 (The Korean Ophthalmological Society)|2021.04|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제62권 제4호|pp. 429-438

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키워드

Compliance0.1% Cyclosporin AOcular discomfort
주제분류안과학

초록

목적: 0.1% 사이클로스포린 양이온 나노 에멀젼 안약의 점안감 및 순응도에 미치는 영향력 인자를 탐색하고자 하였다. 대상과 방법: 0.1% 사이클로스포린 양이온 나노 에멀젼(Ikervis®)을 처방받은 환자 중 점안감 및 순응도를 평가하는 EDSQ 설문지(점안감 평가: 질문 1-4, 순응도 평가: 질문 5-7)를 작성한 환자를 대상으로 하였다. 이들 중 초기 점안감 및 순응도에 영향을 미치는 인자를 분석하기 위해 점안 초기 3개월 내 최초 설문을 시행한 환자군(코호트 1)에서 각 질문의 점수와 연령, 성별, 점안 기간, 마이봄샘기능장애, 눈물 분비량, 각막지각 역치, 각막미란, 안구표면염색지수, 눈물 내 matrix metalloproteinase 9 (MMP-9) 발현 등급 및 안구표면질환지수 간 상관관계를 분석하였다. 또한, 점안 지속에 따른 점안감 및 순응도의 변화를 평가하기 위해 2회 이상의 설문을 시행한 환자군(코호트 2)에서 각 질문 점수들의 시간에 따른 변화를 분석하였다. 결과: 코호트 1 (39명, 74안)에서 질문 1-4의 점안 시 불편감 점수들은 여성에서 유의하게 더 높았고, 안약 점안 기간 및 연령과는 음의 상관관계를, 눈물 분비량, 각막미란, 안구표면염색지수 및 눈물 내 MMP-9 발현 등급과는 양의 상관관계를 보였다. 눈물 내 MMP-9 발현 등급이 높을수록 질문 5의 약제 순응도 점수가 유의하게 낮았다. 코호트 2 (34명)에서 점안 시 불편감 점수들은 누적 점안 기간이 길어지면서 감소하는 경향을 보였다. 결론: 본 연구 결과를 통해 0.1% 사이클로스포린 안약의 점안감에 대한 환자별 맞춤 설명과 순응도 향상에 도움을 줄 것으로 기대된다.

Abstract

Purpose: We investigated the contributing factors affecting the ocular discomfort on instillation and compliance of 0.1% cyclosporin A (CsA) cationic nanoemulsion eye drops. Methods: We enrolled patients who were prescribed 0.1% CsA eye drops (Ikervis®) and who filled out an eye drop satisfaction questionnaire to assess ocular discomfort on instillation (questions Q1-Q4) and compliance of eye drops (Q5-Q7). First, to identify the contributing factors affecting the early ocular discomfort of 0.1% CsA instillation and compliance, Q1-Q7 scores were correlated with respect to age, sex, instillation period duration, meibomian gland dysfunction, tear secretion, corneal sensitivity, corneal erosions, Sjögren's International Collaborative Clinical Alliance ocular staining score (OSS), tear matrix metalloproteinase 9 (MMP-9), and ocular surface disease index in patients who completed the first questionnaire within the first 3 months of instillation of 0.1% CsA (referred to as Cohort 1). Second, to evaluate the change in ocular discomfort on instillation and compliance, along with the prolonged instillation of 0.1% CsA, the changes in individual scores for questions Q1-Q7 were analyzed in patients who completed at least two or more serial questionnaires (corresponding to Cohort 2). Results: In Cohort 1 (74 eyes in 39 patients), the scores for ocular discomfort on instillation (Q1-Q4) were higher in females and correlated negatively with the instillation period duration and age and positively with tear secretion, corneal erosions, OSS, and tear MMP-9 grades. The higher the grade of tear MMP-9, the lower the compliance score of Q5. In Cohort 2 (34 patients), the scores for ocular discomfort on instillation tended to decrease as the cumulative instillation period lengthened. Conclusions: The results of this study may aid clinicians in explaining to patients the ocular discomfort on instillation of 0.1% CsA, so as to improve treatment compliance.

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