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안구건조증에서 자가 혈소판 풍부 혈장이 안구표면에 미치는 영향: 임상 및 실험 분석

Effects of Platelet-rich Plasma on Ocular Surface in Patients with Dry Eye Syndrome: Clinico-experimental Analysis

김홍균|이상희|정재욱
대한안과학회 (The Korean Ophthalmological Society)|2019.12|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제60권 제12호|pp. 1169-1175

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Platelet-rich plasmaDry eye syndromesInflammatory factors
주제분류안과학

초록

목적: 고삼투압성 눈물막에 의한 안구표면손상이 있는 환경에서 자가 혈소판 풍부 혈장이 어떠한 영향을 주는지 후향적 임상분석 및 실험 방법을 통하여 확인하고자 한다. 대상과 방법: 기존 치료에 효과가 없었던 중등도 안구건조증환자 80안을 대상으로 자가 혈소판 풍부 혈장 사용 전과 사용 후 1, 3, 6개월에 각각 시력, 안압, 눈물막파괴시간, 각결막 표면 형광염색점수, 안구표면질환지수를 비교 분석하였으며, 각막윤부상피세포 배양과 고삼투압 스트레스 실험 모델을 이용하여 안구표면세포의 염증성 인자의 변화를 분석하였다. 결과: 후향적 임상분석에서 자가 혈소판 풍부 혈장을 사용 후 64안(80%)에서 안구표면질환지수 설문조사에서 치료 전과 비교하여 증상 호전 및 증상 점수의 유의한 감소를 보였다. 객관적 지표인 눈물막파괴시간 및 각결막 표면 형광염색 점수 역시 각각 68안(85%), 72안(90%)에서 눈물막파괴시간의 유의한 증가 및 각결막 표면 형광염색점수의 유의한 감소를 보였다. 고삼투압하에서의 각막윤부상피세포는 혈소판 풍부 혈장을 추가한 경우 interleukin-1, tumor necrosis factor-α, metalloproteinase (MMP)-1, MMP-3과 같은 염증성 인자들이 감소하였다. 결론: 자가 혈소판 풍부 혈장의 사용으로 눈물막파괴시간, 각결막 표면 형광염색 점수, 안구표면질환지수에서 치료 전후 통계학적으로 의미 있는 호전을 보였으며, 안구건조증을 시뮬레이션한 고삼투압모델에서 항염증 효과가 입증되어 중등도 안구건조증에 자가혈소판풍부 혈장 투여가 효과적으로 사용될 수 있을 것으로 보인다.

Abstract

Purpose: To evaluate the effect of platelet rich plasma (PRP) on ocular surface damage caused by hyperosmotic conditions using retrospective clinical and experimental analyses. Methods: Eighty eyes of moderate dry eye syndrome patients who had no responses using conventional treatments were included in the study. Before and 1, 3, and 6 months after the use of autologous PRP, the visual acuity, intraocular pressure, tear break-up time (TBUT), ocular staining score (OSS), and ocular surface disease index (OSDI) were compared. The changes in inflammatory factors of ocular surface cells were analyzed using a corneo-limbal epithelial cell culture and a hyperosmotic stress experimental model. Results: Using retrospective clinical analyses, in 64 eyes (80%) after the use of autologous PRP, the symptom scores and symptoms were significantly reduced in the OSDI questionnaire when compared with the symptom scores and symptoms before treatment. The TBUT and OSS, which were objective indicators showed a significant increase of TBUT and significant decrease of OSS in 68 eyes (85%) and 72 eyes (90%), respectively. The expression of inflammatory factors such as interleukin-1, tumor necrosis factor-α, metalloproteinase (MMP)-1, and MMP-3 decreased in corneo-limbal epithelial cells under hyperosmotic conditions when PRP was added. Conclusions: The use of autologous PRP showed significant improvement before and after treatment in the TBUT, OSS, symptom scores and symptoms, and OSDI. In addition, anti-inflammatory effects were demonstrated in hyperosmotic models simulating dry eye syndrome. Therefore, autologous PRP could be used effectively for the treatment of moderate dry eye syndrome.

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