약물 치료에 반응이 없는 안구건조증 환자의 눈꺼풀경계부상피병변 평가
Lid Wiper Epitheliopathy in Patients with Dry Eye Refractory to Conventional Medical Treatment
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목적: 약물 치료에 반응이 없는 안구건조증 환자에서 임상 소견과 눈꺼풀경계부상피병변(lid wiper epitheliopathy)을 평가한 후 각 검사 수치 간의 상관성을 알아보고자 하였다. 대상과 방법: 46명(46안)의 환자를 대상으로 후향적으로 연구를 진행하였다. 환자는 자각적 검사인 안구표면질환지수(Ocular Surface Disease Index, OSDI) 점수와, 타각적 검사인 눈물막파괴시간, 각막형광염색(National Eye Institute score), 눈물막 삼투압, 눈꺼풀경계부상피병변을 평가하고, 각 지표 간의 상관성을 알아보기 위해 회귀 분석(simple and multiple linear regression test)을 시행하였다. 결과: 평균 OSDI 점수는 48.06 ± 21.19점이었고, 이 중 중증에 해당하는 33점 이상의 환자가 34명(73.9%)이었다. 평균 각막형광염색점수는 1.59 ± 2.13으로 높지 않았다. 평균 눈물막 삼투압은 298.15 ± 12.83 mOsm/L였고, 300 mOsm/L 이상은 18명(39.1%), 308 mOsm/L 이상은 6명(13.04%)이었다. 윗눈꺼풀에 눈꺼풀경계부상피병변을 보이는 환자는 41명(89.1%)으로 높은 비율을 차지하였으며, 평균 점수는 2.27 ± 0.91이었다. 각 지표 간의 상관성을 분석한 결과 OSDI 점수는 각막형광염색 점수와 양의 상관관계를 보였고(r=0.54, p<0.01), 눈꺼풀경계부상피병변 점수도 양의 상관관계를 보였다(r=0.56, p<0.01). OSDI 점수와 눈물막파괴시간, 눈물막 삼투압은 유의한 상관관계를 보이지 않았다(r=-0.16, p=0.279; r=0.16, p=0.298). 결론: 상급종합병원에 내원한 초진 안구건조증 환자에서 눈꺼풀경계부상피병변을 보이는 경우가 약 90% 정도였으며 눈꺼풀경계부상피병변 점수와 OSDI 점수 간에 유의한 상관관계가 있었다.
Abstract
Purpose: We evaluated the effects of lid wiper epitheliopathy on the clinical manifestations of dry eye in patients refractory to conventional medical treatment. Methods: Forty-six patients (46 eyes) completed the subjective Ocular Surface Disease Index (OSDI), and we obtained objective measures including the tear break-up time (TBUT), the National Eye Institute (NEI) corneal staining score, tear osmolarity, and lid wiper epitheliopathy as revealed on photographs taken using a yellow filter after fluorescein instillation. The images were graded using the Korb B protocol. Results: The mean OSDI score was 48.06 ± 21.19; 34 patients (73.9%) were had scores ≥33. Lid wiper epitheliopathy was evident in 41 (89.1%), and the epitheliopathy grade and OSDI score were correlated (r = 0.56, p < 0.01). The NEI score was also positively correlated with the OSDI score (r = 0.54, p < 0.01), but the mean value was low (1.59 ± 2.13). The OSDI score did not correlate significantly with either the TBUT or tear osmolarity (r = –0.16, p = 0.279; r = 0.16, p = 0.298, respectively). Conclusions: Lid wiper epitheliopathy was present in about 90% of patients with dry eye who visited our tertiary hospital, and a significant correlation was evident between the epitheliopathy grade and the OSDI score.
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