인공눈물 점안 후 안구 표면 두께 간섭계를 이용한 눈물 지질층 두께의 변화 분석
Evaluation of Changes in Tear Film Lipid Layer Thickness Using Ocular Surface Interferometer after Artificial Tear Application
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목적: 농도 및 보존제 유무에 따른 히알루론산 나트륨제제의 인공누액 점안 후 LipiView® II 간섭계(TearScience Inc., Morrisville, NC, USA)를 이용하여 눈물 지질층 두께의 시간에 따른 변화를 측정, 비교 분석함으로써, 인공눈물의 사용이 LipiView® II 검사 결과에 미치는 영향을 분석하고자 한다. 대상과 방법: 건성안 환자를 대상으로 전향적 연구를 시행하였다. 모든 대상자에게 눈물막 파괴 시간 측정, 쉬르머 검사, 각막 및 결막형광염색 검사, 마이봄샘 기능부전 평가, ocular surface disease index 설문조사를 실시하였으며, 대상자를 난수표를 이용한 무작위추출로 인공누액 종류에 따라 세 그룹(1군: 무보존제 0.1% 히알루론산 나트륨제제 인공눈물, 2군: 무보존제 0.3% 히알루론산 나트륨인공눈물, 3군: 0.003% 염소 벤잘코니움을 포함하는 0.1% 히알루론산 나트륨제제 인공눈물)으로 나눠 각각의 인공눈물을 점안 전, 직후, 1, 3, 6시간 후의 눈물지칠층의 두께를 LipiView® II 간섭계로 측정 후 비교 분석하였다. 안검염의 유무에 따라 두 군으로 나누어 눈물지칠층의 두께를 추가로 분석하였다. 결과: 눈물 지질층의 두께를 측정한 결과, 인공눈물제제를 점안하고 3시간 뒤 눈물 지질층의 두께 변화가 유의하게 나타났다(p=0.03). 제1군 및 2군에서 시간에 따른 눈물 지질층 두께의 변화가 유의하게 측정되었고(p<0.01, p<0.01), 제3군에서는 눈물 지질층 두께 변화가 관찰되지 않았다(p=0.71). 환자를 안검염 그룹과 비안검염그룹으로 세분화하여 분석해 보았을 때, 비안검염 그룹에서는 인공눈물점안과 상관 없이 눈물지질층의 두께가 일정하였고(p=0.19), 안검염 그룹에서는 제1군과 2군에서 인공눈물 점안 후 시간 경과에 따라 눈물지질층 두께가 변화하였다(p<0.01, p=0.01). 안검염 그룹에서 제1군과 2군의 눈물 지질층의 두께를 비교하면, 인공눈물 점안 직후 및 1시간, 3시간 뒤까지 유의한 차이를 보였으며(p=0.04, p<0.01, p=0.02), 6시간째에는 유의한 차이가 없었다. 제1군과 3군의 경우에는 시간별 차이가 없었다(p=0.08). 결론: LipiView® II 간섭계를 이용해 측정한 눈물 지질층 두께는 인공눈물의 농도와 보존제의 유무에 따라서도 수치의 차이를 보였으며, 안검염의 유무에 따라서도 인공눈물 점안 후 눈물 지질층의 두께 변화 양상에 차이가 있었다. 이는 LipiView® II 간섭계로 눈물 지질층을 측정하는 경우 인공눈물 종류와 관계없이 적어도 6시간의 점안을 금해야 하며, 또한 안검염이 있는 환자군과 보존제를 포함하는 인공눈물을 사용하는 환자에서 더욱 유의해야 함을 시사한다.
Abstract
Purpose: The changes in tear film lipid layer thickness (LLT) after artificial tears application using LipiView®II interferometer were assessed. Methods: We performed a prospective study of patients with dry eye disease. All subjects underwent measurement of tear film break-up time, Schirmer test, ocular surface staining, meibomian gland evaluation, and subjective score assessment using the Ocular Surface Disease Index. All subjects were randomly assigned to 1 of 3 groups using table of random numbers (group 1, sodium hyaluronate [HA] 0.1% eye drops without preservatives; group 2, HA 0.3% eye drops without preservatives and group 3, HA 0.1% with benzalkonium chloride 0.003%). LLT was measured before, immediately after and 1 hr, 3 hrs, and 6 hrs after artificial tears application. Additionally, the patients were divided into 2 subgroups depending on the presence of meibomian gland dysfunction (MGD) and further evaluated. Results: Significant change in LLT was observed at 3 hrs after artificial tears instillation. LLT in groups 1 and 2 showed significant changes over time (p < 0.01 and p < 0.01, respectively). However, LLT in group 3 showed no change. LLT was unchanged in patients without MGD. Conversely, in MGD patients, a significant difference in LLT between groups 1 and 2 was observed immediately after and 1 hr and 3 hrs after instillation of artificial tears (p = 0.04, p < 0.01 and p = 0.02, respectively) but not at 6 hrs. However, no significant difference in LLT between groups 1 and 3 was observed in MGD patients. Conclusions: LLT after instillation of artificial tears measured using LipiView®II interferometer was affected by artificial tear concentration and presence of preservatives. Additionally, the presence of MGD can impact the pattern of LLT changes induced by artificial tear instillation. Therefore, LLT measurements using LipiView®II interferometer require at least a 6-hrs interval after use of eye drops, especially for patients with MGD or using artificial tears with preservatives.
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