반복각막진무름 환자의 임상양상 및 치료 효과
Clinical Presentation and Treatment Outcomes of Recurrent Corneal Erosion
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목적: 반복각막진무름 환자들의 임상양상과 치료 효과를 알아보고자 한다. 대상과 방법: 2008년 1월부터 2015년 3월까지 본원 안과에서 반복각막진무름을 진단 받은 환자 48명 53안을 대상으로 의무기록을 후향적으로 분석하였다. 질환의 발생과 관련하여 환자들의 나이, 성별, 병변의 위치, 발생 원인을 분석하였다. 치료법에 따라 점안약치료만 시행한 A군, 점안약 치료에 치료용 콘택트렌즈 착용을 병행한 B군, 양막이식술을 시행 받은 C군, 기타 시술을 받은 D군으로 나누었으며, 치료 받은 인원이 적은 D군을 제외하고 A, B, C 각 군의 재발률을 확인하고 비교하였다. 결과: 환자들의 평균 나이는 45.6 ± 14.3세(19세-76세), 성별 및 좌우에 따른 발생률의 차이는 없었으며, 굴절수술을 받은 경우를 제외하고는 50대에서 호발하였다. 발생 위치는 하부(58.5%), 중심부(30.2%) 순이었으며, 발생 원인은 외상에 의한 경우, 원인을 알 수 없는 경우, 과거 굴절수술을 받은 경우, 기타 안질환과 관련된 경우 순으로 많았다. 전체 대상안 중 A군은 11안(20.8%), B군은 30안(56.6%), C군은 8안(15.1%) D군은 4안(7.3%)이었고 치료 방법에 따른 재발률은 A군 27.3%, B군 23.3%, C군 12.5%로 양막이식술을 시행한 군이 다른 군에 비해 의의 있는 차이를 보이지 않았으나 낮은 재발률을 보였다. 결론: 결론적으로 반복각막진무름은 굴절수술을 받은 경우를 제외하고 50대에서 호발하며, 가벼운 외상에 의해 각막하부에 잘 발생하고 점안약, 콘택트렌즈와 같은 치료에도 자주 재발하는 경우에는 양막이식술과 같은 수술적 치료가 도움이 될 것이다.
Abstract
Purpose: To investigate the clinical presentation and treatment outcomes of recurrent corneal erosion patients. Methods: Retrospective analysis was performed on the medical records of 48 patients (53 eyes) diagnosed with recurrent corneal erosion by our ophthalmology department between January 2008 and March 2015. Patient age, gender, lesion location, and cause of disease were analyzed against occurrence of disease. Patients were classified by treatment method into group A, which was treated with eye drops; group B, which was treated with therapeutic contact lenses and eye drops; group C, which was treated with amniotic membrane transplantation; and group D, which was treated with other procedures, and the recurrence rates were compared. Results: The mean age of patients was 45.6 ± 14.3 years (19-76 years), with no significant difference in recurrence rates dependent on gender or eye. Patients in their 50s were most affected, excluding refractive surgery patients. The most frequent lesion location was the inferior area of the cornea (58.5%), followed by the central area (30.2%), and the most common cause of disease was trauma, followed by unknown causes, past refractive surgery, and complications from other eye diseases. Group A had 11 eyes (20.8%), while groups B, C, and D had 30 eyes (56.6%), 8 eyes (15.1%) and 4 eyes (7.3%), respectively. The recurrence rates according to treatment method were 27.3% in group A, 23.3% in group B, and 12.5% in group C. The lower recurrence rate in the group treated with amniotic membrane transplantation was not significant compared to that of conservatively treated groups. Conclusions: Recurrent corneal erosion mostly affects patients in their 50s, excluding refractive surgery patients, and occurs frequently in the inferior area of the cornea due to mild trauma. Surgical treatment including amniotic membrane transplantation should be considered instead of conservative treatment in order to prevent reoccurrence.
참고문헌 (32)
- Thomas OW, "Recurrent erosion", Tr Am Ophth Soc, 82, pp.850~898 (1984)
- 서연, "장기 관찰을 통한 반복 각막진무름의 치료효과", 대한안과학회지, 43(9), pp.2~1576 (2002), 대한안과학회
- Diez-Feijóo E., "Clinical presentation and causes of recurrent corneal erosion syndrome : review of 100 patients", Cornea, 33, pp.571~575 (2014)
- 이상협, "반복각막진무름 후 혼합 세균각막염 1례", 대한안과학회지, 48(3), pp.449~454 (2007), 대한안과학회
- Sherman W. Reeves, "Recurrent Corneal Erosion Syndrome: A Study of 364 Episodes", Ophthalmic Surgery, Lasers, and Imaging (2010), SLACK, Inc.[DOI]
- Diez-Feijóo E., "Optical coherence tomography findings in recurrent corneal erosion syndrome", Cornea, 34, pp.290~295 (2015)
- Sakimoto T., "Upregulation of matrix metalloproteinase in tear fluid of patients with recurrent corneal erosion", Jpn J Ophthalmol, 51, pp.343~346 (2007)
- Kameishi S., "Remodeling of epithelial cells and basement membranes in a corneal deficiency model long-term follow-up", Lab Invest, 95, pp.168~179 (2015)
- Eke T., "Recurrent symptoms following traumatic corneal abrasion: prevalence, severity, and the effect of a simple regimen of prophylaxis", Eye (Lond), 13(Pt 3a), pp.345~347 (1999)
- Ewald M., "Review of diagnosis and management of recurrent erosion syndrome", Curr Opin Ophthalmol, 20, pp.287~291 (2009)
- Dursun D., "Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix metalloproteinase-9, doxycycline and corticosteroids", Am J Ophthalmol, 132, pp.8~13 (2001)
- Wang L., "Treatment of recurrent corneal erosion syndrome using the combination of oral doxycycline and topical corticosteroid", Clin Experiment Ophthalmol, 36, pp.8~12 (2008)
- Ziakas NG., "Long-term follow up of autologous serum treatment for recurrent corneal erosions", Clin Experiment Ophthalmol, 38, pp.683~687 (2010)
- Yoon KC., "Application of umbilical cord serum eyedrops for recurrent corneal erosions", Cornea, 30, pp.744~748 (2011)
- Moutray TN., "Recurrent erosion syndrome--the patient’s perspective", Cont Lens Anterior Eye, 34, pp.139~143 (2011)
- Fraunfelder FW., "Treatment of recurrent corneal erosion by extended-wear bandage contact lens", Cornea, 30, pp.164~166 (2011)
- Ahad MA., "Randomized controlled study of ocular lubrication versus bandage contact lens in the primary treatment of recurrent corneal erosion syndrome", Cornea, 32, pp.1311~1314 (2013)
- Singh RP., "Alcohol delamination of the corneal epithelium for recalcitrant recurrent corneal erosion syndrome : a prospective study of efficacy and safety", Br J Ophthalmol, 91, pp.908~911 (2007)
- Ryan G., "Epithelial debridement with diamond burr superficial keratectomy for the treatment of recurrent corneal erosion", Clin Experiment Ophthalmol, 41, pp.621~622 (2013)
- Avni Zauberman N., "Anterior stromal puncture for the treatment of recurrent corneal erosion syndrome: patient clinical features and outcomes", Am J Ophthalmol, 157, pp.273.e1~279.e1 (2014)
- Tsai TY., "Recurrent corneal erosions treated with anterior stromal puncture by neodymium : yttrium-aluminum-garnet laser", Ophthalmology, 116, pp.1296~1300 (2009)
- 김서영, "난치성 반복각막진무름에서 엔디야그레이저전측각막실질 미세천자술", 대한안과학회지, 56(3), pp.331~338 (2015), 대한안과학회
- 최문정, "반복각막진무름에서 Nd:YAG Laser 치료와 보존적 치료의 비교", 대한안과학회지, 56(5), pp.687~693 (2015), 대한안과학회
- 고병이, "난치성 반복각막진무름에서 치료레이저각막절제술의 임상결과", 대한안과학회지, 52(4), pp.392~400 (2011), 대한안과학회
- Kim JC., "Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas", Cornea, 14, pp.473~484 (1995)
- 이기환, "다양한 각막표면질환에서 양막이식술의 임상적 효과", 대한안과학회지, 48(1), pp.7~12 (2007), 대한안과학회
- Malhotra C., "Human amniotic membrane transplantation : different modalities of its use in ophthalmology", World J Transplant, 4, pp.111~121 (2014)
- Koizumi NJ., "Growth factor mRNA and protein in preserved human amniotic membrane", Curr Eye Res, 20, pp.173~177 (2000)
- Fukuda K., "Differential distribution of subchains of the basement membrane components type Ⅳ collagen and laminin among the amniotic membrane, cornea, and conjunctiva", Cornea, 18, pp.73~79 (1999)
- Meller D., "Amniotic membrane transplantation for acute chemical or thermal burns", Ophthalmology, 107, pp.980~989 (2000)
- 이효석, "수포각막병증에서 치료레이저각막절제술의 단독시행 또는 양막이식술과 동시시행의 치료효과 비교", 대한안과학회지, 54(8), pp.1180~1186 (2013), 대한안과학회
- 염호엽, "양막이 라섹(LASEK) 수술 후 상피 치유와 임상적 결과에 미치는 영향", 대한안과학회지, 45(2), pp.195~202 (2004), 대한안과학회