동일초점현미경을 이용한 비쇼그렌건성안 각막 미세구조의 변화 및 임상증상과의 관계
Corneal Microstructural Changes in Non-Sjögren Dry Eye Using Confocal Microscopy: Clinical Correlation
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목적: 동일초점현미경을 이용해 비쇼그렌건성안 환자에서 관찰되는 각막 상피세포와 기저하신경의 변화와 임상 증상과의 관계를 알아본다. 대상과 방법: 건성안 환자 40명과 정상인 18명이 연구에 참여했다. 설문을 통해 건성안 증상을 visual analogue scale (VAS) 통증지수로 평가해서 0점에서 5점을 낮은 통증지수군(low VAS score group, LVS), 6점에서 10점을 높은 통증지수군(high VAS score group, HVS)으로 구분했다. 모든 피험자의 양안을 대상으로 쉬르머 검사, 눈물막파괴시간 및 각막염색점수 검사를 시행한 후, 동일초점현미경을 이용해 각막 중심부에서 상피층과 기저하신경의 미세구조를 촬영했다. 정상안 23안과 건성안 54안이 분석에 포함되었다. ImageJ와 NeuronJ 프로그램을 이용해 세포의 밀도와 형태학적 특징을 분석했다. 결과: 대조군에 비해 두 건성안군에서 표층, 중간 및 기저상피세포의 밀도가 유의하게 감소해 있었다(p＜0.001). 중간상피세포는 증상이 심한 건성안군에서 보다 낮은 밀도로 관찰되었다(p＜0.0001). 기저하신경의 밀도는 높은 통증지수군에서 대조군 및 낮은 통증지수군에 비해 낮았고(p＜0.005), 신경의 염주화, 비틀림 정도 및 반사성은 높은 통증지수군에서 대조군 및 낮은 통증지수군보다 높게나타났다(p＜0.05). 결론: 동일초점현미경으로 분석한 건성안 환자 각막의 세포 수준의 변화는 건성안의 병리 및 임상증상과 연관성이 있다. 이는 건성안환자의 진단 및 치료 반응 평가에 보다 객관적인 지표가 될 수 있다.
Abstract
Purpose: To investigate the relationship between changes of corneal epithelium and subbasal nerves in non-Sjögren dry eye using in vivo confocal microscope (IVCM) and self-reported clinical symptoms. Methods: The present study included 40 patients with dry eye and 18 healthy control subjects. The dry eye group underwent an evaluation of dry eye symptoms using visual analogue scale (VAS) score and was subdivided into 2 groups; score 0-5 as the low VAS score (LVS) group and score 6 - 10 as the high VAS score (HVS) group. The tear film break-up time, fluorescein staining, Schirmer test and microstructural imaging of epithelium, and subbasal nerve at cornea center with IVCM were performed on both eyes of each patient. Twenty-three normal eyes and 54 eyes of dry eye patients were included in the study. Cell densities and morphological characteristics were analyzed using ImageJ and NeuronJ softwares. Results: Both LVS and HVS groups had decreased cell density of superficial, intermediate, and basal epithelium (p < 0.001). Intermediate epithelial cells were more decreased in the dry eye group with more severe symptoms (p < 0.0001). Subbasal nerve density (p < 0.005) was more decreased and nerve beadings, tortuosity, and reflectivity increased in the HVS group than both LVS and control groups (p < 0.05). Conclusions: The alterations of corneal cellular level in dry eye patients visualized using IVCM are correlated with pathology and clinical symptoms and may be useful objective criteria in diagnosis and monitoring treatment efficacy.
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