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당뇨 환자에서 연성 콘택트렌즈 착용에 의한 중심각막두께 및 각막내피세포의 변화

Changes in Central Corneal Thickness and Corneal Endothelial Morphology in Contact Lens-Wearing Diabetic Patients

신기철|강준원
대한안과학회 (The Korean Ophthalmological Society)|2014.10|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제55권 제10호|pp. 1426-1431

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Diabetes mellitusContact lensCorneal endothelial cellCorneal thickness
주제분류안과학

초록

목적: 당뇨 환자에서 연성 콘택트렌즈 착용에 의한 중심각막두께 및 각막내피세포의 변화에 대해 알아보고자 하였다. 대상과 방법: 2006년 8월부터 2007년 8월까지 건국대학교 병원을 방문한 환자 113명을 대상으로 당뇨 환자 중 콘택트렌즈를 착용하는 환자 26명(1군), 당뇨 환자 중 콘택트렌즈를 작용하지 않는 환자 27명(2군), 당뇨가 없고 콘택트렌즈를 착용하는 환자 30명(3군),당뇨도 없고 콘택트렌즈도 착용하지 않는 환자 30명(4군)으로 나누었다. 대상군의 우안에서 초음파 각막두께측정기와 비접촉경면현미경을 이용하여 중심각막두께, 각막내피세포 밀도, 세포 면적의 변이계수, 내피세포의 육각형 세포의 비율을 조사하여 비교하였다. 결과: 당뇨의 평균 유병기간은 1군과 2군에서 4.38년, 4.41년, 콘택트렌즈 착용 기간은 1군과 3군에서 5.27년, 3.65년이었다. 중심각막두께는 1군에서 3군과 4군에 비해 유의하게 두꺼웠고, 각막내피세포 밀도는 유의하게 낮았다. 세포 면적의 변이계수는 1군에서 2군과4군에 비해 유의하게 높았고, 3군에서 4군에 비해 유의하게 높았다. 내피세포의 육각형 세포 비율은 3군에서 4군에 비해 유의하게낮았다. 결론: 중심각막두께와 각막내피세포 밀도는 당뇨에 의해 더 큰 영향을 받았고, 각막내피세포의 형태는 콘택트렌즈 착용에 의해 더큰 영향을 받았다. 당뇨 환자 중 콘택트렌즈를 착용한 환자군에서 중심각막두께, 각막내피세포 밀도, 다면성, 다형성 모두 저해된 것을알 수 있었다. 따라서 당뇨 환자는 연성 콘택트렌즈 착용에 있어 보다 더 세심한 주의가 필요할 것으로 생각한다.

Abstract

Purpose: To evaluate the changes in central corneal thickness and corneal endothelium in contact lens-wearing diabeticpatients. Methods: This study included 113 patients who visited the Department of Ophthalmology, Konkuk University Medical Centerfrom August 2006 to August 2007. Ultrasound pachymetry and noncontact specular microscopy were performed on the righteyes of 26 diabetic patients who regularly wore soft contact lenses (group 1), 27 diabetic patients who did not wear soft contactlenses (group 2), 30 soft contact lens-wearers without diabetes mellitus (DM) (group 3), and 30 normal subjects who did not wearsoft contact lenses (group 4). Central corneal thickness, corneal endothelial cell density, endothelial cell coefficient of variation,and percentage of hexagonal endothelial cells were compared between the groups. Results: Average duration of diabetes in groups 1 and 2 was 4.38 and 4.41 years, respectively, and average duration of soft contactlens wear in groups 1 and 3 was 5.27 and 3.65 years, respectively. The central cornea was significantly thicker and the endothelialcell density was significantly lower in group 1 than in groups 3 and 4. The cell size coefficient of variation was higher ingroup 1 than in groups 2 and 4 and higher in group 3 than in group 4. The percentage of hexagonal cells was significantly lowerin group 3 than in group 4. Conclusions: Central corneal thickness and endothelial cell density are more affected by DM than contact lens use, and cornealendothelial cell morphology is influenced more by contact lens use than DM. Contact lens use in diabetic patients significantly influencesall characteristics of the corneal endothelium compared with those in normal subjects. Patients with DM should be advisednot to wear contact lenses.

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