단안 분지망막정맥폐쇄 환자의 무증상 반대안에서 안구관류압의 일중변동
Diurnal Fluctuation of Ocular Perfusion Pressure in the Fellow Eyes of Branch Retinal Vein Occlusion
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목적: 단안 분지망막정맥폐쇄 환자에서 혈압, 안압, 안구관류압의 일중 변동을 정상인과 비교하여 차이점을 알아보고자 하였다. 대상과 방법: 전향적 환자‐대조군 연구로 50명의 단안 분지망막정맥폐쇄 환자와 50명의 정상인을 대상으로 연구를 진행하였으며, 모든대상자는 빛간섭단층촬영(OCT)을 포함한 종합적인 안과 검사를 진행하였다. 혈압, 안압을 아침 8시, 10시, 오후 2시, 6시에 하루 4회측정하였으며, 혈압과 안압의 평균과 변동치, 평균동맥압, 평균안구관류압, 이완기안구관류압을 분지망막정맥폐쇄 환자의 무증상 반대안과 대조군의 정상안을 비교 분석하였다. 결과: 망막신경섬유층 두께의 평균은 대조군에 비하여 분지망막정맥폐쇄 환자의 무증상 반대안에서 유의하게 감소되어 있었다(p＜0.001). 평균안압, 안압변동치는 차이가 없었으나, 혈압 변동치(수축기 혈압 변동치, p=0.045, 이완기 혈압 변동치, p=0.037) 그리고 평균동맥압변동치(p=0.011)는 분지망막정맥폐쇄 환자에서 훨씬 더 크게 측정되었다. 평균안구관류압과 이완기안구관류압의 평균은두 군에 차이가 없었으나, 평균안구관류압의 변동치(p＜0.001)와 이완기안구관류압의 변동치(p＜0.001)는 분지망막정맥폐쇄 환자에서유의하게 증가되어 있었다. 혈압, 평균동맥압, 평균안구관류압, 이완기안구관류압의 평균과 변동치는 분지망막정맥폐쇄 환자의 무증상반대안에서 망막신경섬유층의 평균 두께 감소와 관련성을 보였다. 결론: 본 연구 결과를 통해, 단안 분지망막정맥폐쇄 환자의 무증상 반대안은 녹내장성 손상이 진행할 위험성이 있다는 것을 보여준다.
Abstract
Purpose: To investigate diurnal change in blood pressure (BP), intraocular pressure (IOP), and ocular perfusion pressure(OPP) in patients with unilateral branch retinal vein occlusion (BRVO) and compare the results with healthy controls. Methods: We conducted a prospective case‐control study which included 50 patients with unilateral BRVO and 50 agematchedvolunteers as controls. Each participant underwent a comprehensive ophthalmic examination including opticalcoherence tomography (OCT). BP and IOP were evaluated 4 times daily at 8 AM, 10 AM, 2 PM and 6 PM. The mean andfluctuation of BP, IOP, mean arterial pressure (MAP), mean OPP (MOPP), and diastolic OPP (DOPP) were compared betweenfellow eyes of BRVO patients and normal control eyes. Results: The average retinal nerve fiber layer (RNFL) thickness was significantly reduced in the fellow eyes of BRVO patientscompared to control eyes (p < 0.001). Mean IOP and IOP fluctuation did not differ, but BP fluctuation (systolic BPfluctuation, p = 0.045; diastolic BP fluctuation, p = 0.037) and MAP fluctuation (p = 0.011) were greater in the fellow eyesof BRVO patients compared to normal eyes. The mean MOPP and DOPP did not differ between groups, however, the fluctuationof MOPP (p < 0.001) and DOPP (p < 0.001) were significantly increased in the fellow eyes of BRVO patients. Themean and fluctuation of BP, MAP, MOPP and DOPP were associated with reduced average RNFL thickness in the felloweyes of BRVO patients. Conclusions: These results suggest the fellow eyes of unilateral BRVO patients may be at risk of developing glaucomatousdamage.
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