혈액투석이 안압, 망막신경섬유층 두께 및 각막두께에 미치는 영향
The Effect of Hemodialysis on Intraocular Pressure, Retinal Nerve Fiber Layer Thickness and Corneal Thickness
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목적: 대조군과 혈액투석을 받고 있는 만성신부전 환자에서 안압, 망막신경섬유층 두께, 중심각막 두께를 측정하여 두 군 간의 차이와혈액투석 전후의 변화를 살펴보고자 하였다. 대상과 방법: 혈액투석을 받고 있는 만성신부전 환자 36명의 36안과 대조군 54명의 54안을 대상으로 하였다. 실험군과 대조군에서모두 안압측정, 중심각막두께 측정, 망막신경섬유층 두께 측정을 포함한 안과 검사가 이루어졌다. 실험군은 혈액투석 1시간 후에 안압,망막신경섬유층 두께, 중심각막두께를 다시 측정하였다. 결과: 망막신경섬유층 두께는 실험군이 대조군에 비해 평균 14.84 ± 5.61 μm 얇았다(p＜0.001). 실험군에서 투석 전과 투석 후를 비교하였을 때 안압은 평균 1.63 ± 3.27 mmHg 감소하였고(p=0.005), 망막신경섬유층 두께(p=0.148)와 중심각막두께(p=0.352)는 투석전후 유의한 차이를 보이지 않았다. 결론: 혈액투석을 받는 만성신부전 환자는 대조군보다 얇은 망막신경섬유층을 가지고 있으며, 혈액투석 후 안압이 감소하는 소견을보였다. 혈액투석을 받는 만성신부전 환자의 안질환 평가 시 이러한 변화를 고려해야 할 것으로 생각한다.
Abstract
Purpose: To compare the intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness and central corneal thickness (CCT) in healthy individuals and patients with chronic renal failure (CRF) undergoing hemodialysis, and to evaluate the changes in each parameter before and after hemodialysis in patients with CRF. Methods: Thirty-six eyes of 36 patients with CRF undergoing hemodialysis were included in the hemodialysis group and 54 eyes of 54 healthy subjects were recruited as the control group. All subjects underwent a complete eye examination, including best-corrected visual acuity (BCVA), slit lamp examination, dilated funduscopic examination, gonioscopy, automated perimetry, IOP measurement, corneal pachymetry, and evaluation of RNFL thickness. In the hemodialysis group,IOP, RNFL thickness, and CCT were measured again within 1 hour of hemodialysis. Results: Age, sex, BCVA, cup-to-disc ratio, IOP, and CCT were not statistically different between the 2 groups. The RNFL of the hemodialysis group was statistically significantly thinner than the control group (p < 0.001). The IOP decreased from 16.52 ± 2.95 mm Hg to 14.88 ± 2.03 mm Hg after hemodialysis (1.63 ± 3.27 mm Hg; p = 0.005). The changes in RNFL thickness and CCT were not statistically significant (p = 0.148, p = 0.352). Conclusions: In CRF patients with hemodialysis, RNFLs were thinner in the control group and hemodialysis induced significant IOP reduction. The results from the present study should be considered for the proper evaluation of ocular disorders in CRF patients with hemodialysis.
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