수정체비늘증후군 환자에서 각막내피세포의 변화
Corneal Endothelial Cell Changes in Korean Patients with Exfoliation Syndrome
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 단안 수정체비늘증후군 환자에서 수정체비늘증후군의 이환 여부에 따른 각막내피세포의 형태학적 차이를 알아보고자 하였다. 대상과 방법: 2000년 3월부터 2011년 2월까지 영남대학교병원에서 단안 수정체비늘증후군으로 진단받은 환자 72명(144안)의 의무기록을 후향적으로 분석하였다. 경면현미경검사와 각막두께검사를 이용하여 양안의 각막내피세포와 각막두께를 비교하였으며 안내 수술을 시행한 경우 수술의 빈도와 수술 전후의 각막내피세포의 변화를 분석하였다. 결과: 수정체비늘증후군에 이환된 눈에서 더 낮은 각막내피세포 밀도를 보였지만 통계적으로 유의하지는 않았고(2587.0 ± 391.0 vs. 2626.8 ± 354.6 cells/mm2, p=0.321), 변이계수, 육각형세포비율, 각막두께검사에서도 차이를 보이지 않았다. 수정체비늘증후군안에서 반대안에 비해 높은 안내 수술 빈도를 보였으며(p＜0.001) 각막내피세포 감소량도 더 높게 나타났다(p=0.007). 결론: 단안 수정체비늘증후군 환자에서 각막내피세포의 경면현미경 소견 및 각막두께는 양안에서 차이를 보이지 않았다. 다만, 수정체비늘증후군에 이환된 눈에서 보다 많은 안내 수술이 필요하고, 그로 인한 각막내피세포의 소실이 많은 점을 염두에 두고, 수술자는수술 전 경면현미경검사를 통한 각막내피세포의 변화를 평가하고 수술 후 각막부종의 가능성을 고려하여야 한다.
Abstract
Purpose: To compare the corneal endothelial cell changes in both eyes of Korean patients with clinically unilateral exfoliation syndrome using specular microscopy. Methods: A total of 144 eyes of 72 patients diagnosed with clinically unilateral exfoliation syndrome at Yeungnam University Hospital between March 2000 and February 2011 were retrospectively reviewed. Comparisons of corneal morphometric analysis were made including endothelial cell density, coefficient of variation, hexagonality, and central corneal thickness between the exfoliative and fellow non-exfoliative eyes in 72 patients with naive unilateral exfoliation syndrome. If patients received intraocular surgery during the follow-up periods, the number of intraocular surgeries and changes of the above-mentioned morphometric analysis were evaluated. Results: The paired exfoliative and fellow non-exfoliative eyes did not differ in endothelial cell density (2587.0 ± 391.0 vs. 2626.8 ± 354.6 cells/mm2, p = 0.321), in the coefficient of variation of cell size (35.9 ± 5.1 vs. 37.1 ± 4.7%), hexagonality (59.5 ± 7.3 vs. 57.8 ± 6.3%), and central corneal thickness (530.5 ± 37.6 vs. 532.0 ± 35.2 μm). However, the exfoliative eyes had significantly higher values for the number of intraocular surgeries (0.97 ± 0.78 vs. 0.28 ± 0.48, p < 0.001) and decrement of corneal endothelial cells (410.9 ± 538.7 vs. 19.0 ± 284.5 cells/mm2, p = 0.007). Conclusions: There were no significant morphologic differences in corneal endothelium between exfoliative eyes and fellow eyes in the present study. However, the authors suggest that specular microscopic examination be performed before intraocular surgery in eyes with exfoliation syndrome when considering the higher frequency of intraocular surgeries and the resultant corneal endothelial damages observed in the present study.
참고문헌 (38)
- Roth M, "Exfoliation syndrome", Am J Ophthalmol, 89, pp.477~481 (1980)
- Naumann GO, "Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations", Ophthalmology, 105, pp.951~968 (1998)
- Ritch R, "Exfoliation syndrome", Surv Ophthalmol, 45, pp.265~315 (2001)
- Schlötzer-Schrehardt U, "Ocular and systemic pseudoexfoliation syndrome", Am J Ophthalmol, 141, pp.921~937 (2006)
- Ritch R, "Exfoliation syndrome-the most common identifiable cause of open-angle glaucoma", J Glaucoma, 3, pp.176~177 (1994)
- Ritch R, "Exfoliation syndrome", Curr Opin Ophthalmol, 12, pp.124~130 (2001)
- Futa R, "Clinical features of capsular glaucoma in comparison with primary open-angle glaucoma in Japan", Acta Ophthalmol (Copenh), 70, pp.214~219 (1992)
- Aasved H, "Prevalence of fibrillopathia epitheliocapsularis(pseudoexfoliation) and capsular glaucoma", Trans OphthalmolSoc U K, 99, pp.293~295 (1979)
- Cho SW, "Changes in corneal endothelial cell density in patients with normal-tension glaucoma", Jpn J Ophthalmol, 53, pp.569~573 (2009)
- Hau S, "Corneal complications of glaucoma surgery", Curr Opin Ophthalmol, 20, pp.131~136 (2009)
- Gharagozloo NZ, "Aqueous dynamics in exfoliation syndrome", Am J Ophthalmol, 114, pp.473~478 (1992)
- Tanhehco T, "Pseudoexfoliation syndrome and cataract surgery", Int Ophthalmol Clin, 50, pp.81~93 (2010)
- Ishikawa A, "Risk factors for reduced corneal endothelial cell density before cataract surgery", J Cataract Refract Surg, 28, pp.1982~1992 (2002)
- Miyake K, "Corneal endothelial changes in pseudoexfoliation syndrome", Am J Ophthalmol, 108, pp.49~52 (1989)
- Naumann GO, "Primary corneal graft failure", Arch Ophthalmol, 114, pp.1031~ (1996)
- Naumann GO, "Keratopathy in pseudoexfoliation syndrome as a cause of corneal endothelial decompensation: a clinicopathologic study", Ophthalmology, 107, pp.1111~1124 (2000)
- Quiroga L, "Characteristics of the corneal endothelium and pseudoexfoliation syndrome in patients with senile cataract", Clin Experiment Ophthalmol, 38, pp.449~455 (2010)
- Zheng X, "In vivo confocal microscopic evidence of keratopathy in patients with pseudoexfoliation syndrome", Invest Ophthalmol Vis Sci, 52, pp.1755~1761 (2011)
- Ringvold A., "Corneal endothelial involvement in pseudoexfoliation syndrome", Arch Ophthalmol, 112, pp.297~298 (1994)
- Wirbelauer C, "Corneal endothelial cell changes in pseudoexfoliation syndrome after cataract surgery", Arch Ophthalmol, 116, pp.145~149 (1998)
- Ehlers N, "Biometric correlations of corneal thickness", Acta Ophthalmol (Copenh), 53, pp.652~659 (1975)
- Puska P, "Corneal thickness and corneal endothelium in normotensive subjects with unilateral exfoliation syndrome", Graefes Arch Clin Exp Ophthalmol, 238, pp.659~663 (2000)
- Chang WH, "Clinical manifestations of exfoliation syndrome in Korea", J Korean Ophthalmol Soc, 41, pp.1768~1774 (2000)
- 최진, "한국인에서 거짓비늘증후군의 임상양상", 대한안과학회지, 47(4), pp.577~586 (2006), 대한안과학회
- Stefaniotou M, "The cornea in exfoliation syndrome", Doc Ophthalmol, 80, pp.329~333 (1992)
- Schlötzer-Schrehardt UM, "Corneal endothelial involvement in pseudoexfoliation syndrome", Arch Ophthalmol, 111, pp.666~674 (1993)
- Vesti E, "Exfoliation syndrome and exfoliation glaucoma", Prog Retin Eye Res, 19, pp.345~368 (2000)
- Tarkkanen A, "Cumulative incidence of converting from clinically unilateral to bilateral exfoliation syndrome", J Glaucoma, 13, pp.181~184 (2004)
- Kivelä T, "Autopsy analysis of clinically unilateral exfoliation syndrome", Invest Ophthalmol Vis Sci, 38, pp.2008~2015 (1997)
- Hammer T, "Unilateral or asymmetric pseudoexfoliation syndrome? An ultrastructural study", Arch Ophthalmol, 119, pp.1023~1031 (2001)
- Kim KS, "Morphometric analysis of the corneal endothelial cells in normal Korean", J Korean Ophthalmol Soc, 33, pp.320~325 (1992)
- Laatikainen L, "Fluorescein angiographic studies of the peripapillary and perilimbal regions in simple, capsular and low-tension glaucoma", Acta Ophthalmol Suppl, 111, pp.3~83 (1971)
- Baba H, "Investigation of the pathogenesis of glaucoma capsulare with special discussion of alpha 1 Lp and Cp in aqueous humor", Graefes Arch Clin Exp Ophthalmol, 218, pp.283~286 (1982)
- Johnson DH, "Dynamics of aqueous humor in the syndrome of exfoliation with glaucoma", Am J Ophthalmol, 93, pp.629~634 (1982)
- Wali UK, "In vivo morphometry of corneal endothelial cells in pseudoexfoliation keratopathy with glaucoma and cataract", Ophthalmic Res, 41, pp.175~179 (2009)
- Gagnon MM, "Corneal endothelial cell density in glaucoma", Cornea, 16, pp.314~318 (1997)
- Kozart DM, "Intraocular pressure status in 100 consecutive patients with exfoliation syndrome", Ophthalmology, 89, pp.214~218 (1982)
- Pohjanpelto PE., "The fellow eye in unilateral hypertensive pseudoexfoliation", Am J Ophthalmol, 75, pp.216~220 (1973)