실모양각막염의 발생에 건성 각결막염과 각막의 폐쇄가 미치는 영향의 비교
The Difference in Filaments between Corneal Occlusion and Keratoconjunctivitis Sicca
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목적: 실모양각막염의 발생에 건성 각결막염과 각막의 폐쇄가 미치는 영향을 비교하고자 한다. 대상과 방법: 실모양각막염 환자 중 안검경련, 안검하수, 마비성 사시로 인해 각막폐쇄를 가진 11안, 건성각결막염으로 발생한 11안,두 가지 특징을 모두 갖는 13안에서 세극등 현미경으로 사상체의 숫자를 기록하고, 니트로셀룰로스막을 이용하여 일부의 사상체를 채취하여 뮤신 함유량에 따라 1(없음)-4(매우 많음)로 분류하고, H&E와 면역염색(AE1/AE3, MUC1, 5AC, 16)을 실시하여 그 특징을 분석하였다. 결과: 각막의 폐쇄만을 보인 환자군(11안)의 평균 사상체 수는 2.7 ± 1.4개로 건성각결막염만 가진 환자군(11안)의 평균 사상체 수(5.1± 2.2개, p=0.009)에 비하여 유의하게 적은 수의 사상체가 관찰되었다. 뮤신의 함유량은 각막의 폐쇄를 가진 환자군(2.7 ± 0.9)이건성각결막염 환자군(1.9 ± 0.8, p=0.034)에 비하여 유의하게 높았다. 병리검사상 사상체의 중심섬유는 핵과 피질로 구성되어 있으며 핵은 화생된 각막상피세포가 벽돌처럼 정렬되어 있고 피질은 전혀 염색되지 않았으며 섬유주변은 뮤신으로 구성되어 있었다. 결론: 각막패쇄로 발생된 실모양각막염은 건성각결막염에 의한 경우보다 사상체의 수가 적고 뮤신의 함유량이 많으므로 치료에 있어고려해야 할 것이다.
Abstract
Purpose: To examine histopathological findings of filamentary keratitis due to corneal occlusion. Methods: We analyzed filamentary keratitis in 11 eyes with corneal occlusion due to blepharospasm, ptosis and paralytic strabismus,11 eyes with keratoconjunctivitis sicca, and 13 eyes with both corneal occlusion and keratoconjunctivitis sicca. The followingprotocols were used for filament analyses: slit lamp examination for counting filament numbers, impression cytology forgrading mucin content, and histopathology (hematoxylin and eosin staining) and immunohistochemistry (with AE1/AE3, MUC1,5AC, 16) for histological analysis. Results: Slit lamp biomicrosopy showed a significantly smaller number of filaments in the corneal occlusion group (11 eyes, 2.7± 1.4) than the keratoconjunctivitis sicca group (11 eyes, 5.1 ± 2.2, p = 0.009). In impression cytology, the standard photographgrade of mucin content was significantly higher in the corneal occlusion group (2.7 ± 0.9) than the keratoconjunctivitis siccagroup (1.9 ± 0.8, p = 0.034). On pathological exam, filaments showed a central filament with peripheral mucin. The central filamentswere composed of core and cortex, and the core contained multiple deformed nuclei. However, the cortex was not stainedby AE1/AE3, MUC1, 5AC, 16. Conclusions: Filamentary keratitis due to corneal occlusion showed a smaller number of filaments and higher mucin content thanfilamentary keratitis induced by keratoconjunctivitis sicca and should be considered during treatment.
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