익상편 절제술 후 익상편의 크기 지표에 따른 평균 각막 굴절력 변화량 예측

남기태,엄영섭,임재원,강수연,김효명,송종석,Ki Tae Nam,MD,Young Sub Eom,MD,Jay Won Rhim,MD,Su Yeon Kang,MD,Hyo Myung Kim,MD,PhD,Jong Suk Song,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.11

Purpose: To assess the changes in mean corneal refractive power (ΔK) following pterygium surgery and to predict ΔK in cases of combined cataract and pterygium surgery. Methods: Thirty-seven eyes of unilateral pterygium patients who underwent pterygium surgery were analyzed retrospectively with at least more than 1 month of follow-up. Preoperative and postoperative 1 month corneal refractive power was measured using auto-keratometer (RK-F1, Canon, Tokyo, Japan). Pterygium horizontal extension, width, and area were measured and correlation with ΔK before and after surgery analyzed. We also compared ΔK of the contralateral normal eye. Results: The mean corneal refractive (Km) power measured before and 1 month after surgery was 43.30 ± 1.66 D and 44.07 ± 1.42 D, respectively. The Km significantly increased at 4 weeks after surgery (<EM>p </EM>< 0.001). However, postoperative Km was not significantly different when compared with the contralateral normal eye (43.86 ± 1.34 D; p = 0.59). All parameters of pterygium size including horizontal extension, width, and area were positively correlated with the mean ΔK. Among parameters, horizontal extension was best correlated with mean ΔK (<EM>p</EM> < 0.001). The mean ΔK with horizontal extension was predicted using linear regression (2.5 mm to 1 D, 4.0 mm to 1.8 D). Conclusions: We recommend contralateral corneal refractive power or prediction of corneal refractive power using linear regression with pterygium horizontal extension for determining intraocular lens power in cases of combined cataract and pterygium surgery. J Korean Ophthalmol Soc 2014;55(11):1613-1617

항암치료를 위해 사용된 표피성장인자 수용체 억제제로 유발된 긴속눈썹증 2예

나건후,엄영섭,강수연,김효명,송종석.Kun Hoo Na. MD. Young Sub Eom. MD. Su Yeon Kang. MD. Hyo Myung Kim. MD. PhD. Jong Suk Song. MD. PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.6

Purpose: To introduce 2 cases of trichomegaly associated with the use of systemic epidermal growth factor receptor (EGFR) inhibitors for the treatment of lung cancer. Case summary: An 82‐year‐old female visited our clinic for ocular pain in both eyes. She was suffering from metastatic lung cancer and was under daily treatment with gefitinib (Iressa<sup>®, AstraZeneca, London, UK) for 6 months. On ophthalmologic examination, she presented with abnormally elongated eyelashes, hyperemic conjunctiva and dense corneal erosion. A 52‐year‐old male who was diagnosed with non‐small cell lung cancer 7 months before and treated with erlotinib (Tarceva<sup>® OSI Pharmaceuticals, Inc., Melville, NY, USA) was referred to our clinic for injection and foreign body sensation in both eyes. Although there were no remarkable changes in eyelashes at the initial visit, long, curly, uneven eyelashes were observed after 3 months. Conclusions: Due to the increased use of EGFR inhibitors in anti‐cancer treatment, ophthalmologists should be aware of these chemotherapeutics' adverse effects. J Korean Ophthalmol Soc 2014;55(6):908-912

온열마사지가 눈꺼풀 온도 및 눈물막 지방층 두께에 미치는 효과

강동완(Dong Wan Kang),엄영섭(Young Sub Eom),임재원(Jay Won Rhim),강수연(Su Yeon Kang),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 상품화된 온열패드를 이용한 온열마사지가 눈꺼풀 온도 및 눈물막 지방층 두께에 미치는 효과를 평가하고자 하였다. 대상과 방법: 건성안이나 마이봄샘 기능장애 등 특별한 안질환이 없는 13인 26안을 대상으로 LipiView 2Ⓡ System (TearscienceⓇ, Morrisville, NY, USA)을 이용, 각각 양안의 평균 눈물막 지방층 두께를 측정하였다. 온열마사지의 효과를 알아보기 위하여 양안 중우안에만 찜질을 시행하였고, 찜질 시작 직후와 3분, 5분의 우안 눈꺼풀 온도를 측정하여 찜질을 하지 않은 좌안과 비교하였다. 5분간의 온열마사지 후 다시 양안의 눈물막 지방층 두께를 측정하여 온열마사지가 눈물막 지방층 두께에 미치는 영향을 분석하였다. 결과: 13인 26안에서의 온열마사지 전 평균 눈물막 두께는 우안 55.1 ± 21.0 nm, 좌안 53.9 ± 13.9 nm로 측정되었다(p=0.474). 온열마사지 전 눈꺼풀 온도는 우안 35.9 ± 0.3℃, 좌안 35.9 ± 0.2℃로 측정되었고, 마사지 시작 직후, 3분, 5분 후 눈꺼풀 온도는 각각 40.3 ± 1.3℃, 40.3 ± 1.3℃, 40.3 ± 1.9℃로 마사지를 하는 동안 눈꺼풀의 온도가 비교적 일정하게 유지되었다. 온열마사지 후 눈물막 지방층 두께는 우안 83.5 ± 18.8 nm로 마사지 전에 비해 유의한 증가를 보였고(p=0.001), 좌안 65.5 ± 27.1 nm에 비해서도 유의하게 차이를 보였다(p=0.005). 결론: 온열마사지는 정상안에서 마사지 후 눈물막 지방층의 두께를 증가시켰고, 5분의 마사지 시간 동안 40.3oC 정도의 비교적 안정적인 온도의 증가를 보여 눈물막 지방층 유지에 도움이 될 것이라 생각된다. <대한안과학회지 2016;57(6):876-880> Purpose: Warm compression using a commercial heat pad was used to evaluate the effects of temperature on the eyelids and tear film lipid layer thickness. Methods: Targeting 13 patients (26 eyes) with non-specific eye disease such as dry eye syndrome or Meibomian gland dysfunction, we measured the average thickness of the tear film lipid layer in both eyes with the LipiView 2?? System (Tearscience??, Morrisville, NY, USA). We performed warm compression on the right eye only in order to evaluate the effectiveness of massage and measured the temperature of the right eye lid immediately, 3 minutes, and 5 minutes after compression in order to compare with the untreated left eye. After warm compression for 5 minutes, we measured tear film lipid layer thickness of both eyes and analyzed the effectiveness of warm compression. Results: The average tear film lipid layer thickness was 55.1 ± 21.0 nm in the right eyes and 53.9 ± 13.9 nm in the left eyes (p = 0.474). Before performing the warm compression, the temperature of the right eye lid was 53.9 ± 13.9 nm, and that of the left was 35.9 ± 0.2oC. The eye lid temperature of the right eye immediately, 3 minutes, and 5 minutes after warm compression was 40.3 ± 1.3oC, 40.3 ± 1.3oC, and 40.3 ± 1.9oC, respectively, and these temperatures were relatively constant during the massage. Tear film lipid layer thickness after warm compression in the right eye was 83.5 ± 18.8 nm, which was increased compared to the original temperature (p = 0.001) and showed significant difference compared with the 65.5 ± 27.1 nm in the left eye (p = 0.005). Conclusions: Warm compression increased the tear film lipid layer thickness and showed a relatively constant increased temperature of 40.3°C over 5 minutes. This technique will be helpful for maintaining tear film lipid layer thickness in patients with Meibomian gland dysfunction. J Korean Ophthalmol Soc 2016;57(6):876-880

수성 눈물 부족 건성안 환자에서 수술적 눈물점 폐쇄의 효과 평가

안소민(So Min Ahn),엄영섭(Young Sub Eom),임재원(Jay Won Rhim),강수연(Su Yeon Kang),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

Purpose: To analyze the improvement of symptoms and signs of dry eye after surgical punctual occlusion and to evaluate the effects of secondary systemic disease in dry eye patients. Methods: From March 2011 to July 2014, 15 eyes of 8 dry eye patients with a history of punctal plug insertion underwent surgical punctal occlusion. Schirmer test was measured based on mean 2.9 mm. The patients consisted of 4 dry eye patients with Sjogren’s disease, 1 with rheumatoid arthritis, 1 with graft-versus-host disease (GVHD), and 2 with no secondary systemic disease. Preoperative and postoperative ophthalmic examinations of log MAR visual acuity, subjective symptoms, corneal staining(National Eye Institute [NEI] score), and tear break-up time (BUT) were performed and the effects of secondary systemic disease in dry eye patients were evaluated. The results of surgical punctual occlusion were analyzed. Results: All patients showed a statistically significant improvement of log MAR visual acuity, subjective symptoms, corneal staining (NEI score), and tear BUT. The patients with rheumatoid-related diseases showed improved symptoms after surgery, but the patient with GVHD showed no significant improvement after surgery. Among the study patients, 80.0% showed completely closed punctum and 20.0% showed partial recanalization. Conclusions: Surgical punctal occlusion is an effective alternative in patients with severe aqueous deficient dry eye who show recurrent punctal plug loss or complications associated with punctal plugs.

부분결합레이저간섭계로 안구생체계측 가능 여부에 따른 백내장수술의 합병증 발생빈도

최한뉘(Han nuy Choi),엄영섭(Young sub Eom),강수연(Su Yeon Kang),송종석(Jong Suk Song),김효명(Hyo Myung Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.7

목적: 수술 전 IOLMaster를 이용한 안구생체계측 가능 여부를 수정체유화술 및 인공수정체삽입술의 수술 중 및 수술 후 합병증 발생의 예측인자로 사용 가능한지 확인하고자 한다. 대상과 방법: 이번 연구에서는 수정체유화술 및 인공수정체삽입술을 시행 받은 1,456명 2,107안을 술 전 IOLMaster를 이용한 안구생체계측의 가능 여부에 따라 두 군으로 나누었다(측정가능군: 1,141명 1,746안, 측정불가능군: 315명 361안). 두 군 간에 수술 중 및 수술 후 합병증 발생 빈도를 비교 분석하였다. 결과: 전체 2,107안 중 361안(17.1%)에서 IOLMaster로 안구생체계측을 할 수 없었다. 후낭하백내장(56.0%)이 IOLMaster로 안구생체계측을 할 수 없는 주된 원인이었으며, 그 다음으로 흔한 원인은 전낭하백내장(12.5%)이었다. 수정체유화술 및 인공수정체삽입술 중후낭파열(posterior capsule rupture) 및 전낭절개의 주변부확장(radial tear)의 빈도는 측정불가능군에서 측정가능군보다 통계적으로 유의하게 높았다(각각 p=0.001, p<0.001). 술 후 1주일까지 지속된 각막부종(corneal edema) 또한 측정불가능군(16.1%)에서 측정가능군(5.3%)보다 통계적으로 유의하게 높았다(p<0.001). 결론: IOLMaster를 이용하여 술 전 안구생체계측을 할 수 있는지 여부는 수정체유화술 및 인공수정체삽입술 수술 중 및 수술 후 합병증 발생의 예측인자로 사용할 수 있을 것으로 생각된다. 따라서 술자는 IOLMaster를 이용한 안구생체계측이 불가능한 환자들을 수술하게 될 경우, 수술 중 보다 세심한 주의를 기울이는 것이 필요하겠다. <대한안과학회지 2017;58(7):804-810> Purpose: To validate the possibility of IOLMaster measurement as a predictor of intraoperative and postoperative complications during phacoemulsification surgery. Methods: In this study, 2,107 eyes from 1,456 patients who underwent phacoemulsification with intraocular lens (IOL) implantation were divided into two groups according to the possibility of performing optical biometry with the IOLMaster (measurable group: 1,746 eyes from 1,141 patients, unmeasurable group: 361 eyes from 315 patients). The intraoperative and postoperative complication rates were compared between the two groups. Results: Three hundred sixty-one eyes (17.1%) could not be measured using optical biometry. Dense posterior subcapsular cataract (56.0%) was the main factor resulting in failed measurements with optical biometry, followed by anterior subcapsular cataract (12.5%). The rates of posterior capsule rupture and radial tear were significantly higher in the unmeasurable group than in the measurable group (p = 0.001, p < 0.001, respectively). Corneal edema was significantly higher in the unmeasurable group (16.1%) than in the measurable group (5.3%) at postoperative 1 week (p < 0.001). Conclusions: Possibility of optical biometry measurement can be used as a simple predictor of intraoperative and postoperative complications of phacoemulsification surgery. Surgeons should pay close attention to patients who cannot be measured using IOLMaster. J Korean Ophthalmol Soc 2017;58(7):804-810

자동굴절검사기를 이용한 연령에 따른 객관적 조절력 평가

강동완(Dong Wan Kang),엄영섭(Young Sub Eom),임재원(Jay Won Rhim),강수연(Su Yeon Kang),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2016 대한안과학회지 Vol.57 No.1

Purpose: To evaluate the objective amplitude of accommodation in various age groups using an autorefractometer and to compare the results with subjective assessments on accommodation. Objective accommodative amplitude of artificial lenses in post-operative cataract patients was also measured. Methods: In this study, 41 patients who visited Korea University Guro Hospital from July through August 2014 were categorized into 6 different age groups. Accommodative amplitude was measured using long-distance refraction at 5 m and short-distance refraction at 20 cm. In 20 patients, subjective amplitude of accommodation was measured using the minus lens technique and was compared with the measured objective accommodative amplitude. Accommodative amplitude was also measured in 8 patients who received cataract surgery. Results: The mean accommodative ability in normal people was 2.38 D. The age groups of 10-19, 20-29, 30-39, 40-49, 50-59, and over 60 years showed accommodative amplitudes of 3.31 ± 0.99 D, 3.25 ± 0.34 D, 3.78 ± 0.68 D, 1.00 ± 0.60 D, 0.22 ± 0.23 D, 0.00 ± 0.00 D, respectively. The results showed a rapid decrease in accommodative ability of patients older than 40 years and demonstrated a correlation between objective and subjective amplitude of accommodation (Pearson’s correlation coefficient 0.838). There was a significant difference between objective and subjective accommodative amplitudes in artificial lenses (p =0.015), with average objective and subjective measures of 0.10 ± 0.23 D and 0.59 ± 0.35 D, respectively. Conclusions: Measuring amplitude of accommodation using an autorefractometer can be useful in assessing results of presbyopia treatment.

안내후방콘택트렌즈삽입술 7년 후 발생한 급격한 내피세포 감소 1예

강동완(Dong Wan Kang),엄영섭(Young Sub Eom),임재원(Jay Won Rhim),강수연(Su Yeon Kang),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2015 대한안과학회지 Vol.56 No.5

목적: 안내후방콘택트렌즈(implantable Collamer Lens, ICL) 삽입술을 받은 환자에서 6년째까지 정상내피세포 밀도를 보이다가 7년째 급격한 내피세포 감소가 발생한 환자가 있어 이를 보고하고자 한다. 증례요약: 남자 45세, 난시를 동반한 고도근시 환자에서 Toric ICL 삽입술을 시행하였다. 환자는 수술 전 최대교정시력이 양안 모두 0.7이었으며, 수술 후에는 나안시력이 양안 모두 0.9, 교정시력이 양안 모두 1.0으로 시력향상을 보였다. 수술 전 각막내피세포 밀도는 우안 3,063 cells/mm2, 좌안 3,126 cells/mm2였고 수술 후 5년째의 각막내피세포 밀도는 우안 2,897 cells/mm2 좌안 2,974 cells/mm2로 별 변화가 없었으나 6년째에는 우안 2,198 cells/mm2 좌안 2,803 cells/mm2로 내피세포의 감소가 관찰되었다. 1년 후 다시 측정한 각막내피세포 밀도는 우안 1,272 cells/mm2 좌안 2,852 cells/mm2로 우안의 내피세포밀도가 급격히 감소한 것이 관찰되었고, 우안의 Toric ICL 렌즈를 제거하고 수정체유화술 및 인공수정체 삽입술을 시행하였다. 수술 후 두 달째 측정한 각막내피세포 밀도는 1,257 cells/mm2로 수술로 인한 각막내피세포의 손상은 심하지 않았다. 결론: ICL과 같은 유수정체인공수정체를 삽입한 환자에서는 수술 후 백내장은 물론 각막내피세포에 영향을 줄 수 있어 정기적이고 규칙적인 내피세포밀도 측정을 시행해야 한다. <대한안과학회지 2015;56(5):784-788 > Purpose: To report a case of decreased endothelial cell density 7 years after posterior chamber phakic intraocular lens implantation. Case summary: A 45-year-old man with high myopia combined with astigmatism was treated with Toric implantable Collamer Lens (ICL) implantation. The patient's best corrected visual acuity was 0.7 in both eyes before the operation. After the treatment, his uncorrected visual acuity was 0.9 and corrected visual acuity was 1.0 in both eyes, indicating an improvement in visual function. Preoperative endothelial cell density measured 3,063 cells/mm2 in the right eye and 3,126 cells/mm2 in the left eye. At 5 years postoperatively, measurements were 2,897 cells/mm2 in the right eye and 2,974 cells/mm2 in the left, showing little change. However, a 6-year postoperative measurement of 2,198 cells/mm2 in the right eye and 2,803 cells/mm2 in the left showed a slight decrease in endothelial cell density in the right eye, and a follow-up measurement one year later displayed a rap-id decline to 1,272 cells/mm2 in the right eye and 2,852 cells/mm2 in the left eye. The Toric ICL lens was removed from the right eye and phacoemulsification and posterior chamber intraocular lens implantation was performed. Two-month postoperative en-dothelial cell density was 1,257 cells/mm2 and endothelial cell damage from the operation itself was minimal. Conclusions: ICL implantation may cause complications related to corneal endothelial cells as well as glaucoma. Patients should receive regular follow-up examinations for endothelial cell density. J Korean Ophthalmol Soc 2015;56(5):784-788

조명차퍼를 이용한 백내장수술에서 최소-에너지 수정체유화술

김진수(Jinsoo Kim),이기웅(Ki Woong Lee),이대영(Dae Young Lee),엄영섭(Young Sub Eom),남동흔(Dong Heun Nam) 대한안과학회 2022 대한안과학회지 Vol.63 No.2

목적: 백내장수술에서 조명차퍼를 이용한 변형된 수정체 핵 쪼개기로 수술 중 발생하는 초음파 에너지와 수술 시간을 최소화하고자 하였다. 대상과 방법: 단일 술자에 의해 전방내 조명기를 사용한 Stop & Chop 방식으로 노인성 백내장수술 받은 34명 45안과 조명차퍼를 사용한 Illuminated chop (I-Chop) 방식으로 수술 받은 49명 71안에서 수술 중 사용된 유효 초음파 에너지양을 나타내는 수술 기구의 고유 상수(EFX), 수정체유화술 시간, 각막내피세포수 변화 등을 비교하고, I-Chop군에서 제로-에너지 수정체유화술 비율을 조사하였다. 결과: 두 그룹에서 수술 중 사용된 유효 초음파 에너지양은 각각 0.82 ± 3.53, 18.08 ± 16.15 (p=0.001), 수정체유화술 시간은 162.04 ± 49.65초, 185.08 ± 41.42초(p=0.01)로 유의한 차이를 보였다. 하지만 각막내피세포 감소량은 7.13 ± 9.47%, 7.03 ± 7.89%로 유의한 차이를 보이지 않았다(p=0.76). I-Chop군에서 제로-에너지 수정체유화술 환자는 56안(86%)이었으며, EFX>1인 환자들에서 핵경화 정도는 더 심한 경향을 보였다(2.90 ± 0.71 vs. 4.5 ± 1.0; p=0.001). 결론: 조명차퍼를 이용한 I-Chop 수정체 핵 쪼개기를 통해 백내장수술에서 초음파 에너지를 최소화할 수 있었다. Purpose: To minimize ultrasound power use and surgical phaco time in illuminated chop cataract surgery. Methods: The charts of patients who underwent senile cataract surgery by a single surgeon were reviewed retrospectively. A conventional intracameral endoilluminator was used in a Stop & Chop group (n = 45), while an illuminated chopper was used in an illuminated chop (I-Chop) group (n = 71). EFX, a unitless value that roughly correlates with ultrasound energy during phacoemulsification, surgical phaco time, and changes in endothelial cell count were compared between the two groups and the ratio of zero phacoemulsification in the I-Chop group was evaluated. Results: EFX of the Stop & Chop and I-Chop groups was 18.08 ± 16.15 and 0.82 ± 3.53, respectively (p = 0.001), while the surgical phaco time was 185.08 ± 41.42 and 162.04 ± 49.65 seconds (p = 0.01). However, the endothelial loss did not differ in the two groups (7.03 ± 7.89 vs. 7.13 ± 9.47%, p = 0.76). In the I-Chop group, 56 (86%) eyes had zero phaco energy and patients with EFX >1 (n = 6) had more severe nuclear sclerosis grading (2.90 ± 0.71 vs. 4.5 ± 1.0; p = 0.001). Conclusions: The I-Chop group had lower EFX and shorter surgical phaco time than the Stop & Chop group. Illuminated chop using an illuminated chopper is one way to attain minimal phacoemulsification.

유리체절제술 시 평면부 초음파분쇄술 후 각막내피세포의 장기 변화

최수연(Soo Youn Choi),한지윤(Ji Yun Han),엄영섭(Young sub Eom),김성우(Seong Woo Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.4

목적: 유리체절제술과 백내장수술을 동시에 시행 받았던 유리체절제술 시 평면부를 통한 초음파분쇄술의 술 후 2년째 각막내피세포 변화를 알아보고자 한다. 대상과 방법: 유리체절제술 시 평면부를 통한 초음파분쇄술을 시행 받은 환자 중 2년 이상 정기적으로 추적관찰하였던 환자 20안을 대상으로 후향적 의무기록을 분석하였다. 경면현미경을 이용하여 수술 전, 수술 후 1달, 3달, 6달, 1년, 2년째 측정한 각막내피세포 밀도(endothelial cell density, ECD), 세포면적변이계수(coefficient of variation, CV), 육각형세포율(hexagonality, HA)을 비교하였다. 결과: 수술 전 측정된 평균 ECD는 1,782 ± 623개/mm2, CV는 35.55 ± 3.03%, HA는 49.86 ± 5.60%였다. 수술 2년 후 측정한 평균 ECD는 1,722 ± 532개/mm2, CV는 35.50 ± 3.03%, HA는 53.00 ± 4.91%로 수술 전과 유의한 차이를 보이지 않았으며 (p=0.9731, 1.000, 0.997), 수술 후 1개월, 3개월, 6개월 및 1년의 시점에 측정한 값과도 유의한 차이를 보이지 않았다. 결론: 유리체절제술 시 평면부를 통한 초음파분쇄술은 수술 전 ECD가 적은 환자에게 수술에 따른 각막내피세포 손실을 최소화할 수 있는 선택 가능한 수술 방법임을 확인하였다. Purpose: To evaluate the long-term changes in cornea endothelial cell density (ECD) after pars plana vitrectomy (PPV) with fragmentation. Methods: Twenty patients (20 eyes) who underwent PPV with fragmentation and who were followed up for 2 years were enrolled in this retrospective study. The cornea ECD, coefficient of variation (CV), and hexagonality (HA) were calculated using a specular microscopy at 1, 3, 6, 12 months, and 2 years after surgery. Results: The preoperative mean ECD was 1,782 ± 623 cells/mm2, and the postoperative mean ECD did not significantly change at 1, 3, 6, and 12 months. Additionally, there were no significant changes in CV or HA. At 2 years after surgery, the mean ECD was 1,722 ± 532 cells/mm2, the mean CV was 35.50 ± 3.03%, and the mean HA was 53.00 ± 4.91%. There were no significant changes in ECD, CV, or HA preoperatively and postoperatively at 1, 3, 6, and 12 months. Conclusions: In this study, the mean ECD did not significantly decrease after PPV with fragmentation at 2 years after surgery. A PPV with fragmentation was an appropriate surgical procedure for patients with low cornea endothelial cell density.

토끼에서 3% 디쿠아포솔 점안 후에 나타나는 각막습윤성 및 눈물 내 Mucin-5AC 농도 변화

연동윤(Dong Yun Yeon),강보람(Bo Ram Kang),엄영섭(Young Sub Eom),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

목적: 토끼 눈에 3% diquafosol tetrasodium을 점안한 직후에 나타나는 눈물 내 MUC5AC 농도 변화와 각막 습윤성(corneal wetting property)의 변화를 평가해 보고자 하였다. 대상과 방법: 뉴질랜드 흰 토끼(New Zealand white rabbit) 6마리를 사용하여 우안에는 3% 디쿠아포솔, 좌안에는 생리식염수를 각각 50 μL씩 점안하고 15분 후에 전신 마취 상태에서 각막습윤성과 눈물 내 MUC5AC 농도, 결막 압흔 세포검사를 통하여 periodic acid-Schiff (PAS) 염색된 결막 술잔세포의 면적을 측정하였다. 각막 습윤성 평가는 눈을 한 번 감겼다가 벌린 후 각막에 맺힌 현미경조명 모양이 서서히 번져 보이기 시작할 때까지의 시간을 측정하였다. 결과: 각막 습윤성 평가는 디쿠아포솔 그룹에서 평균 86.40 (±17.90)초, 대조군에서 평균 49.00 (±6.35)초였으며, 두 그룹 간 유의한 차이를 보였다(p=0.043). 눈물 내 MUC5AC 농도는 디쿠아포솔 그룹에서 평균 18.21 (±1.52) ng/mL로 대조군의 평균 12.75 (±1.82)ng/mL에 비해 유의하게 높았다(p=0.028). 결막 압흔 세포검사에서 PAS 염색된 결막 술잔세포의 면적을 전체면적에 대비해 평가하였을 때 3% 디쿠아포솔을 점안하고 15분 후에는 평균 23.17 (±0.05)%로 생리식염수를 점안한 대조군의 평균 32.50 (±0.08)%에 비해 유의하게 감소한 소견을 보였다(p=0.028). 결론: 생리식염수와 비교하였을 때 3% 디쿠아포솔은 점안 후 즉각적으로 각막 습윤성을 향상시켰으며 결막의 술잔세포에서 분비되는 눈물 내 MUC5AC의 농도 증가를 보였다. Purpose: To evaluate the immediate effects of 3% diquafosol ophthalmic solution on tear MUC5AC concentration and corneal wetting property in rabbit eyes. Methods: Six New Zealand white rabbits were used in the present study. Fifteen minutes after instilling 50 μL of 3% diquafosol into the right eye of each rabbit and 50 μL of saline into the left eye, corneal wetting property, tear MUC5AC concentrations and the area of periodic acid-Schiff (PAS)-stained conjunctival goblet cells were evaluated under general anesthesia using conjunctival impression cytology. Corneal wetting property was evaluated by measuring the duration from when the image of the microscopic light beam was clear on the corneal surface immediately after blinking to when the image began to blur. Results: The mean time of corneal wetting property was 86.40 (± 17.90) seconds in the diquafosol group and 49.00 (± 6.35) seconds in the control group. There was a significant difference between the two groups (p = 0.043). The mean concentration of tear MUC5AC was significantly higher in the diquafosol group (18.21 ± 1.52 ng/mL) than the control group (12.75 ± 1.82 ng/mL; p = 0.028). Conjunctival impression cytology showed the area of PAS-stained conjunctival goblet cells was significantly lower in the diquafosol group (23.17 ± 0.05%) than the control group (32.49 ± 0.08%; p = 0.028). Conclusions: Immediately after instilling 3% diquafosol, corneal wetting property improved significantly. Also tear MUC5AC concentration, which was released from conjunctival goblet cells increased compared to saline.