눈물주머니코안연결술 전후 각막형태검사기의 눈물막 스캔과 Munk 점수의 연관성 = Associations between the Munk Score and Tear Film Scan Revealed by Corneal Topography after Dacryocystorhinostomy

다국어 초록 (Multilingual Abstract)

Purpose: We evaluated changes in the tear film parameters of the corneal surface, and their correlations with Munk scores, based on corneal topographic scans of patients with nasolacrimal duct obstructions who underwent dacryocystorhinostomy (DCR). We explored whether tear parameters can serve as useful indicators of functional surgical success.
Methods: We assessed 72 eyes of 45 patients diagnosed with nasolacrimal duct obstruction who underwent DCR. Tear film parameters were measured via corneal topography (Keratograph® 5M) once before, and three times after surgery, and included tear meniscus height (TMH), and the initial and average keratographic tear break-up time (NIKBUT-first and NIKBUT-average, respectively; measured noninvasively).
Results: The three postoperative TMH values were 0.31 ± 0.20, 0.30 ± 0.22, and 0.29 ± 0.15 mm, all of which were significantly lower than the preoperative value of 0.48 ± 0.29 mm (all, p < 0.001). Three months after surgery, the NIKBUT-first (6.90 ± 3.39 seconds) was significantly shorter than the preoperative value (8.39 ± 5.34 seconds; p = 0.030). The preoperative NIKBUT-average did not differ significantly from the values at the three postoperative timepoints (p = 0.756, p = 0.753, and p > 0.999).
Changes in the Munk score after surgery correlated significantly with changes in the TMH (r = 0.46, p < 0.001). When functional success was defined as a Munk score ≤ 1, the area under the curve (AUC) value corresponding to the ability of TMH to define functional success of 0.995, was statistically significant (cut-off of 0.31 mm; p < 0.001).
Conclusions: The TMH DCR correlated significantly with the Munk score, which is a quantitative measure of clinical symptom severity. The ability of TMH to define functional surgical success was excellent.

국문 초록 (Abstract)

목적: 눈물주머니코안연결술을 시행한 코눈물관막힘 환자에서 각막형태검사기의 눈물막 스캔을 이용하여, 수술 전후 각막표면상의 눈물막 지표들을 계측하여 변화를 살펴보고, Munk 점수와의 관련성을 알아보며, 수술의 기능적 성공을 평가하는 지표로 유용한지 확인하였다.
대상과 방법: 코눈물관막힘으로 진단받고 눈물주머니코안연결술을 시행한 환자 45명 72안을 대상으로 하였다. 수술 전 1회, 수술 후 3회에 걸쳐 각막형태검사기 Keratograph® 5M의 tear film (TF)-스캔을 이용하여 눈물막지표를 검사하였다. 눈물띠 높이, 첫 눈물막파괴시간, 평균 눈물막파괴시간의 수술 전후 차이를 비교하였고, Munk 점수와 TF-스캔 지표들과 상관관계를 확인하였으며, 기능적 성공에 대한 TF-스캔 지표들의 판별력을 조사하였다.
결과: 눈물띠 높이는 수술 전 측정값(0.48 ± 0.29 mm)에 비해 수술 후 3회에 걸쳐 측정한 값(0.31 ± 0.20 mm, 0.30 ± 0.22 mm, 0.29 ± 0.15 mm)이 각각 유의하게 낮았다(p<0.001, p<0.001, p<0.001). 첫 눈물막파괴시간은 수술 전(8.39 ± 5.34초)에 비해 수술 후 3개월(6.90 ± 3.39초)에만 유의하게 짧아졌다(p=0.030). 평균 눈물막파괴시간은 수술 전에 비해 수술 후 3회에 걸쳐 측정한 값이 모두 유의한 차이를 보이지 않았다(p=0.756, p=0.753, p>0.999). 수술 전후 Munk 점수의 변화량과 눈물띠 높이의 변화량은 유의한 상관관계를 보였다(r=0.46, p<0.001). 수술의 기능적 성공을 Munk 점수 1점 이하로 정의하였을 때, 기능적 성공에 대한 눈물띠 높이(임계값: 0.31mm)의 판별력은 AUC 0.995였으며 통계적으로 유의하였다(p<0.001).
결론: 눈물주머니코안연결술 시행 전후 측정한 TF-스캔 지표인 눈물띠 높이와 Munk 점수와의 상관 관계를 통해 눈물흘림 증상의 호전을 정량적으로 표현 가능함을 확인하였다. 또한 수술의 기능적 성공을 눈물띠 높이로 평가 시 판별력이 우수함을 확인하였다.

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