알고있는 양과 농도의 fluorescein을 점안하고 일정시간이 지난 후 누액의 새로운 분비와 배출등에 의해 제거되어진 fluorescein의 양과 농도를 측정하여 누액 청소율 (tear clearance)을 측정하는 검사가 Pflugfelder와 Tseng에 의하여 발표되었으나 측정시간에 길어, 저자들은 이 방법을 변형하여 그 유용성을 알아보고자 정상인 60안과, 본태성 안검경련환자 36안 및 반측안면경련환자 32안을 대상으로 fluorescein clearance test(FCT 1; 점안마취하에 0.25%, 20㎕, ) fluorescein을 점안하고 10분후에 Schirmer 용지로 1분간 측정, FCT 2; FCT 1 시행 10분후 비강자극하에 Schirmer 용지로 1분측정)를 실시하였다. 묻어나온 fluorescein의 길이를 측정하고, fluorescein의 농도를 cobalt blue light하에 사진 촬영하여 색의 짙은 정도에 따라 5단계로 나누어 판정하였다. 1명의 검사자가 2회이상 판정했을때 Intra-observer간에 일치도는 k=0.84이고, Intra-observer 일치도는 k=0.77로 높은 일치도(k＞0.75)를 보였다. 또한 안구건조증이 흔히 동반되는 것으로 알려진 본태성 안검경련환자군에서는 정상인에 비해 FCT 결과에서 짧은 fluorescein측정길이 (p＜0.001)를 보여 basal secretion의 감소를 보였으며 높은 fluorescein농도(p＜0.001)를 보여 지연된 청소율을 보였다. 따라서 농도판정에 있어서의 높은 재현성과 안구 건조증이 동반된 경우에 지연된 누액청소율을 보이는 fluorescein clearance test는 누액순환장애의 진단에 있어 유용한 검사방법으로 생각된다(한안지 37:393~399, 1996).
On the proposed fluorescein clearance test by Pflugfelder & Tseng, measurements of volume and concentration of instilled fluorescein, being changed by tear secretion, pumping action, during confined time, are able to discern tear turnover rate(tear clearance). We performed TBUT, Schirmer test and modified FCT to the 60 eyes of healthy person, to the 3 eyes of essential blepharospasm patient, and to the 32 eyes of hemifacial spasm patients. We modified the FCT to economize time. Under the topical anesthesia with 0.5% propacaine, test was perfomed after instilling a 20㎕ of Flucaine (0.25% fluorescein sodium, and 0.5% propacaine) into the conjunctival sac and standard Scirmer strip was then placed for another 10 minutes. The length of the portion was measured and the concentration of tint fluorescein was graded into 5 degree (photodocumented classification under the cobalt blue light) (FCT 1). Waiting 10 minutes, a standard Schirmer strip was placed into with nasal stimulation and length and concentration was also measured (FCT2). The agreement of classification was determined with Kappa values for evaluation for reproducibility and and reliability of FCT. The intra-observer agreement (examination repeated twice) was k=0.84 and the intra-observer agreement(two observers` examination) was k=0.77, which revealed a consistent result. Patients with blepharospasm was indicated decreased basal secretion compared with normal control (p＜0.001) and also showed delayed tear clearance whith represented significant increased concentration (p＜0.001). We concluded that FCT was revealed high reproducibility by intra-observer and inter-observer agreement and test may be useful diagnostic method to evaluate delayed tear clearance (J Korean Ophthalmol Soc 37:393~399, 1996).
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