건성안 환자에서 빛간섭단층촬영을 이용한 눈물띠 분석

Tear Meniscus Evaluation Using Optical Coherence Tomography in Dry Eye Patients

목적: 눈물생성부족 건성안에서 푸리에도메인 빛간섭단층촬영(Fourier-domain OCT, FD-OCT)을 이용한 눈물띠 분석을 시행하여 쉬르머검사, 눈물막 파괴시간 및 플루오레신 각막염색과의 상관관계를 알아보고 임상적 유용성을 확인하고자 하였다. 대상과 방법: 눈물생성부족 건성안 79안과 정상 대조군 50안에서 FD-OCT를 이용하여 눈물띠의 높이(tear meniscus height, TMH),깊이(tear meniscus depth, TMD), 넓이(tear meniscus area, TMA)를 측정하고, 쉬르머검사, 눈물막 파괴시간, 플루오레신 각막염색을 시행하여 각 검사 간 상관관계를 비교 분석하고, area under the receiver operating characteristic curve (AUROC)를 평가하였다. 결과: 눈물띠 변수들은 눈물생성부족 건성안에서 정상 대조군에 비해 모두 유의하게 감소되었다(p＜0.05). 눈물생성부족 건성안에서 TMH, TMD, TMA는 쉬르머검사 및 눈물막 파괴시간과 양의 상관관계를 보였고(p＜0.05), TMH, TMD는 각막염색점수와 음의 상관관계를 보였다(p＜0.05). TMH, TMD, TMA의 AUROC는 각각 0.978, 0.788, 0.957로 TMH가 가장 넓었다. 결론: 눈물생성부족 건성안에서 FD-OCT로 측정한 눈물띠의 양은 정상 대조군에 비해 감소되어 있고 쉬르머검사, 눈물막 파괴시간및 플루오레신 각막염색점수와 상관관계를 나타내며 높은 진단력을 보여 눈물생성부족 건성안 환자의 진단 및 치료에 유용하게 사용될 것으로 기대한다.

Purpose: To evaluate the tear meniscus in aqueous tear-deficient dry eye patients using Fourier-domain optical coherence tomography(FD-OCT) and to investigate the clinical usefulness of tear meniscus values. Methods: The present study included 79 aqueous tear-deficient dry eyes and 50 normal eyes. Tear meniscus height(TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were imaged using FD-OCT and measured with computer calipers. Schirmer’s test, tear break-up time, and corneal fluorescein staining were also performed and the correlations between the tests were analyzed. Additionally, the diagnostic power of tear meniscus values was compared using area under the receiver operating characteristic curve (AUROC). Results: Tear meniscus values were significantly decreased in the aqueous tear-deficient dry eye group (p < 0.05). TMH, TMD,and TMA were positively correlated with Schirmer’s test and tear break-up time (p < 0.05), and TMH and TMD were negatively correlated with corneal fluorescein staining in the aqueous tear-deficient dry eye group (p < 0.05). The AUROCs of TMH, TMD,and TMA were 0.978, 0.788, and 0.957, respectively. Conclusions: Tear meniscus values measured using FD-OCT were significantly lower in aqueous tear-deficient dry eyes and were correlated with Schirmer’s test, tear break-up time, and corneal fluorescein staining. Tear meniscus measurements obtained using FD-OCT can be useful clinical parameters for the diagnosis and treatment of aqueous tear-deficient dry eye.