소아사시수술 후 무보존제 플루오로메토론 0.1% 점안액의 결막충혈과 각막독성에 대한 영향

Effects of Corneal Toxicity and Conjunctival Injection of Preservative-free 0.1% Fluorometholone after Pediatric Strabismus Surgery

목적: 사시수술 후 점안한 플루오로메토론 0.1%의 보존제 유무에 따라 술 후 결막충혈 및 각막독성의 정도를 비교하고자 하였다. 대상과 방법: 간헐외사시 수술을 시행한 환자를 대상으로 전향적 임상연구를 시행하였다. 대상자를 무작위 배정하여 항생제와 함께 보존제(1군) 또는 무보존제(2군) 플루오로메토론 0.1%를 하루 3번 점안하도록 하였다. 술 후 1주와 3주 결막충혈과 각막독성 정도를 Image J program으로 측정한 평균 픽셀 값과 Oxford stain score (OSS)를 평가하여 두 군 간의 결과를 비교하였다. 결과: 총 61명의 환자 중 1군(보존제군) 17명(34안), 2군(무보존제군) 20명(40안)이 최종적으로 포함되었다. 술 후 1주일 결막충혈 정도를 측정한 평균 픽셀 값은 1군이 31,732 ± 9,946, 2군이 38,347 ± 12,189였고, 술 후 3주에는 각각 10,150 ± 4,493, 11,836 ± 4,290 이었다. 3주 동안 감소한 결막충혈의 평균 픽셀 값은 각각 21,582 ± 8,716, 26,510 ± 11,153으로 2군의 충혈 감소량이 통계적으로 유의하게 많았다(p=0.040). 술 후 3주에 측정한 OSS는 두 군 간 유의한 차이는 보이지 않았으나 설문지로 조사한 술 후 불편감의 정도는 2군에서 통계적으로 유의하게 낮았다(p=0.001). 결론: 사시수술 후 무보존제 플루오로메토론 0.1% 점안액을 사용하였을 때 결막충혈 감소량이 유의하게 더 많았으며 술 후 불편감 또한 통계적으로 유의하게 낮았다. 따라서 사시수술 후 무보존제 스테로이드 점안액 사용이 술 후 충혈을 감소시키고 불편감을 줄이는데 보다 효과적일 것으로 생각된다. <대한안과학회지 2017;58(7):846-851>

Purpose: To compare the degrees of conjunctival injection and corneal toxicity between preservative and preservative-free topical 0.1% fluorometholone after strabismus surgery. Methods: A randomized, prospective clinical study was performed to compare the degrees of conjunctival injection and corneal toxicity between preservative and preservative-free topical 0.1% fluorometholone after strabismus surgery. Sixty-one patients with intermittent exotropia were included in this study. They were told to apply antibiotic eye drops (ED) and either preservative or preservative-free topical 0.1% fluorometholone (F1) three times a day. Measurements of the degrees of conjunctival injection and corneal toxicity were performed at postoperative 1 week and 3 weeks each. Results: Seventeen patients (34 eyes) were included in group 1 (preservative F1) and twenty patients (40 eyes) were included in group 2 (preservative-free F1). The average pixel value (measured via the Image J software) representing the degree of conjunctival injection was 31,732 ± 9,946 in group 1 and 38,347 ± 12,189 in group 2 at postoperative 1 week, while the average pixel value was 10,150 ± 4,493 in group 1 and 11,836 ± 4,290 in group 2 at postoperative 3 weeks. There was a significant difference between the decrease in pixel value for the two groups (p = 0.040). There was no significant difference in the mean value of the Oxford stain score between the two groups at postoperative 3 weeks, however the mean questionnaire scores in group 2 were significantly lower than in group 1 (p = 0.001). Conclusions: Preservative-free 0.1% fluorometholone ED demonstrated a larger decrease in the degree of conjunctival injection than for preservative ED after strabismus surgery. Therefore, the use of preservative-free steroid ED may be beneficial for decreasing both conjunctival injection and postoperative discomfort following strabismus surgery. J Korean Ophthalmol Soc 2017;58(7):846-851