건성안을 동반한 갑상샘안병증에서 0.05% 사이클로스포린 A 점안액 사용 후 눈물막과 안구표면의 변화

목적: 건성안을 동반한 갑상샘안병증 환자에서 0.1% 히알루론산나트륨과 0.05% 사이클로스포린 A 점안액 병합사용 후 눈물막과 안구표면의 변화에 대하여 알아보고자 하였다. 대상과 방법: 0.1% 히알루론산나트륨만 사용한 18명 36안을 1군, 0.05% 사이클로스포린 A 점안액을 동시에 사용한 18명 36안을 2군으로 나누어 사용 전과 사용 후 1, 3, 6개월에 각각 눈물막파괴시간, 기본눈물분비, 눈물청소율, 각막상피병증과 각막감각을 측정하고, 점안액 사용 전과 사용 후 3개월 째 인상세포 검사 및 눈물 내 CXCL (Chemokine (C-X-C motif) ligand) 11 농도를 측정하여 비교하였다. 결과: 1군에서는 눈물막파괴시간, 기본눈물분비, 눈물청소율, 각상피병증과 각막감각이 6개월째 호전되었으며(p＜0.05), 2군에서는 3개월째 호전되었다(p＜0.05). 편평상피화생, 술잔세포밀도와 CXCL11 농도는 1군에서는 3개월째 차이가 없었으나, 2군에서는 3개월째 호전되었다(p＜0.05). 결론: 건성안을 동반한 갑상샘안병증 환자에서 0.1% 히알루론산나트륨과 0.05% 사이클로스포린 A의 점안액의 병합 사용은 눈물막과 안구 표면 지표의 빠른 호전을 보이므로 효과적이라고 생각된다. Purpose: The present study was performed to evaluate the changes in tear film and ocular surface parameters after using sodium hyaluronate (SH) 0.1% alone or in combination with cyclosporine A (CsA) 0.05% in patients with thyroid-associated ophthalmopathy accompanied by dry eye. Methods: A total of 72 eyes from 36 patients were divided into two groups; 36 eyes of 18 patients were treated with 0.1% SH alone (group 1), and 36 eyes of 18 patients were treated with SH 0.1% and CsA 0.05% (group 2). Tear break-up time (BUT), basal tear secretion test (BST), tear clearance rate (TCR), fluorescein staining (FS) and corneal sensitivity test (CST) were evaluated at pre-treatment and one, three and six months post-treatment. Conjunctival impression cytology was performed and tear CXCL11 (Chemokine (C-X-C motif) ligand) levels were measured pre-treatment and three months post-treatment. Results: BUT, BST, TCR, KEP and CST were significantly improved at six months in group 1 (p < 0.05) and at three months in group 2 (p < 0.05). The degree of conjunctival squamous cell metaplasia, goblet cell density and tear CXCL11 levels were significantly changed at three months in group 2 (p < 0.05). However, there were no significant changes in group 1 after 3 months. Conclusions: Combined use of topical 0.1% SH and 0.05% CsA can result in early improvement in tear films and ocular surface parameters in patients with thyroid-associated ophthalmopathy accompanied by dry eye. J Korean Ophthalmol Soc 2010;51(10):1319-1326