각막 굴절교정수술 전후 각막미란 및 안구건조증에 대한 변화양상을 비교하기 위해 정량적 검사지표와 Diagnostic corneal surface digital photography를 이용한 Oxford corneal stain grading scheme을 사용하여 이들 검사지표의 변화와 유용성을 분석하고, LASIK 과 LASEK 시술군의 차이를 비교하고자 하였다. 굴절교정수술을 위해 내원한 환자 134명 (267안)을 대상으로 한 명의 술자가 LASIK(110안)과 LASEK(157안)을 시행하였고, 수술 방법에 따라 두 군으로 나누어, 술 전과 술 후 7일, 1개월, 3개월 및 6개월에 각각 Tear break-up time(TBUT), Fluorescein stained corneal surface digital photography를 시행하였고, 또한 술 전과 술 후 1개월 3개월에 Schirmer test를 시행하여, 술 후 각막미란 및 안구건조증 검사지표의 변화양상을 관찰하였다. Digital photography 에서 Corneal staining은 Oxford scheme을 이용하여 하였다. 안구건조증에 대한 정량적 검사 지표는 두 군 모두 수술 초기에 건조증이 심하였다가 시간이 경과할수록 회복되는 양상을 보였다. TBUT와 Schirmer test는 추적 관찰기간 내내 술전 보다 낮았고(p

The purpose of this study is to assess the clinical applicability of Oxford corneal stain grading using diagnostic corneal surface digital photography in corneal erosion and dry eye syndrome after corneal refractive surgery. Two hundred and sixty seven eyes of 134 patients were enrolled in this study. LASIK was performed in 110 eyes and LASEK was performed in 157 eyes. All the surgery was done by a single surgeon. Tear beak-up time(TBUT) and fluorescein stained corneal surface digital photography were performed preoperatively and on postoperative day 7, 1 month, 3 months, and 6 months. Schirmer test was performed preoperatively and on postoperative 1 month and 3 months in order to evaluate the clinical aspects of dry eye syndrome. Dry eye syndrome which was assessed using TBUT and Schirmer test, was aggravated at early postoperative period but improved after time in both LASIK and LASEK group. Postoperative TBUT and Schirmer test were significantly lower than that of the preoperative in all follow-up periods(p < 0.05) and LASIK group showed significantly lower postoperative TBUT and Schirmer test values than LASEK group(p < 0.05). Fluorescein staining grading showed aggravating corneal erosion until the postoperative 3 months but showed improvement to the preoperative level at postoperative 6 months. Although the LASEK group had more corneal erosion until postoperative day 7, the LASIK group had more corneal erosion on postoperative 1 month and afterwards. In conclusion, the corneal surface digital photography using fluorescein staining grading is an effective and objective method in assessing the corneal erosion and dry eye syndrome since it can show directly the true morphologic corneal damage and reflect the severity of the disease. Moreover, it showed that LASIK could induce more severe corneal erosion and dry eye syndrome than LASEK.

• 김유진(삼성병원 안과) | Yoo-Jin Kim
• 두하영(전북과학대학 안경광학과) | Ha-Young Doo
• 마기중(을지대학교 보건대학원) | Ki-Choong Mah