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1 대한안과학회지 2015 년제 56 권제 7 호 J Korean Ophthalmol Soc 2015;56(7): ISSN (Print) ISSN (Online) Original Article 굴절교정레이저각막절제술후 0.1% 플루오로메토론점안액사용으로인한안압상승의빈도 The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy 김욱겸 조은영 김희선 김진국 Wook Kyum Kim, MD, Eun Young Cho, MD, Hee Sun Kim, MD, Jin Kuk Kim, MD 비앤빛강남밝은세상안과 B&Viit Eye Center, Seoul, Korea Purpose: To analyze the time and incidence of increased intraocular pressure (IOP) induced by 0.1% fluorometholone used to prevent corneal haze after photorefractive keratectomy (PRK). Methods: The present study included 826 patients (826 eyes) who underwent PRK between November 2012 and October 2013 and were followed up for more than 6 months. After surgery the patients were treated with 0.1% fluorometholone for 3-6 months according to their corneal conditions. The time and incidence was analyzed with the time and incidence when anti-glaucoma eye drops were used. Results: Anti-glaucoma eye drops were used in 312 eyes (38%). The anti-glaucoma eye drops were started before 4 weeks postoperatively in 105 eyes (13%) and postoperatively at 5-8 weeks in 86 eyes (10%), at 9-12 weeks in 83 eyes (10%), at weeks in 25 eyes (3%) and after 17 weeks in 13 eyes (2%). Conclusions: The overall incidence of increased IOP when treated with 0.1% fluorometholone for 3-6 months after PRK was approximately 38%. The incidence of increased IOP in each month for the first 3 months was almost identical implying that the longer 0.1 fluorometholone was used, the higher incidence of increased IOP occurred. These results can be helpful in educating patients regarding the risk of increased IOP and determining the follow-up period after PRK. J Korean Ophthalmol Soc 2015;56(7): Key Words: Fluorometholone, Intraocular pressure, LASEK, Photorefractive keratectomy, Steroid-induced glaucoma 굴절교정레이저각막절제술은근시및난시등을교정하는표면각막굴절교정수술방법으로그효과와안정성이 Received: Revised: Accepted: Address reprint requests to Jin Kuk Kim, MD B&Viit Eye Center, #3 Seocho-daero 77-gil, Seocho-gu, Seoul , Korea Tel: , Fax: bestjinkuk@gmail.com * This study was presented as an e-poster at the 113th Annual Meeting of the Korean Ophthalmological Society 입증되어널리행해지고있다. 특히라식후발생할수있는각막확장증등의합병증을피하고자하는경우, 건조증이심한경우, 고도근시나각막이얇은경우에서도비교적안전하게시행할수있는수술방법이다. 1,2 굴절교정레이저각막절제술후각막상피층의손상과기질세포의소실로인하여각막기질에치유과정이진행되면서수술부위각막에혼탁이발생할수있다. 각막혼탁은술후시력저하, 대비감도의감소, 눈부심, 달무리, 빛번짐등을유발할수있으므로이를예방, 치료하고자많은방법들이연구되고시도되고있는데술중에 Mitomycin C (MMC) 를사용하는것, 3,4 술후자외선차단을하도록하는 c2015 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 985

2 - 대한안과학회지 2015 년제 56 권제 7 호 - 것, 5 그리고술후항염증점안액을사용하는것등의방법을들수있다. 술후사용하는항염증점안액으로는비스테로이드성소염제점안액, 6 트라닐라스트 (0.5% tranilast, Krix R, JW pharmaceutical, Seoul, Korea) 와같은항히스타민점안액, 7 그리고스테로이드점안액이사용되고있으나, 스테로이드점안액이가장효과적인방법으로서많이사용되고있다. 4,8-10 스테로이드점안액은장기간사용시안압상승을유발하고이를발견하지못했을때는비가역적인시신경손상을유발할수있으므로사용시반드시정기적인안압검사가필요하다 굴절교정레이저각막절제술후에는안압상승의위험이가장낮은 0.1% 플루오로메토론점안액이가장많이사용되고있으며, 8 빈도는 12%, 23% 로보고되었다. 8,15-17 그러나지금까지의연구들은 2개월정도의비교적단기간스테로이드점안액을사용한경우에대한연구였다. 2,3,8,16,17 최근에는고도근시에서도굴절교정레이저각막절제술을자주시행하여, 4,18-20 장기간 0.1% 플루오로메토론을사용하는경우가많아졌으나, 장기간점안하였을때에발생하는안압상승빈도나시기에대한연구는아직까지없었다. 이에본연구는굴절교정레이저각막절제술을시행하고 0.1% 플루오로메토론을 3-6개월사용한경우에서안압상승의빈도와시기를알아보고자하였다. 특히본연구는외래에서많이사용하고있는비접촉안압계를이용한연구로서실제굴절교정레이저각막절제술을시행하고술후진료를하는환경에서그활용도가높을것으로생각한다. 대상과방법 본연구는 2012년 11월부터 2013년 10월까지 1년간본원에서알레그레토레이저 (Allegretto Wave Eye-Q Laser; Alcon, Irvine, CA, USA) 를사용하여굴절교정레이저각막절제술을받고 6개월이상경과관찰이가능했던환자 826 명의우안 (826안) 을대상으로하였다. 만 18세이상으로 1 년이상굴절값의변화가없고술전검사시각막두께와각막지형도상의각막모양을고려하여각막굴절교정술이가능한경우를대상으로하였다. 최대교정시력 0.6 이하의약시와각막표면염증성질환, 녹내장이있는경우, 원시로수술받은경우는제외하였으며, 0.1% 플루오로메토론외의스테로이드점안액을술후에사용한경우는제외하였다. 모든환자의술전병력, 술전후시력, 안압, 중심각막두께, 근시, 난시등굴절이상, 각막곡률, 중심각막절제량등을조사하였다. 안압은비접촉안압계 (NT-510; NIDEK, Tokyo, Japan) 로측정하였으며, 중심각막두께는초음파각 막두께검사계 (SP-3000; Tomey, Nagoya, Japan) 로측정하였다. 수술은 0.5% Proparacaine hydrochloride (Alcaine R, Alcon Laboratories Inc., Fort Worth, TX, USA) 를소독직전과직후, 수술직전에양안에각각 1번씩점안후시행하였다. 수술시광학부 (optical zone) 의크기는 6.3 mm 이상으로하였다. Amoil 브러쉬 (Amoils epithelial scrubber R, Innovative eximer solution Inc., Toronto, Canada) 를이용하여각막상피를제거한후알레그레토레이저를이용하여각막절제술을시행하였다. 그리고 0.02% MMC를면봉에묻혀절제부위에 10-20초간접촉시킨뒤차가운평형염류용액으로 20초간각막표면과결막낭을충분히세척하였다. 그후치료용콘택트렌즈를착용하고항생제안약을점안하였다. 수술당일부터 0.5% Levofloxacin (Cravit R, Santen pharmaceutical Co., Osaka, Japan) 을 3시간마다사용하였으며, 술후 3-5일째치료용콘택트렌즈를제거한후, 하루 4회 1 주간더사용하였다. 0.1% Fluorometholone (Ocumetholone R, Samil, Seoul, Korea) 은치료용콘택트렌즈를제거한후사용하였으며 1주간은 3시간마다사용하고, 그후 1달간하루 4번씩사용하였으며점차사용빈도를줄여술후 3-6 개월간사용하였다. 술후각막혼탁을예방, 치료하기위하여야외활동시자외선차단안경을술후 6개월간착용하도록하였고, 0.1% 플루오로메토론점안약을각막의회복정도에따라서 3-6 개월간사용하였다. 술후측정한비접촉안압계를사용하여측정한안압의평균값을각막절삭두께 100 µm 5.5 mmhg가감소한다는최근연구결과 21 에따라술후비접촉안압계에의한정상안압을예측하였으며, 이보다 mmhg 증가한경우에스테로이드점안액에의한안압상승으로판단하여안압하강제를추가하여사용하도록하였다. 안압이상승한환자의경우에는안압상승정도, 각막혼탁정도, 수술후기간등을고려하여 0.1% 플루오로메토론점안액의사용횟수를조절하고, 안압하강제를사용하면서정기적으로검사하여, 필요시안압약을변경하거나하나더추가하여정상안압을유지시켰다. 통계방법은수술후의안압하강제사용시기및빈도를기술통계로제시하였으며, 안압하강제가사용된군과그렇지않은군에서의술전인자및수술후 0.1% 플루오로메토론사용시기에차이가있는지를알아보기위하여 Student s t-test를사용하여분석하였다. SPSS 15.0 프로그램 (SPSS Inc., Chicago, IL, USA) 을이용하였으며 p값이 0.05 미만인경우를통계학적으로의미가있다고정의하였다. 986

3 - 김욱겸외 : 술후플루오로메토론안압상승빈도 - 결과 전체환자는 826명 826안이었으며나이는평균 28.6세, 그중남자는 251명여자는 575명이었다 (Table 1). 0.1% 플루오로메토론점안액사용중안압상승으로판단하여안압하강제를추가한환자는전체 826명중 312명 (38%) 이었으며, 이중 4주이내에추가한경우는 105명 (13%), 5-8주에추가한경우는 86명 (10%), 9-12주에추가한경우는 83명 (10%), 13-16주에추가한경우는 25명 (3%), 17주이후에추가된경우는 13명 (2%) 이었다 (Table 2, Fig. 1). 전체환자에서 0.1% 플루오로메토론을사용한기간은술후평균 18.2 ± 3.8주였으며, 안압하강제를추가한군에서는술후 19.2 ± 3.8주를사용하였고, 안압하강제를추가하지않은환자군에서는술후 17.7 ± 3.7주간사용하였으며통계적으로유의한차이는없었다 (Table 3). 술후안압약을사용한군과사용하지않은군의술전인자를비교해보면, 안압약을사용한군에서환자의술전근시량과난시 Percentage of patients (%) Accumulative percentage of patients (%) 량이더많았고술전안압이더높았으나모두통계적으로유의하지는않았다 (Table 3). 안압하강제의사용기간은평균 11주였으며, 스테로이드점안액에의해유발된안압상승을낮추고, 치료기간동안안압을높아지지않게하기위하여최소 2주에서최대 20 주이상사용하였다. 안압하강제를 2개월이내로사용한환자가 114명으로안압하강제를사용한환자 312명중 36% 였으며, 2개월이상안압하강제를사용한경우는 198명으로 63% 에해당되었다 (Table 4). 처음안압을낮추기위하여사용된안압하강제는단일제제인 timolol (0.5% Timoptic XE, MSD, Whitehouse Station, NJ, USA) 이 108명 (35%), 복합제제인 brinzolamide 1% 와 timolol 0.5% 복합제제 (Elazop, Alcon Laboratories Inc., Fort Worth, TX, USA) 나 dorsolamide/timolol 복합제제 (Cosopt, MSD) 를사용한경우가 202명 (64%), 복합제제와함께 Brimonidine 0.15% (Alphagan P eye drops 0.15% Brimonidine tartrate, Allergan, Irvine, CA, USA) 를사용한경우가 2명 (1%) 이었다. Timolol을사용하다가복합제제로변경한경우가 26명 (8%) 이었으며, 복합제제를사용하다가단일제제로변경한경우는 1명이었고복합제제사용중에 Brimonidine 0.15% 를추가하여두안압하강제를사용한경우는 5명 (2%) 이었다 (Table 5). 고 찰 Figure 1. The graph shows the time when the patients started to use anti glaucoma medication during 0.1% fluorometholone treatment after photorefractive keratectomy. 굴절교정레이저각막절제술후스테로이드점안액사용으로인한안압상승의빈도나시기에대한연구가지금까지많지않았으며, 이는각막굴절수술후얇아진각막으로 Table 1. General characteristics of 826 eyes of 826 patients who received photorefractive keratectomy Characteristics Values Age at operation (years) 28.6 ± 5.0 Male:female (No. of patients) 251:575 Preoperative myopia (diopters) ± 1.81 Preoperative astigmatism (diopters) ± 0.76 Preoperative BCVA (log MAR) ± 0.04 Preoperative IOP (mm Hg) ± 2.70 Preoperative central cornea thickness (μm) ± 29.2 Postoperative UCVA (log MAR) ± 0.03 Postoperative IOP (mm Hg) 10.4 ± 2.0 Values are presented as mean ± SD. BCVA = best corrected visual acuity; IOP = intraocular pressure; UCVA = uncorrected visual acuity. Table 2. The analysis of the time when the anti-glaucoma medication started to use for lowering intraocular pressure Time - 4 weeks 5-8 weeks 9-12 weeks weeks weeks weeks Total Number of patients 105 (13) 86 (10) 83 (10) 25 (3) 10 (1) 3 (0) 312 (38) Accumulative number of patients 105 (13) 191 (23) 274 (33) 299 (36) 309 (37) 312 (38) 312 (38) The increased intraocular pressure was induced by 0.1% fluorometholone after photorefractive keratectomy. Values are presented as n (%). 987

4 - 대한안과학회지 2015 년제 56 권제 7 호 - Table 3. The comparison of IOP increased group and IOP normal group after LASEK IOP increased (312 eyes) IOP normal (514 eyes) p-value * Age at operation (years) 28.1 ± ± Preoperative myopia (diopters) ± ± Preoperative astigmatism (diopters) ± ± Ablation depth (μm) 81.2 ± ± Preoperative central cornea thickness (μm) ± ± Residual corneal thickness (μm) ± ± Preoperative IOP (mm Hg) 15.2 ± ± Preoperative pupil size (mm) 6.7 ± ± Preoperative white to white (mm) 11.7 ± ± Preoperative visual acuity (log MAR) ± ± Postoperative visual acuity (log MAR) ± ± Duration of usage of fluorometholone (weeks) 19.2 ± ± The patients in IOP increased group need to use anti glaucoma eye drops to lowering IOP. Values are presented as mean ± SD. IOP = intraocular pressure; LASEK = laser-assisted sub-epithelial keratectomy. * Student s t-test was done. Table 4. The analysis of durations for while the anti-glaucoma medication was used to lower the intraocular pressure elevated by 0.1% fluorometholone - 4 weeks 5-8 weeks 9-12 weeks weeks weeks >21 weeks Total No. of patients 41 (13) 73 (23) 89 (29) 75 (24) 30 (10) 4 (1) 312 (100) Values are presented as n (%). Table 5. The analysis about which anti-glaucoma eye drops were used initially and to which the initial eye drops changed if it happened Anti-glaucoma eye drops Number of patients Timolol 0.5% only 82 (26) DTFC/BTFC * only 196 (63) Timolol 0.5% DTFC/BTFC 26 (8) DTFC/BTFC DTFC/BTFC + Brimonidine 0.15% 5 (2) DTFC/BTFC + Brimonidine 0.15% DTFC/BTFC or Brimonidine 0.15% 2 (1) DTFC/BTFC Timoptic XE 1 (0) Values are presented as n (%). DTFC = dorzolamide-timolol fixed combination; BTFC = brinzolamide-timolol fixed combination. One of DTFC or BTFC; means initial anti-glaucoma eye drops changed during treatment. 측정된안압을정확히보정하는방법에대한연구가부족하여술후안압상승을판단하는것이어려웠기때문이라고생각된다. 8,16,17 특히비접촉안압계는골드만안압계에비하여부정확하다는인식때문에이를이용한연구들이적었다. 본연구는최근에발표된굴절교정레이저각막절제술후안압의저평가정도에관한연구 21 를토대로술후비접촉안압계로측정한안압을수술량으로보정하고이를술전안압과비교하여안압이상승하였는지를판단하였다. 굴절교정레이저각막절제술후스테로이드점안액사용으로인한안압상승에대한연구로서 0.1% Dexamethasone 과 0.1% 플루오로메토론을비교하여안압상승이각각 36%, 12.4% 였음을보고한연구 8 가있었으며, 본연구에서는 0.1% 플루오로메토론에의한안압상승빈도가 38% 로비교적높게나타났다. 이는기존보고들에서스테로이드점안 액의사용기간이 2개월정도로짧았던것과, 2,3,8,16,17 안압상승으로판단하는기준이연구자에따라서차이가나기때문으로생각된다. 안압상승이발생한시기에대해서도기존의연구들은술후 1개월전후에대부분안압상승이발생했다고보고했지만, 본연구는술후 3개월까지안압상승의발생빈도가매달비슷한것으로나타났다. 8,16,17 이러한결과의차이도기존연구에서는스테로이드점안액의사용기간이짧아서장기적안압상승에대한충분한연구가될수없었다고생각된다. 본연구는술후 3-6개월간 0.1% 플루오로메토론점안액을사용할경우매달약 10% 정도의환자에서안압상승이발생하였음을보여주며, 이는안압상승빈도는스테로이드점안액의사용기간에비례하여증가함을보여주는것이라고생각된다. 굴절교정레이저각막절제술후각막혼탁을예방하는방 988

5 - 김욱겸외 : 술후플루오로메토론안압상승빈도 - 법으로자외선차단 4,5 과술중 MMC 사용이알려져있으며, 3,4 본연구의대상이된모든환자에서도술후각막혼탁예방및 0.1% 플루오로메토론의사용기간을줄이기위하여, 술후 6개월동안야외활동시선글라스나자외선차단코팅이된보안경을착용하도록하였으며, 술중에는 0.02% MMC를약 20초간사용하였다. 안압하강제를사용한군에서사용하지않은군에비하여 0.1% 플루오로메토론의사용기간이더길게나타났다. 이는안압상승으로 0.1% 플루오로메토론의사용횟수를줄여서사용하였기때문에효과적인각막혼탁치료가지연되어더장기적으로 0.1% 플루오로메토론을점안하였기때문으로생각된다. 본연구에서는오직 0.1% 플루오로메토론만을술후항염증제로사용하였으나, 안압상승유발빈도가적다고알려진로테맥스점안액 (Lotemax Eye Drops, 0.5% loteprednol etabonate ophthalmic suspension, Bausch & Lomb Inc., Rochester, NY, USA) 25 이나, 안압상승을전혀유발하지않는항알러지점안액 7 을술후 0.1% 오큐메토론과병행하여사용하는것이각막혼탁의치료에효과가있는지에대해서는추가적인연구가필요하다. 최근에는고도근시에서도굴절교정레이저각막절제술의안정성과효과가입증되어 4,18 고도근시에서도굴절교정레이저각막절제술이많이시행되고환자들의술후시력의질에대한기대치상승으로인하여술후 0.1% 플루오로메토론을장기간사용하는것이필요하게되었다. 이에따라술후각막혼탁을예방하는방법과스테로이드점안액의안압상승빈도등에대한관심이높아지고있다. 2,20 스테로이드소염제는장기간사용시안압상승을유발할수있고상승된안압을발견하지못하면시신경손상을초래할수있다. 굴절교정레이저각막절제술후 0.1% 플루오로메토론을 9개월간사용한환자에서말기녹내장으로진단되어섬유주절제술을시행한예가보고된적이있었다. 12 굴절교정레이저각막절제술후 0.1% 플루오로메토론을점안하는동안에는정기적안압검사가반드시필요하며, 특히장기적으로사용하는경우는더욱그렇다 술후안압상승의위험이있으므로정기적인안압검사가필요함을환자에게잘교육하는것도순응도를높이는데도움이될것으로생각된다. 또한내원시측정한안압을보정하여안압상승여부를조기에판단하여늦지않게안압하강제를추가하여안압을조절하는것이중요하다. 조기에안압상승을발견하기위해서는술후보정한정상안압을결정하는것이가장중요한데, 최근에발표된각막굴절수술후비접촉안압계를이용한술후안압의저평가정도에관한보고는술후비접촉안압계로측정한안압이술전에비하여상승한것인지를판단하는데좋은근거가될수있을것으 로생각된다. 21 본연구에서는안압하강제를시작하면서 0.1% 플루오로메토론을중단한경우가 5안이었으며, 나머지의경우는안압하강제를사용하면서 0.1% 플루오로메토론을사용하는횟수를줄여서계속사용하였으며, 모든경우에각막을충분히회복시켰다. 안압약은약 25% 에서는 timolol만으로안압이잘유지되었으며, 8% 에서는복합안압하강제로변경하여안압을정상범위로유지하였다 본연구에서 0.1% 플루오로메토론으로인한안압상승은 38% 에서나타났으며, 이는기존연구결과들보다높은수치이다. 0.1% 플루오로메토론을장기간사용한환자에서비접촉안압계를이용한첫연구로서안압의일중변동이나연중변동을고려하지못한점, 비접촉안압계로측정한안압의정확성등의한계점이있으므로 38% 의결과가과평가된것인지에대해서는추가적인연구들에의해서뒷받침되어야할것이다. 또한본연구는안압상승의빈도를알아보고자안압상승으로판단되면안압하강제를추가하였으나, 실제임상에서는안압상승이녹내장성시신경손상의위험인자이긴하지만치료자에따라서약제사용의기준은다를수있으므로안압하강제의사용빈도는본연구결과와는차이가있을것으로생각된다. 본연구는굴절교정레이저각막절제술후 0.1% 플루오로메토론점안액을 3-6개월간장기적으로사용한경우에 3개월간매달안압상승이약 10% 씩발생하여전기간동안약 38% 의환자에서스테로이드점안액으로인한안압상승이발생하였음을보여준다. 이러한결과를바탕으로술후정기적검사로조기에안압상승을발견하여적절하게치료하는것이술후안압상승으로인한합병증을최소화할수있는방법으로생각된다. REFERENCES 1) O'Brart DP, Shalchi Z, McDonald RJ, et al. Twenty-year follow-up of a randomized prospective clinical trial of excimer laser photorefractive keratectomy. Am J Ophthalmol 2014;158: ) Yuksel N, Bilgihan K, Hondur AM, et al. Long term results of Epi-LASIK and LASEK for myopia. Cont Lens Anterior Eye 2014;37: ) Sia RK, Ryan DS, Edwards JD, et al. The U.S. army surface ablation study: comparison of PRK, MMC-PRK, and LASEK in moderate to high myopia. J Refract Surg 2014;30: ) Hofmeister EM, Bishop FM, Kaupp SE, Schallhorn SC. Randomized dose-response analysis of mitomycin-c to prevent haze after photorefractive keratectomy for high myopia. J Cataract Refract Surg 2013;39: ) Corbett MC, O'Brart DP, Warburton FG, Marshall J. Biologic and environmental risk factors for regression after photorefractive keratectomy. Ophthalmology 1996;103:

6 - 대한안과학회지 2015 년제 56 권제 7 호 - 6) Baek SH, Choi SY, Chang JH, et al. Short-term effects of flurbiprofen and diclofenac on refractive outcome and corneal haze after photorefractive keratectomy. J Cataract Refract Surg 1997;23: ) Kim SI, Oh TH. Effects of topical tranilast on corneal haze with the Pentacam(R) after photorefractive keratectomy. J Korean Ophthalmol Soc 2014;55: ) Deng Y, Wnag L, Liu C, Cai R. Effects of Dexamethasone, Fluorometholone and Florex on intraocular pressure after photorefractive keratectomy. Hua Xi Yi Ke Da Xue Xue Bao 1999;30: ) Vetrugno M, Quaranta GM, Maino A, Cardia L. A randomized, comparative study of fluorometholone 0.2% and fluorometholone 0.1% acetate after photorefractive keratectomy. Eur J Ophthalmol 2000;10: ) Machat JJ. Double-blind corticosteroid trial in identical twins following photorefractive keratectomy. Refract Corneal Surg 1993;9(2 Suppl):S ) Levy Y, Hefetz L, Zadok D, et al. Refractory intraocular pressure increase after photorefractive keratectomy. J Cataract Refract Surg 1997;23: ) Yamaguchi T, Murat D, Kimura I, et al. Diagnosis of steroid-induced glaucoma after photorefractive keratectomy. J Refract Surg 2008;24: ) Morales J, Good D. Permanent glaucomatous visual loss after photorefractive keratectomy. J Cataract Refract Surg 1998;24: ) Razeghinejad MR, Katz LJ. Steroid-induced iatrogenic glaucoma. Ophthalmic Res 2012;47: ) Morrison E, Archer DB. Effect of fluorometholone (FML) on the intraocular pressure of corticosteroid responders. Br J Ophthalmol 1984;68: ) Javadi MA, Mirbabaei-Ghafghazi F, Mirzade M, et al. Steroid in duced ocular hypertension following myopic photorefractive keratectomy. J Ophthalmic Vis Res 2008;3: ) Lee KM, Kim MK, Wee WR, Lee JH. Risk factors of the steroid induced ocular hypertension after corneal refractive surgery. J Korean Ophthalmol Soc 2010;51: ) Hashemi H, Miraftab M, Asgari S. Comparison of the visual outcomes between PRK-MMC and phakic IOL implantation in high myopic patients. Eye (Lond) 2014;28, ) Kang H, Choe CM, Choi TH, Kim SK. Comparison of clinical results between transepithelial photorefractive keratectomy and brush photorefractive keratectomy. J Korean Ophthalmol Soc 2014;55: ) Kuo IC, Lee SM, Hwang DG. Late-onset corneal haze and myopic regression after photorefractive keratectomy (PRK). Cornea 2004;23: ) Kim WK, Cho EY, Kim HS, et al. Analysis of postoperative intraocular pressure underestimation measured with non contact tonometry after corneal refractive surgery. J Korean Ophthalmol Soc 2014;55: ) Nagy ZZ, Szabó A, Krueger RR, Süveges I. Treatment of intraocular pressure elevation after photorefractive keratectomy. J Cataract Refract Surg 2001;27: ) Park HS, Choi CY, Bae JH, Kim JM. The effect of fixed combination of brinzolamide 1% and timolol 0.5% in normal-tension glaucoma. J Korean Ophthalmol Soc 2014;55: ) Jang SR, Lee MV, Ahn JH. Comparison of dorzolamide-timolol fixed combination and latanoprost, effects on intraocular pressure and ocular pulse amplitude. J Korean Ophthalmol Soc 2014;55: ) Pleyer U, Ursell PG, Rama P. Intraocular pressure effects of common topical steroids for post-cataract inflammation: are they all the same? Ophthalmol Ther 2013;2:

7 - 김욱겸외 : 술후플루오로메토론안압상승빈도 - = 국문초록 = 굴절교정레이저각막절제술후 0.1% 플루오로메토론점안액사용으로인한안압상승의빈도 목적 : 굴절교정레이저각막절제술 (Photorefractive Keratectomy) 후각막혼탁을예방하기위해사용한 0.1% 플루오로메토론 (Fluorometholone) 점안액으로인한안압상승의빈도와시기를알아보고자하였다. 대상과방법 : 2012 년 11 월부터 2013 년 10 월까지 1 년간본원에서굴절교정레이저각막절제술을시행받고 6 개월이상경과관찰이가능했던환자 826 명 (826 안 ) 을대상으로하였다. 수술후 0.1% 플루오로메토론점안액을수술후각막상태에따라 3-6 개월사용하였으며, 이로인한안압상승의빈도와그시기를안압하강제를추가한빈도와시기를이용하여분석하였다. 결과 : 굴절교정레이저각막절제술후안압상승으로판단되어안압하강제를사용한환자는모두 312 안 (38%) 이었으며, 안압하강제를시작한시기는술후 4 주이내에 105 안 (13%), 5-8 주에 86 안 (10%), 9-12 주에 83 안 (10%), 주에 25 안 (3%), 17 주이후에 13 안 (2%) 이었다. 결론 : 굴절교정레이저각막절제술후 0.1% 플루오로메토론을 3-6 개월점안한경우에안압상승이약 38% 에서발생하였으며, 술후 3 개월까지매달비슷한빈도로발생하였다. 이는술후 0.1% 플루오로메토론의점안기간이길어질수록안압상승의빈도가증가함을의미한다. 본연구의결과는술후 0.1% 플루오로메토론에의한안압상승에대해환자에게설명하고, 재내원기간을결정하는데도움을줄것으로생각한다. < 대한안과학회지 2015;56(7): > 991

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770>

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실