<30362D30342D313528BCBAB9CEC3B62DC0CCB9CEC1F E687770>

Size: px

Start display at page:

Download "<30362D30342D313528BCBAB9CEC3B62DC0CCB9CEC1F E687770>"

주화 목
6 years ago
Views:

1 대한안과학회지 2015 년제 56 권제 10 호 J Korean Ophthalmol Soc 2015;56(10): ISSN (Print) ISSN (Online) Original Article 비접촉경면현미경, 이중샤임플러그전안부사진기, 초음파각막두께측정계를이용해측정한중심각막두께의비교 Central Corneal Thickness Measured by Noncontact Specular Microscopy, Dual Rotating Scheimpflug Camera and Ultrasound Pachymetry 이민지 신용운 임한웅 강민호 조희윤 성민철 Min Jee Lee, MD, Yong Un Shin, MD, PhD, Han Woong Lim, MD, PhD, Min Ho Kang, MD, PhD, Hee Yoon Cho, MD, PhD, Min Cheol Seong, MD, PhD 한양대학교의과대학한양대학교구리병원안과학교실 Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea Purpose: To compare central corneal thickness (CCT) as measured using noncontact specular microscopy (NCSM), dual rotating Scheimpflug camera (Galilei ), and ultrasound pachymetry (USP). Methods: The measurements of CCT using NCSM, dual rotating Scheimpflug camera and USP in 70 eyes of 70 healthy subjects were compared. Results: The average measurements of CCT using NCSM, dual rotating Scheimpflug camera, and USP were ± µm, ± µm, and ± µm, respectively. The CCT measurement using NCSM was statistically significantly thicker than when measured using USP (p < 0.05). There was no significant difference between the NCSM and dual rotating Scheimpflug camera (p = 0.138). Additionally, there was no significant difference between the dual rotating Scheimpflug camera and USP (p = 0.656). A significant linear correlation was observed among the NCSM, dual rotating Scheimpflug camera, and USP (r > 0.900, p < 0.001). Conclusions: The results of the 3 methods were significantly correlated but the measurement using NCSM was significantly thicker than when using USP. CCT measurements of healthy eyes using dual rotating Scheimpflug camera were more correlated with USP than NCSM. The CCT measurements using dual rotating Scheimpflug camera is a better alternative for USP than NCSM. J Korean Ophthalmol Soc 2015;56(10): Key Words: Central corneal thickness, Dual rotating Scheimpflug camera, Noncontact microscopy, Ultrasound pachymetry 중심각막두께의측정은여러안과질환의평가및수술 Received: Revised: Accepted: Address reprint requests to Min Cheol Seong, MD, PhD Department of Ophthalmology, Hanyang University Guri Hospital, #153 Gyeongchun-ro, Guri 11923, Korea Tel: , Fax: goddns76@hanmail.net * This study was presented as a poster at the 113th Annual Meeting of the Korean Ophthalmological Society 전검사에있어서매우중요하다. 굴절교정수술전의각막두께측정은수술종류와수술조건의결정에중요한요소이며수술후에는각막두께측정으로원추각막, 각막확장증등의합병증을예측하거나진단할수있다. 1,2 각막이식술후에도중심각막두께의측정은각막내피기능을평가하는데있어서중요하다. 3-5 또한녹내장에서도안압을측정할때각막두께에따라안압을보정해야하므로각막두께의정확한측정이요구되고, 각막두께가얇을수록시신경의손상이빠르게진행된다고보고된바있어녹내장의진단 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. 1520

2 - 이민지외 : 세가지방법에의한각막두께의비교 - 과치료에도각막두께측정은중요하다. 6,7 현재각막두께측정에는다양한방법들이사용되고있는데크게접촉식방법과비접촉식방법두가지가있다. 접촉식방법으로는초음파각막두께측정계 (ultrasound pachymetry) 가대표적이고가장널리이용되고있다. 하지만각막에직접접촉해서측정해야하므로각막의측정위치에따라잘못측정될수있고접촉에의한각막상피손상이나감염도발생할수있어근래에는비접촉식방법으로각막두께를측정하는검사장비들이많이개발되고있다. 8 비접촉식방법으로는비접촉경면현미경 (noncontact specular microscopy), 전안부빛간섭단층촬영계 (anterior segment optical coherence tomography), slit-scanning을이용한 Orbscan (Orbtek Inc., Salt Lake City, UT, USA), 회전샤임플러그카메라 (rotating Scheimpflug camera) 를이용한 Pentacam (Oculus, Wetzlar, Germany) 이있고최근도입된갈릴레이 (Galilei, Ziemer, Port, Switzerland) 는이중회전샤임플러그카메라 (dual rotating Scheimpflug camera) 와 placido topographer가결합된방식으로정확한각막두께및전안부생체계측치를측정할수있다. 9 비접촉경면현미경 (noncontact specular microscopy) 은각막전면의상피세포와후면의내피세포에서반사되는빛의거리차를이용하여각막두께를측정한다. 10 Orbscan, Pentacam, Galilei 는전안부의스캔을통해각막두께를측정하고각막지형도를만드는방식인데, Orbscan 은좌우로만지나가는 slit beam을이용한이미지임에비해 Pentacam 과 Galilei 는회전하는샤임플러그카메라 (rotating Scheimpflug camera) 를사용한다. Pentacam 은 1대의 360도회전하는샤임플러그카메라를사용하여각막두께에관한정보를제공하였으나, Galilei 는 2대의샤임플러그카메라가 180도씩분리되어회전하면서측정하여더정확한각막두께를제공한다고알려져있다. 11 그동안이러한비접촉각막두께측정방법들과초음파각막두께측정계의측정치차이에대한보고가있었으나, 정상안에서비접촉경면현미경을이용하여측정한각막두께와이중샤임플러그전안부사진기를이용하여측정한각막두께의비교는아직보고된바가없다. 따라서본연구는정상인을대상으로하여접촉식각막두께측정계인초음파각막두께측정계와비접촉식각막두께측정계인비접촉경면현미경, 이중샤임플러그전안부사진기를이용하여중심각막두께를측정하여비교해보고자하였다. 대상과방법 본연구는고혈압이나당뇨같은전신질환이없으며안 과적과거력이없는건강한성인 70명 70안을대상으로하였다. 모든대상환자에서나안시력및교정시력을측정하고, 안압검사, 세극등현미경검사를시행하였다. 이상의검사에서최대교정시력 0.8 이상, 안압이 21 mmhg 미만이며세극등현미경전안부검사에서각막, 홍채및전방에이상소견이없는경우를대상으로하였다. 안과적수술력이나각막질환의과거력, 외상력이있는경우는대상에서제외하였다. 모든검사는한명의검사자에의해시행되었다. 초음파각막두께측정시발생할수있는각막의손상을최소화하기위해비접촉성검사인비접촉경면현미경 (noncontact specular microscopy) 과이중샤임플러그전안부사진기검사를먼저시행하고초음파각막두께측정검사 (ultrasound pachymetry) 를가장마지막에실시하였다. 실험안은우안과좌안중무작위로선택하였으며본연구는본원의학윤리심의위원회의심의를거친후진행되었다. 비접촉경면현미경 (specular microscopy-nspc, Konan medical, Tokyo, Japan) 을이용한각막두께측정시에는세극등검사와같이대상자의턱을대고이마를붙인후눈높이를조절하고주시점을보게하였다. 기계를각막중심부에위치시킨후자동적으로초점을맞춰각막중심부의내피영상을촬영하면서각막두께를측정하였다. 이중샤임플러그전안부사진기 (Galilei, Ziemer Group, Port, Switzerland) 를이용한각막두께측정도마찬가지로대상자의턱과이마를검사대에고정시킨후눈을주시점에고정하게하였다. 그다음모니터상에서붉은십자표시가네개의흰점위에놓이면서붉은색의가로선이각막의외측경계에닿을때스캔을하도록하였다. 동공중심이중앙에위치하고눈물층이마르기전에측정을하였고결과지에나타난중심각막두께의값을측정치로하였다. 이상의검사는 2회반복해서시행한후평균값을구해서측정치로하였다. 초음파각막두께측정계 (Pachymeter-SP3000, Tomey corporation, Tokyo, Japan) 를이용한검사는가장마지막에시행하였으며검사전 proparacaine 0.5% (Paracaine, Han Mi Pharm., Seoul, Korea) 로각막을마취한다음환자를똑바로눕힌후측정하지않는눈으로정면을주시하게한후소식자 (probe) 를각막중심에수직으로접촉하여 10회측정한후평균값을구하여측정치로하였다. 세검사기기로측정된중심각막두께의값을비교하여검사기계간의차이를분석하였다. 각각의검사기기로측정된중심각막두께측정치에대한비교는 one-way ANOVA 를이용하여비교하였고 Scheffe multiple comparison test 를이용하여사후검정을시행하였다. Bland and Altman plots 를이용하여검사기기간의일치도를분석하였고 Pearson correlation test를이용해검사기기간의상관관계에대해서 1521

3 - 대한안과학회지 2015 년제 56 권제 10 호 - 도알아보았다. 통계처리는 SPSS 20.0 (SPSS Inc., Chicago, IL, USA) 버전을사용하여분석하였고 p값이 0.05 미만인경우를통계적으로유의하다고판단하였다. 결과 전체대상군은총 70명 70안이었으며이중남자는 38명, 여자는 32명이었으며평균나이는 56.4 ± 8.3세 (23-72세) 였다. 실험안은우안이 36안이고좌안이 34안이었다. 비접촉경면현미경을이용하여측정한중심각막두께의평균값은 ± µm (range: µm) 였고, 이중샤임플러그전안부사진기를이용하여측정한값은 ± µm (range: µm), 초음파각막두께측정계는 ± µm (range: µm) 로, 비접촉경면현미경이가장두껍게측정되었고초음파각막두께측정계가가장얇게측정되었으며, 각측정치사이에통계적으로유의한차이를보였다 (p=0.013) (Table 1, Fig. 1). 세검사기기중어떠한검사기기사이에서통계적으로유의한차이를보였는지를 Scheffe multiple comparison test 를이용하여알아보았다. 비접촉경면현미경과이중샤임플러그전안부사진기를이용한측정치는 9.85 ± 4.92 µm, 비 접촉경면현미경과초음파각막두께측정계를이용한측정치는 ± 4.87 µm, 이중샤임플러그전안부사진기와초음파각막두께측정계를이용한측정치는 4.52 ± 5.14 µm의차이가있었고비접촉경면현미경과초음파각막두께측정계의차이만이통계적으로유의한차이를보였다 (p=0.015) (Table 2). 세검사기기중두가지사이의차이에대해알아보기위해서 Bland-Altman plots를만들어일치도범위를알아보았다. 일치도분석에서는비접촉경면현미경과이중샤임플러그전안부사진기로측정한측정치간의 95% 일치도범위는 µm (-0.74~20.44 µm), 비접촉경면현미경과초음파각막두께측정계의측정치간의 95% 일치도범위는 µm ( µm), 이중샤임플러그전안부사진기와초음파각막두께측정계의측정치간의 95% 일치도범위는 µm (-4.46~13.5 µm) 로비접촉경면현미경과초음파각막두께측정계간의일치도범위가가장작았고비접촉경면현미경과이중샤임플러그전안부사진기로측정한측정치간의일치도범위가가장컸다 (Fig. 2). 세검사기기간상관관계분석에서는비접촉경면현미경과이중샤임플러그전안부사진기의측정값, 비접촉경면현미경과초음파각막두께측정계의측정값, 이중샤임플러그전안부사진기와초음파각막두께측정계의측정값은모두통계적으로높은양의상관관계를보였다 (Pearson correlation, r=0.946, r=0.966 r=0.956 and p<0.001 in all group) (Fig. 3). 고찰 정확하게각막두께를측정하는것은안과질환의진단과치료에있어서필수적이며, 특히각막굴절교정수술이발달 Figure 1. Mean value, 95% CI and range of CCT measured by NCSM, dual rotating Scheimpflug (Galilei ), and USP. CI = confidence interval; CCT = central corneal thickness; NCSM = noncontact specular microscopy; USP = ultrasound pachymetry. Table 2. Pairwise comparison of central corneal thickness measurements Comparison Mean difference ± SD (μm) p-value * NCSM and Galilei 9.85 ± NCSM and USP ± Galilei and USP 4.52 ± Values are presented as mean ± SD unless otherwise indicated. SD = standard deviation; NCSM = noncontact specular microscope; USP = ultrasound pachymetry. * Scheffe multiple comparison test. Table 1. Mean CCT measured by NCSM, dual rotating Scheimpflug (Galilei ), and USP NCSM Galilei USP p-value * CCT (μm) ± ± ± Values are presented as mean ± SD unless otherwise indicated. CCT = central cornea thickness; NCSM = noncontact specular microscope; USP = ultrasound pachymetry. * One-way analysis of variance (ANOVA); CCT measured with NCSM was significantly thicker than with USP but there was no significant difference between NCSM and Galilei, Galilei and USP. 1522

4 - 이민지외 : 세가지방법에의한각막두께의비교 - A B C Figure 2. Bland Altman plots between the 2 methods. The middle line is the mean and the lines on the side represent the upper and lower 95% LoA. (A) NCSM and dual rotating Scheimpflug (Galilei ). (B) NCSM and USP. (C) Galilei and USP. LoA = limits of agreement; NCSM = noncontact specular microscopy; USP = ultrasound pachymetry. 하면서정확한각막두께측정의필요성이더욱중요하게여겨지고있다. 16 각막두께측정에는여러가지방법이있지만초음파각막두께측정계가쉽게사용할수있고상대적으로저렴한검사비용과높은정확도로현재표준검사로간주되고있다 하지만검사전점안마취가필요하고소식자가각막에직접접촉하여측정하기때문에검사자에따라가해지는압력의차이나측정위치에따라측정값에차이가있을수있고, 각막상피의손상, 감염의전파등의위험이있을수있다. 8 이러한문제점들로인해여러비접촉식각막두께측정법이개발되어시용되고있는데그중에한가지방법인비접촉경면현미경은각막의내피세포를평가해서각막질환의진단에중요한역할을하는검사이며현재국내에서널리쓰이고있다. 또한각막내피세포검사뿐아니라각막전면의상피세포와후면의내피세포에서반사되는빛의거리차를이용하여각막두께를측정할수있다. 20 또다른비접촉각막두께측정법중한가지인 Galilei 는최근에도입된각막지형도장비로 1대의샤임플러그카메라가 360도회전하여측정하는 Pentacam 과는달리 2대의샤임플러그카메라가 180도씩분리되어회전하 면서측정하기때문에보다더정확한각막두께에대한정보를제공할수있다. 21 이러한비접촉경면현미경과이중회전샤임플러그카메라의발전으로두기계를통해중심각막두께측정이가능해졌지만아직정확성에대한논란이있으며두기계를통한검사결과의정확성을평가하고, 지금까지가장널리이용되고있는초음파각막두께측정계의측정치를비교해보는것이필수적이라생각된다. Bovelle et al 22 과 Módis et al 23 은비접촉경면현미경으로측정한중심각막두께가초음파각막두께측정계에비해각각 31.6 µm, 28.0 µm 얇게측정된다고보고하였다. 국내에서는 Jung et al 24 이굴절교정수술전후중심각막두께를측정하여비교했는데비접촉경면현미경이초음파각막두께측정계보다 14.4 µm 얇게측정된다고보고하였다. 최근에반대되는연구결과가있었는데 Yang and Koh 25 는비접촉경면현미경을이용하여중심각막두께를측정한경우가초음파각막두께측정계를이용하여중심각막두께를측정한경우보다 0.54 µm 두껍게측정되었다고보고했다. 이중샤임플러그전안부사진기를이용한기존의연구에서 Yeter et al 26 은근시환자 81명 161안을대상으로이중 1523

5 - 대한안과학회지 2015 년제 56 권제 10 호 - A B C Figure 3. Scattergram showing the correlation of central corneal thickness measured by NCSM, dual rotating Scheimpflug (Galilei ), and USP. (A) Correlation between NCSM and Galilei (r = 0.946, p < 0.001). (B) Correlation between NCSM and USP (r = 0.966, p < 0.001). (C) Correlation between Galilei and USP (r = 0.956, p < 0.001). NCSM = noncontact specular microscopy; USP = ultrasound pachymetry. 샤임플러그전안부사진기와초음파각막두께측정계로중심각막두께를측정하여비교했는데두검사기기의측정값사이에유의한차이가없었다. Ladi and Shah 27 도정상안 46명 92안을대상으로중심각막두께를측정하였는데, 이중샤임플러그전안부사진기로측정한중심각막두께가초음파각막두께측정계에의해측정된값과유의한차이가없었다고보고하였다. 국내에서는 Kim et al 15 이정상인 20명 40안을대상으로중심각막두께를측정하였는데이중샤임플러그전안부사진기로측정한중심각막두께가초음파각막두께측정계에비해약 3.83 µm 얇게측정되었지만두기기사이에상관관계는매우유의하게나타났으며모두높은일치도를보였다. 본연구에서는비접촉경면현미경을이용하여측정한중심각막두께가초음파각막두께측정계를이용한측정치보다약 14.4 µm 두껍게측정되었으며이는통계적으로유의하였다. 하지만비접촉경면현미경과이중샤임플러그전안부사진기를이용한중심각막두께측정치와이중샤임플러그전안부사진기와초음파각막두께측정계를이용한중심각 막두께측정치사이에는통계적으로유의한차이가없었다. 본연구에서비접촉경면현미경이초음파각막두께측정계와비교했을때두껍게측정된원인은다음과같은것들을생각해볼수있다. 첫째로컴퓨터와광학기술의발전으로최근개발된비접촉경면현미경은이전에여러논문에사용된비접촉경면현미경과달리각막내피세포의평가와중심각막두께를측정하는데 1-2초정도밖에소요되지않아서눈물층의증발이거의영향을끼치지않기때문에비접촉경면현미경으로검사시각막두께가두껍게측정될수있다. 또다른원인으로는비접촉경면현미경의측정원리를보면각막내피에초점을맞추어각막내피세포의모양을보고그와동시에그부위의각막전면의상피세포와후면의내피세포에서반사되는빛의거리차를이용하여각막두께측정을하기때문에각막의중앙보다약간주변부의각막두께를측정하여두껍게측정되었을가능성도생각해볼수있다. 상대적으로시간이오래걸리는전안부빛간섭단층촬영계로중심각막두께를측정할경우비접촉경면현미경보다 µm 짧게측정된다는보고가있었으며, 25 검 1524

6 - 이민지외 : 세가지방법에의한각막두께의비교 - 사원리가같은두기기에서측정시간의차이가중심각막두께에영향을미치는보고도있었다. 측정시간이짧은스펙트럼영역빛간섭단층촬영계로측정했을때시간영역빛간섭단층촬영계로측정했을때보다중심각막두께가두껍게나타났다. 28 본연구에서통계적으로유의하지않지만이중샤임플러그전안부사진기를이용한측정치가초음파각막두께측정계보다약 4.53 µm 두껍게측정이되었는데, 최근정상안과원추각막안에서중심각막두께측정치를비교한연구에서도정상안에서이중샤임플러그전안부사진기로측정한값이초음파각막두께측정계보다 15.9 µm 두껍게측정되었다고보고된바있다. 29 이는이중샤임플러그전안부사진기검사시간이짧아눈물층증발의영향을거의받지않아눈물층까지측정되어조금두껍게나타나는것으로생각된다. 또한이중샤임플러그전안부사진기도각막중심이컴퓨터에의해자동으로결정되는데눈의움직임이나빛의질과각막의투명도에영향을받을수있어각막의중앙이아닌주변부의두께측정치가나타날수있다. 하지만두개의회전샤임플러그카메라 (rotating Scheimpflug camera) 를이용하여측정된중심각막두께의값을평균화하여나타내기때문에환자가어느정도주시점을잘주시하지못해도비교적정확한중심각막두께측정이가능하며, 컴퓨터에나타난각막지형도검사결과를보고주시가잘안됐을경우검사자가판단하여재검을하거나수동으로각막의중심을다시설정하여보정을할수있는장점이있다. 본연구를통해정상인에서중심각막두께를측정할때이중샤임플러그전안부사진기로측정한중심각막두께가초음파각막두께측정계로측정한값에좀더유사한값을나타냈으며통계적으로도유의한차이를보이지않았다. 결론적으로이중샤임플러그전안부사진기는초음파각막두께측정계를대체하여중심각막두께를측정하는데비접촉경면현미경보다유용한기계라고생각한다. 하지만초음파각막두께측정계를대체하여사용할경우에는초음파각막두께측정계에비하여두껍게측정될수있기때문에향후이중샤임플러그전안부사진기를사용할때에는이를고려해야할것으로생각된다. 참고문헌 1) Ou RJ, Shaw EL, Glasgow BJ. Keratectasia after laser in situ keratomileusis (LASIK): evaluation of the calculated residual stromal bed thickness. Am J Ophthalmol 2002;134: ) Wang Z, Chen J, Yang B. Posterior corneal surface topographic changes after laser in situ keratomileusis are related to resicdual corneal bed thickness. Ophthalmology 1999;106:406-9; discussion ) Yau CW, Cheng HC. Microkeratome blades and corneal flap thickness in LASIK. Ophthalmic Surg Lasers Imaging 2008;39: ) Whitacre MM, Stein RA, Hassanein K. The effect of corneal thickness on applanation tonometry. Am J Ophthalmol 1993;115: ) Kim DH, Kim MS, Kim JH. Early corneal-thickness changes after penetrating keratoplasty. J Korean Ophthalmol Soc 1997;38: ) Doughty MJ, Zaman ML. Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach. Surv Ophthalmol 2000;44: ) Jonas JB, Stroux A, Velten I, et al. Central corneal thickness correlated with glaucoma damage and rate of progression. Invest Ophthalmol Vis Sci 2005;46: ) Li EY, Mohamed S, Leung CK, et al. Agreement among 3 methods to measure corneal thickness: ultrasound pachymetry, Orbscan II, and Visante anterior segment optical coherence tomography. Ophthalmology 2007;114: ) Choi KS, Nam SM, Lee HK, et al. Comparison of central corneal thickness after the instillation of topical anesthetics: proparacaine versus oxybuprocaine. J Korean Ophthalmol Soc 2005;46: ) Kim HS, Kim JH, Kim HM, Song JS. Comparison of corneal thickness measured by specular, US pachymetry, and Orbscan in post-pkp eyes. J Korean Ophthalmol Soc 2007;48: ) Menassa N, Kaufmann C, Goggin M, et al. Comparison and reproducibility of corneal thickness and curvature readings obtained by the Galilei and the Orbscan II analysis systems. J Cataract Refract Surg 2008;34: ) Shim HS, Choi CY, Lee HG, et al. Utility of the anterior segment optical coherence tomography for measurements of central corneal thickness. J Korean Ophthalmol Soc 2007;48: ) Jung YG, Song JS, Kim HM, Jung HR. Comparison of corneal thickness measurements with noncontact specular microscope and ultrasonic pachymeter. J Korean Ophthalmol Soc 2004;45: ) Kim HY, Budenz DL, Lee PS, et al. Comparison of central corneal thickness using anterior segment optical coherence tomography vs ultrasound pachymetry. Am J Ophthalmol 2008;145: ) Kim DW, Yi KY, Choi DG, Shin YJ. Corneal thickness measured by dual Scheimpflug, anterior segment optical coherence tomography, and ultrasound pachymetry. J Korean Ophthalmol Soc 2012;53: ) Thomas J, Wang J, Rollins AM, Sturm J. Comparison of corneal thickness measured with optical coherence tomography, ultrasonic pachymetry, and a scanning slit method. J Refract Surg 2006; 22: ) Ling T, Ho A, Holden BA. Method of evaluating ultrasonic pachometers. Am J Optom Physiol Opt 1986;63: ) Copt RP, Thomas R, Mermoud A. Corneal thickness in ocular hypertension, primary open-angle glaucoma, and normal tension glaucoma. Arch Ophthalmol 1999;117: ) Harper CL, Boulton ME, Bennett D, et al. Diurnal variations in human corneal thickness. Br J Ophthalmol 1996;80: ) Ventura AC, Wälti R, Böhnke M. Corneal thickness and endothelial density before and after cataract surgery. Br J Ophthalmol 2001;85: ) Savini G, Carbonelli M, Barboni P, Hoffer KJ. Repeatability of automatic measurements performed by a dual Scheimpflug analyzer in unoperated and post-refractive surgery eyes. J Cataract Refract Surg 2011;37: ) Bovelle R, Kaufman SC, Thompson HW, Hamano H. Corneal 1525

7 - 대한안과학회지 2015 년제 56 권제 10 호 - thickness measurements with the Topcon SP-2000P specular microscope and an ultrasound pachymeter. Arch Ophthalmol 1999; 117: ) Módis L Jr, Langenbucher A, Seitz B. Corneal thickness measurements with contact and noncontact specular microscopic and ultrasonic pachymetry. Am J Ophthalmol 2001;132: ) Jung YG, Song JS, Kim HM, Jung HR. Comparison of corneal thickness measurements with noncontact specular microscope and ultrasonic pachymeter. J Korean Ophthalmol Soc 2004;45: ) Yang YS, Koh JW. Utility of the noncontact specular microscopy for measurements of central corneal thickness. J Korean Ophthalmol Soc 2014;55: ) Yeter V, Sönmez B, Beden U. Comparison of central corneal thickness measurements by Galilei Dual-Scheimpflug analyzer(r) and ultrasound pachymeter in myopic eyes. Ophthalmic Surg Lasers Imaging 2012;43: ) Ladi JS, Shah NA. Comparison of central corneal thickness measurements with the Galilei dual Scheimpflug analyzer and ultrasound pachymetry. Indian J Ophthalmol 2010;58: ) Prakash G, Agarwal A, Jacob S, et al. Comparison of fourier-domain and time-domain optical coherence tomography for assessment of corneal thickness and intersession repeatability. Am J Ophthalmol 2009;148: e2. 29) Feizi S, Jafarinasab MR, Karimian F, et al. Central and peripheral corneal thickness measurement in normal and keratoconic eyes using three corneal pachymeters. J Ophthalmic Vis Res 2014;9: = 국문초록 = 비접촉경면현미경, 이중샤임플러그전안부사진기, 초음파각막두께측정계를이용해측정한중심각막두께의비교 목적 : 비접촉경면현미경, 이중샤임플러그전안부사진기및초음파각막두께측정계를이용하여중심각막두께의측정치를비교하고자하였다. 대상과방법 : 정상인 70 명 70 안을대상으로비접촉경면현미경, 이중샤임플러그전안부사진기그리고초음파각막두께측정계로측정한중심각막두께를비교하고상관관계를알아보았다. 결과 : 비접촉경면현미경, 이중샤임플러그전안부사진기및초음파각막두께측정계를이용하여측정한중심각막두께는각각 ± μm, ± μm, ± μm 로비접촉경면현미경이가장두껍게측정되었고초음파각막두께측정계가가장얇게측정되었으며, 각측정치사이에통계적으로유의한차이를보였다 (p<0.05). 이중비접촉경면현미경은초음파각막두께측정계보다유의하게두껍게측정되었다 (p<0.05). 세검사는높은양의상관관계를보였다 (r>0.900, p<0.001). 결론 : 비접촉경면현미경에의해측정된중심각막두께는초음파각막두께측정계에의해측정된중심각막두께보다유의하게두껍게측정되어결과해석시이에대한고려가필요할것으로생각된다. 또한이중샤임플러그전안부사진기로측정한중심각막두께가초음파각막두께측정계로측정한값에좀더유사한값을나타내며정상안의중심각막두께측정에이중샤임플러그전안부사진기가비접촉경면현미경보다초음파각막두께측정계를대체할수있는좀더유용한방법이라생각된다. < 대한안과학회지 2015;56(10): > 1526

<28313539392D31363036292032C7FC20BFC0BAEABDBAC4B520B0A2B8B7C1F6C7FCB5B5B8A620C0CCBFEBC7D120BFF8C3DFB0A2B8B7B0FA20BFF8C3DFB0A2B8B7C0C7C1F5C0C720B0A2B8B7C7FCC5C2BAF1B1B3283038292E687770>

<28313539392D31363036292032C7FC20BFC0BAEABDBAC4B520B0A2B8B7C1F6C7FCB5B5B8A620C0CCBFEBC7D120BFF8C3DFB0A2B8B7B0FA20BFF8C3DFB0A2B8B7C0C7C1F5C0C720B0A2B8B7C7FCC5C2BAF1B1B3283038292E687770> 2형 오브스캔 각막지형도를 이용한 원추각막과 원추각막의증의 각막형태비교 1599 1600 Figure 1. The map of Orbscan II topography in keratoconus. The parameters including central corneal power, anterior and posterior elevation from BFS and