대한안과학회지 2017 년제 58 권제 5 호 J Korean Ophthalmol Soc 2017;58(5):503-508 ISSN 0378-6471 (Print) ISSN 2092-9374 (Online) https://doi.org/10.3341/jkos.2017.58.5.503 Original Article 반복각막미란에서앞기질천자술과술후장기간 5% NaCl 안약병용치료의효과 Efficacy of Anterior Stromal Puncture Using 5% NaCl Eye Drops for Prolonged Time in Recurrent Corneal Erosion Syndrome 신다영 정소향 Da-Young Shin, MD, So Hyang Chung, MD, PhD 가톨릭대학교의과대학서울성모병원안과및시과학교실 Department of Ophthalmology and Visual Science, Seoul St. Mary s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Purpose: The purpose of this study is to evaluate the efficacy of the combined treatment of anterior stromal puncture with the concurrent use of 5% NaCl eye drops for 6 months for recurrent corneal erosion syndrome. Methods: A retrospective chart review was conducted for 21 patients (21 eyes) who underwent the combined treatment of anterior stromal puncture with 5% NaCl eye drops qid for 6 months to treat recurrent corneal erosion syndromes. The patients age, gender, history of corneal trauma, history of ocular surgery, recurrence rate, need for additional treatments after recurrence and complication were analyzed. Results: The mean age was 42.05 ± 13.83 years (19-68 years) with no significant difference in gender, and the mean follow up period was 8.48 ± 2.76 months (6-15 months). Among the 21 eyes 14 eyes (66.7%) had a previous history of corneal trauma, 2 eyes (9.52%) had previous refractive surgery, 1 eye (4.8%) had corneal dystrophy, 2 eyes (9.5%) had diabetic mellitus and 5 eyes (28.81%) had an unknown origin. Furthermore, 3 eyes (14.3%) developed recurrences and 2 eyes were resolved with conservative treatment while 1 eye needed additional anterior stroma puncture. There was no recurrence after retreatment with anterior stroma puncture. No significant complications such as infection or inflammation developed with the exception of corneal opacity in which one patient developed glare due to corneal opacity. Conclusions: The combined treatment of anterior stromal puncture with 5% NaCl eye drops for a prolonged time might be effective at preventing the recurrence of refractory recurrent corneal erosion syndrome with conservative treatments. J Korean Ophthalmol Soc 2017;58(5):503-508 Keywords: Anterior stromal puncture, Hyperosmotic agent, Recurrent corneal erosion 반복각막미란 (recurrent corneal erosion) 은각막상피가반 Received: 2017. 1. 12. Revised: 2017. 4. 4. Accepted: 2017. 4. 25. Address reprint requests to So Hyang Chung, MD, PhD Department of Ophthalmology, The Catholic University of Korea Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: 82-2-2258-6203, Fax: 82-2-599-7405 E-mail: chungsh@catholic.ac.kr 복적으로벗겨지는질환으로각막상피와바닥막사이, 바닥막과실질층사이의바닥막복합체 (basement membrane complex) 의약화로반복적으로각막의층이분리되는질환이다. 1 이러한각막상피부착의이상은외부적으로외상, 굴절교정수술과같은각막수술을받은후에발생할수있고, 내부적으로각막이상증, 특히각막상피바닥막이상증, 당뇨및수포각막병증등에의하여유발된다. 2-4 반복각막미란에서보존적치료로인공누액, 고삼투압제제, 치료용콘택트렌즈의착용, 압박안대, 자가혈청점안, matrix metalloproteinase-9 c2017 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 503
- 대한안과학회지 2017 년제 58 권제 5 호 - (MMP9) 억제제인독시사이클린제제복용과스테로이드안약병용사용이있고일부에서는성공적으로치료된다. 5-11 수술적치료로죽은조직제거술 (debridement), 표층각막절제술 (superficial keratectomy), 일회용주사바늘이나미세전기소작기를이용한앞기질천자술 (anterior stromal puncture) 이나 Neodymium:yttrium-aluminum garnet (Nd:YAG) 레이저를이용한앞기질천자술, 알코올또는다이아몬드드릴을사용한표층각막절제술, 엑시머레이저를이용한치료레이저각막절제술 (eximer laser phototherapeutic keratectomy), 양막이식술등이시행되고있다. 12-18 국내에서는보존적치료의임상성적이나 Nd:YAG 레이저를이용한앞기질천자술의임상성적이발표된바있으나주사바늘을이용한앞기질천자술에대한성적은발표된바가없다. 이에저자들은주사바늘을이용한앞기질천자술과시술후고삼투압제제를 6개월간유지한병용치료효과를보고하고자한다. 대상과방법 2012년도 1월부터 2016년도 4월사이에가톨릭대학교서울성모병원에서반복각막미란을진단받은환자에서주사바늘을이용한앞기질천자술을시행하고시술후고삼투압제제인 5% NaCl 안약을 6개월간 4회유지하도록한환자 21명 (21안) 을대상으로의무기록을후향적으로분석하였다. 본연구는가톨릭대학교연구윤리심의위원회 (Instituitional Review Board, IRB) 로부터승인을받았다. 반복각막미란은환자가아침에눈을뜰때통증, 불편감, 눈물흘림등의반복적인증상을호소하면서세극등검사시마취제를넣고면봉으로각막상피를건드려각막상피가밀리는소견이보이는경우진단하였다. 외래방문시문진을통하여환자들의연령, 성별, 병력, 가족력, 수술력, 외상력및시술전병변이재발했던횟수와받았던치료의종류를조사하고시력측정, 안압측정, 세극등검사를시행하였다. 본연구에서재발은통증및눈부심, 눈물흘림같은환자의증상호소및세극등검사상각막상피가밀리는소견의발생으로정의하였고모든환자에서치료전후최대교정시력, 시술후재발률, 재발후의추가시술여부및합병증발생유무에대해서조사하였다. 치료전최대교정시력은환자의통증이심한경우국소마취제를점안후측정하였다. 시술전후최대교정시력의변화는 SPSS 17.0 (SPSS Inc., Chicago, IL, USA) Wilcoxon signed-rank test를이용하여분석하였다. 모든환자는밀리는각막상피를면봉으로제거후동공을제외한주변부에 26 gauge 주사바늘을이용하여 0.1 mm 정도의깊이 19 로앞기질천자술을각막상피가제거된부위에 0.5 mm 간격 14 으로시행하였다. 일주일간치료용콘택트렌즈를유지하였고시술후 0.5% levofloxacin (Oculevo, Samil, Seoul, Korea) 을하루 4회및인공눈물 (Refresh Plus, Allergan, Irvine, CA, USA) 을사용하였다. 일주일후치료용콘택트렌즈를제거하였고렌즈제거후 6개월간 5% NaCl (Muro128, Bauch & Romb, Rochester, NY, USA) 안약과취침전연고 (Liposic ophthalmic gel, Bauch & Romb, Rochester, NY, USA) 를처방하였다. 인공누액은환자가이물감, 뻑뻑함등의자극증상이심한경우에만최소한으로사용하도록하였다. 결 과 총 21명 (21안) 의환자평균나이는 42.05 ± 13.83세 (19-68세) 였고, 그중 11명 (52%) 이남자, 10명 (48%) 이여자로성별간의차이는보이지않았으며모두단안이었다 (Fig. 1). 연령별분포는 30대 (33.3%) 와 60대 (23.8%) 에서가장호발하였고평균관찰기간은 8.48 ± 2.76개월 (6-15개월 ) 이었다 (Fig. 1). 반복각막미란의발생원인으로는과거외상으로인한경우가 21명환자중 14안 (66.7%) 으로가장많았고, 굴절교정수술중라식수술을받은경우가 3안 (14.3%), 각막상피이상증이있는경우가 1안 (4.8%), 당뇨가 Figure 1. Age and gender distribution at the time of diagnosis of recurrent corneal erosion. There was no differences between genders. Table 1. Risk factors in 21 eyes of 21 patients with recurrent corneal erosion Risk factors No. of eyes (n, %) Trauma 14 (66.67) LASIK 2 (9.52) Corneal epithelial dystropy 1 (4.76) Diabetic mellitus 2 (9.52) Unknown origin 5 (23.81) LASIK = laser assisted in situ keratomileusis. 504
- 신다영 정소향 : 반복각막미란에서앞기질천자술및 5% NaCl 안약병용치료 - 있었던환자가 2명 (9.5%) 이었고원인을알수없는경우가 5안 (28.81%) 이었다 (Table 1). 본원에서시술을받기이전에재발했던횟수를보면 5회미만재발한환자가 5명 (33.3%), 5회이상 10회미만재발했던환자가 9명 (42.9%) 및 10회이상재발한환자가 7명 (33.3%) 이었다 (Fig. 2). 또한이전에받았던치료들에대한분포를보면모든환자가인공눈물제제나안연고를사용한경험이있었고치료용콘택트렌즈착용을했었던환자는 9안, 고삼투압제제나압박붕대, 죽은조직제거술시술을받았던환자는각각 8안씩있었다. 이전에타병원에서주사바늘을이용한앞기질천자술을시행받았던환자가 3안있었다 (Fig. 3). 21명 21안에대해주사바늘을이용한앞기질천자술과 6 개월간의고삼투압제제사용중재발한환자는 3명 (14.3%) 이며각각시술후 2개월, 3개월, 4개월째재발하였다. 재발환자 3명중 2명은인공눈물, 고삼투압제제, 취침전연고만유지하는보존적치료후증상이소실되었고 1 명에서만재시술이필요하였다. 재시술받은환자도 1회추가시술후재발하지않았다. 재발한환자 3명중에 2명이 10회이상재발한병력이있었던환자였다. 이전에타병원 Number of recurrence 10 7 eyes (33%) <5 5 eyes (24%) 5-10 9 eyes (43%) Figure 2. Number of previous recurrence in 21 eyes of 21 patients with recurrent corneal erosion. Figure 3. Previous therapies in 21 eyes of 21 patients with recurrent corneal erosion. All 21 eyes had conservative treatment with eye drops and 3 eyes had anterior stromal puncture at other hospitals. 에서주사바늘을이용한앞기질천자술을시행받았으나효과가없었던환자가 3명있었고본원에서앞기질천자술후 5% NaCl 병용치료후재발하지않았다. 18명의환자에서는평균 8.0 ± 2.9 (6-15개월) 관찰기간동안재발없이잘유지되었다. 앞기질천자술로인한각막혼탁외에는감염, 염증등의부작용은없었으며 1명에서각막혼탁으로인한눈부심을호소하였다. 21명환자의시술전최대교정시력은 0.23 ± 0.24 logmar였고시술후최대교정시력은 0.08 ± 0.14 logmar로통계적으로유의하게증가하였다 (p<0.05). 고찰 반복각막미란은각막상피세포와바닥막을연결하는반결합체 (hemidesmosome) 와바닥막과각막실질사이를부착시키는고정미세섬유 (anchoring fibril) 로구성된바닥막복합체 (basement membrane complex) 의부착력약화로인해표층각막의외상에의해바닥막이손상되거나각막이영양증등의유전적이상으로인해반복적으로각막상피의탈락이일어나는질환이다. 1,20 대부분이른아침에잠에서깰때갑자기발생하는강한통증과지속적인불편감, 눈물흘림, 눈부심을유발하며, 시력저하를가져올수있다. 2,3,21,22 이는만성적으로호전과재발을반복할수있는데따라서치료는증상을완화하고재발을방지하기위해각막상피와바닥막의부착력을증가시키는것을목표로한다. 현재시행되고있는수술적방법중단순죽은조직제거술은간단하게시행할수있으나다른수술적방법에비하여재발률이높아단독으로시행하기에바람직하지않다. 엑시머레이저를이용한치료레이저각막절제술은비정상바닥막을제거하고재상피화를위해바닥막표면을부드럽게한후새롭게형성되는상피의부착을강화시키는방법으로다른표층각막절제술에비하여표층각막실질의정확한양을제거하여부착복합체를재형성하는방법으로반흔이적게발생하나굴절이상이발생할수있고고가의레이저장비로인해접근이어렵다는단점이있다. 23 일회용주사바늘을이용하거나미세전기소작기또는 Nd:YAG 레이저를이용한앞기질천자술은각막상피와앞각막기질사이의반흔조직형성을유도하는방법으로각막혼탁이발생하지만보존적방법보다효과가좋고비용이저렴하다. 19 앞기질천자술은앞각막기질혼탁으로인한시력저하, 눈부심등의합병증을막기위해동공중심부를피해주변부앞각막기질에시행한다. 본연구에서시행한일회용주사바늘을이용하는방법은 Nd:YAG 레이저를이용한앞기질천자술에비해비용이더저렴하며가용성이매우좋다는장 505
- 대한안과학회지 2017 년제 58 권제 5 호 - 점이있다. 또한이외에다른치료들이반응하지않을때양막이식도고려해볼수있는데각막혼탁이발생하지않는다는장점이있지만시간이오래걸리고외래에서쉽게시행할수없다는단점이있다. 23 Avni Zauberman et al 14 은앞기질천자술을시행한 35안중에 37.1% 가재발하였고이중재시술이필요한환자는재발한환자중에 17% 라고보고한바있다. 재발한 17% 중표층각막절제술을시행한환자가 16.6%, 앞기질천자술을재시술한환자가 66%, 엑시머레이저치료용각막절제술을받은환자가 16.7% 라고보고하였다. 앞기질천자술후 5 주째내원했을때고삼투압제제를자기전 1회점안하게했다고하였으나얼마나오랫동안지속하게했는지에대한구체적인내용은언급되지않았다. 14 Choi et al 17 은보존적치료와 Nd:YAG 레이저앞기질천자술을시행한반복각막미란환자의재발률을비교한연구에서보존적치료를시행한군에서는 5% NaCl (Muro128, Bauch & Romb, Rochester, NY, USA) 과인공누액점안액을 2개월이상사용하였고재발률은 24안중 12명으로 50% 로보고하였다. Nd:YAG 레이저를시행한 23안에서는 56.5% 인 13안에서재발하였다. Nd:YAG 레이저를시행한군에서는시술후고삼투압제제를사용하였다는기록은있었으나구체적인기간은언급되지않았다. 반복각막미란에서각막부종이발생되면각막기질의수분증가와단백당질의소실로기질의삼투압이떨어지게되는데이때보존적치료로서고삼투압제제를사용할수있다. 5% NaCl은각막상피뿐만아니라각막기질에서도수분을제거할수있어부종을막아상피의부착을증진시키는작용을한다. 20 반복각막미란의재발은주로아침에자고일어났을때발생하는데이는수면중눈꺼풀이닫힌상태에서는눈물증발이줄어듦에따라눈물이저장성으로변하고이로인해발생한삼투압차에의해물이이동하고각막상피에부종이생겨결과적으로각막상피의부착력이떨어지며따라서취침전젤과함께고삼투압제제를같이점안하면상피바깥의삼투압을높게유지할수있고자는동안발생하는급속안구운동이나아침에눈을뜰때윤활제작용을할수있어재발을예방할수있다는가설이있다. 24,25 또한앞기질천자의치료기전으로앞기질천자후천자된공간을상피가채우게되고완전한부착복합체가형성될때까지마치점용접에서와같이느슨한상피판을아래쪽의기질에붙여주는역할을한다는가설이제기된바있고, 19,26 Katsev et al 27 은천자를통해섬유화가촉진되고새로운바닥막이형성됨을보고하였다. Judge et al 26 은토끼의각막에앞기질천자술을시행하고치유되는동안전자현미경을사용하여관찰한실험에서정상적인바닥막부착 복합체가형성되어바닥막이재생되기까지는정상적인각막상피재생기간인 7-14일이아닌 5개월이상이걸렸음을확인하였다. 따라서재생이완료되기전까지는아직상피의부착이완벽하지않기때문에부종을감소시켜부착에도움을줄수있는고삼투압제제를유지하는것이앞기질천자술후환자의재발을막는데도움이될것으로생각된다. 본연구에서는재발이빈번했던환자를대상으로앞기질천자술을시행후 5% NaCl 고삼투압제제하루 4회와취침전젤연고를 6개월동안투여한후재발률을분석하였다. 시술후재발률은전체환자 21명중 3명으로 14.3% 였다. 흥미로운것은본연구에서이미 10회이상재발한병력이있고타병원에서 1차례이상앞기질천자술을받았으나술후고삼투압제제를넣지않고재발했던환자가 3명있었다. 3명중 2명은본원에서시술후 1년이상재발이없었고 1명은 3개월째경도의증상재발이있었지만이후추가치료없이 1년이상재발이없었다는것을보고하였는데이는앞기질천자술을시행후보조적으로고삼투압제제를 6개월이상장기간유지하는것이재발률을줄이는데매우중요할수있다는가설을제시할수있다. 주사바늘을이용한앞기질천자술은외래에서쉽게시행할수있으나각막천공과각막내피손상의위험성이있고, 각막상피와실질을통과하는천공의깊이가일정하지않아시술에대한반응이다양하다는단점이있는데 15,28,29 본연구에서는 26 gauge 바늘의양끝두곳을휘어서약 0.1 mm 의일정한깊이로각막천자를시행할수있게하여천공을예방하고기질천자깊이의일정성을확보하였다 (Fig. 4). 본연구는평균경과관찰기간이약 8개월정도로 2년이상장기추적관찰을한기록이많이포함되어있지않아경과관찰이길어지면재발률이증가할수있다는한계점이있으므로추후장기관찰후재발률분석에대한연구가필 Figure 4. Gross image of 26-Gauge needle used in anterior stromal puncture. The surgeon can bend the disposable 26-Gauge needle using a microneedle holder. 506
- 신다영 정소향 : 반복각막미란에서앞기질천자술및 5% NaCl 안약병용치료 - 요하다. 또한앞기질천자술을시행하고증상호전후증상이없더라도 6개월이상안약을점안해야하기때문에환자교육과환자의순응도가치료성공률을높이는데매우중요할것이다. 결론적으로반복각막미란환자에서미세주사바늘을이용한앞기질천자술과시술후 5% NaCl을 6 개월동안유지하는장기병용요법은반복각막미란환자의재발률을낮추는효과적인치료방법이될수있을것으로생각된다. REFERENCES 1) Ramamurthi S, Rahman MQ, Dutton GN, Ramaesh K. Pathogenesis, clinical features and management of recurrent corneal erosions. Eye (Lond) 2006;20:635-44. 2) Suh Y, Kim MS. The longterm evaluation of recurrent corneal erosion. J Korean Ophthalmol Soc 2002;43:1570-6. 3) Diez-Feijóo E, Grau AE, Abusleme EI, Durán JA. Clinical presentation and causes of recurrent corneal erosion syndrome: review of 100 patients. Cornea 2014;33:571-5. 4) Eke T, Morrison DA, Austin DJ. Recurrent symptoms following traumatic corneal abrasion: prevalence, severity, and the effect of a simple regimen of prophylaxis. Eye (Lond) 1999;13(Pt 3a):345-7. 5) Dursun D, Kim MC, Solomon A, Pflugfelder SC. Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix metalloproteinase-9, doxycycline and corticosteroids. Am J Ophthalmol 2001;132:8-13. 6) Wang L, Tsang H, Coroneo M. Treatment of recurrent corneal erosion syndrome using the combination of oral doxycycline and topical corticosteroid. Clin Exp Ophthalmol 2008;36:8-12. 7) Ziakas NG, Boboridis KG, Terzidou C, et al. Long-term follow up of autologous serum treatment for recurrent corneal erosions. Clin Exp Ophthalmol 2010;38:683-7. 8) Yoon KC, Choi W, You IC, Choi J. Application of umbilical cord serum eyedrops for recurrent corneal erosions. Cornea 2011;30: 744-8. 9) Moutray TN, Frazer DG, Jackson AJ. Recurrent erosion syndrome--the patient s perspective. Cont Lens Anterior Eye 2011;34: 139-43. 10) Fraunfelder FW, Cabezas M. Treatment of recurrent corneal erosion by extended-wear bandage contact lens. Cornea 2011;30:164-6. 11) Ahad MA, Anandan M, Tah V, et al. Randomized controlled study of ocular lubrication versus bandage contact lens in the primary treatment of recurrent corneal erosion syndrome. Cornea 2013; 32:1311-4. 12) Singh RP, Raj D, Pherwani A, et al. Alcohol delamination of the corneal epithelium for recalcitrant recurrent corneal erosion syndrome: a prospective study of efficacy and safety. Br J Ophthalmol 2007;91:908-11. 13) Ryan G, Lee GA, Maccheron L. Epithelial debridement with diamond burr superficial keratectomy for the treatment of recurrent corneal erosion. Clin Exp Ophthalmol 2013;41:621-2. 14) Avni Zauberman N, Artornsombudh P, Elbaz U, et al. Anterior stromal puncture for the treatment of recurrent corneal erosion syndrome: patient clinical features and outcomes. Am J Ophthalmol 2014;157:273-9.e1. 15) Tsai TY, Tsai TH, Hu FR, Hou YC. Recurrent corneal erosions treated with anterior stromal puncture by neodymium: yttrium-aluminum-garnet laser. Ophthalmology 2009;116:1296-300. 16) Kim SY, Ko BY. Evaluaion of anterior stromal puncture using Nd: YAG laser for refractory recurrent corneal erosion. J Korean Ophthalmol Soc 2015;56:331-8. 17) Choi M, Jung JW, Seo KY, et al. Comparison of Nd: YAG laser versus conservative management in the treatment of recurrent corneal erosion. J Korean Ophthalmol Soc 2015;56:687-93. 18) Ko BY, Lee GW. Clinical results of phototherapeutic keratectomy for refractory recurrent corneal erosion. J Korean Ophthalmol Soc 2011;52:392-400. 19) Rubinfeld RS, Laibson PR, Cohen EJ, et al. Anterior stromal puncture for recurrent erosion: further experience and new instrumentation. Ophthalmic Surg 1990;21:318-26. 20) Das S, Seitz B. Recurrent corneal erosion syndrome. Surv Ophthalmol 2008;53:3-15. 21) Reeves SW, Kang PC, Zlogar DF, et al. Recurrent corneal erosion syndrome: a study of 364 episodes. Ophthalmic Surg Lasers Imaging 2010;Mar 9:1-2. doi: 10.3928/15428877-20100215-44. [Epub ahead of print]. 22) Lee SH, Kim TI, Chung SH, et al. A case of combined bacterial keratitis with recurrent corneal erosion. J Korean Ophthalmol Soc 2007;48:449-54. 23) Bea KH, Ahn M, Cho NC, You IC. Clinical presentation and treatment outcomes of recurrent corneal erosion. J Korean Ophthalmol Soc 2016;57:555-61. 24) Liesegang TJ. Physiologic changes of the cornea with contact lens wear. CLAO J 2002;28:12-27. 25) Foulks GN. Treatment of recurrent corneal erosion and corneal edema with topical osmotic colloidal solution. Ophthalmology 1981;88:801-3. 26) Judge D, Payant J, Frase S, Wood TO. Anterior stromal micropuncture electorn microscopic changes in the rabbit cornea. Corena 1990;9:152-60. 27) Katsev DA, Kincaid MC, Fouraker BD, et al. Recurrent corneal erosion: pathology of corneal puncture. Cornea 1991;10:418-23. 28) Hsu JK, Rubinfeld RS, Barry P, Jester JV. Anterior stromal puncture. Immunohistochemical studies in human corneas. Arch Ophthalmol 1993;111:1057-63. 29) Geggel HS. Successful treatment of recurrent corneal erosion with Nd:YAG anterior stromal puncture. Am J Ophthalmol 1990; 110:404-7. 507
- 대한안과학회지 2017 년제 58 권제 5 호 - = 국문초록 = 반복각막미란에서앞기질천자술과술후장기간 5% NaCl 안약병용치료의효과 목적 : 본연구에서는반복각막미란에서앞기질천자술과술후 5% NaCl 안약을최소 6 개월간장기병용치료한효과를알아보고자한다. 대상과방법 : 2012 년도 1 월부터 2016 년도 4 월사이에가톨릭대학교서울성모병원에서반복각막미란을진단받은환자에서앞기질천자술을시행하고시술후 5% NaCl 안약을 6 개월간 4 회유지하도록한환자 21 명 (21 안 ) 을대상으로치료결과의의무기록을후향적으로분석하였다. 환자들의나이, 성별, 각막외상, 안과적수술병력의여부, 시술후재발여부와재발시추가치료필요여부, 술후합병증발생에대해조사하였다. 결과 : 총 21 명의환자평균나이는 42.05 ± 13.83 세 (19-68 세 ) 였고, 성별의비율에차이는없었으며평균관찰기간은 8.48 ± 2.76 개월 (6-15 개월 ) 이었다. 21 명환자의 21 안중 14 안 (66.7%) 에서각막외상, 2 안 (9.52%) 에서굴절수술을받은과거력이있었고각막이상증이있는경우가 1 안 (4.8%), 당뇨가있었던환자가 2 안 (9.5%) 이었고원인을알수없는경우가 5 안 (28.81%) 이었다. 21 안중치료후재발한환자는 3 안 (14.3%) 이었고 2 안은보존적치료후증상소실되었으며 1 안에서만재시술이필요하였다. 재시술을받은환자에서도 1 회추가시술후에는재발하지않았다. 앞기질천자술로인한각막혼탁외에는감염, 염증등의부작용은없었으며 1 명에서각막혼탁으로인한눈부심을호소하였다. 결론 : 반복각막미란환자에서앞기질천자술과술후 5% NaCl 의장기간병용요법은보존적치료에반응하지않는난치성반복각막미란환자의재발을예방하는효과적인치료법임을알수있었다. < 대한안과학회지 2017;58(5):503-508> 508