안구건조증 환자의 백내장수술 후 0.05% 및 0.1% 사이클로스포린의 치료 효과 비교 = Comparison of the Effects of 0.05% and 0.1% Cyclosporine for Dry Eye Syndrome Patients after Cataract Surgery

국문 초록 (Abstract)

목적: 백내장수술 후 0.05% 사이클로스포린과 0.1% 사이클로스포린 점안액 사용이 안구건조증에 미치는 영향을 비교하고자 한다.
대상과 방법: 백내장수술을 받은 안구건조증 환자를 대상으로 의무기록을 조사하여 분석하였다. 술 후 3개월간 0.05% 사이클로스포린을 사용한 군, 0.1% 사이클로스포린을 점안한 군으로 분류하였다. 수술 전, 술 후 2주, 1달, 3달째 쉬르머검사, 눈물막파괴시간, 각결막염색, 안구표면질환지수, 눈물 내 MMP-9 등의 안구건조증 관련 검사를 시행하여 각 군의 변화를 비교하였으며, 안구건조증 정도에따라 환자들을 분류하여 각 군의 변화를 확인하였다.
결과: 총 84명, 84안이 포함되었다. 전체 환자에서 쉬르머검사는 0.05% 사이클로스포린군에서 수술 전과 비교하여 술 후 3달째 유의한 호전을 보였다. 각결막염색은 0.05% 사이클로스포린군에서는 술 후 3달째 유의하게 향상되었으며, 0.1% 사이클로스포린군에서는술 후 1달, 3달째 유의한 향상을 보였다. 안구표면질환지수와 눈물 내 MMP-9 검사에서는 두 군 모두 술 후 2주때부터 호전되었다.
전체 환자에서 두 군 간의 수술 전후 안구건조증 개선 정도는 유의한 차이가 없었다. 안구건조증 2단계 환자에서 술 후 3달째 0.05% 사이클로스포린군은 쉬르머검사, 0.1% 사이클로스포린군은 눈물막파괴시간에서 유의한 호전을 보였다.
결론: 안구건조증 환자의 백내장수술 후 0.05%과 0.1% 사이클로스포린 점안액을 사용한 두 군에서 모두 안구건조증 증상 및 안구염증 수치의 호전을 보였으며, 두 약제의 효과는 유사하였다.

다국어 초록 (Multilingual Abstract)

Purpose: We compared the effects of 0.05% and 0.1% cyclosporine on dry eye symptoms following cataract surgery.
Methods: We retrospectively reviewed the medical records of patients with dry eye syndrome who underwent cataract surgery.
The patients were separated into 0.05% and 0.1% cyclosporine groups. Each group had been treated with their routine eye drops for 3 months after cataract surgery. We evaluated dry eye symptoms and signs using the Schirmer test, tear film breakup time (TBUT), corneal and conjunctival staining score, ocular surface disease index (OSDI), and matrix metalloproteinase 9 (MMP-9) testing of the tear film preoperatively and at 2 weeks, 1 month, and 3 months postoperatively. We also compared dry eye symptoms between the groups by dividing all patients according to dry eye severity.
Results: The study included 84 eyes (84 patients). The 0.05% cyclosporine group had an increase in the Schirmer test and improved corneal and conjunctival staining scores at 3 months postoperatively. The 0.1% cyclosporine group had improved corneal and conjunctival staining scores at 1 and 3 months postoperatively. The OSDI and MMP-9 results indicated a significant decrease in both groups at 2 weeks, 1 month and 3 months postoperatively. There were no significant differences in the change in dry eye symptoms after cataract surgery between the 0.05% and 0.1% cyclosporine groups. In the patients with level II dry eye syndrome, the 0.05% cyclosporine group showed a significant increase in the Schirmer test compared to the 0.1% cyclosporine group at 3 months postoperatively. The 0.1% cyclosporine group showed a significant improvement in TBUT compared to the 0.05% cyclosporine group at 3 months postoperatively.
Conclusions: Both 0.05% and 0.1% cyclosporine are effective treatments for improving dry eye symptoms and ocular surface inflammation after cataract surgery. Both eye drops are considered to have similar effectiveness.

참고문헌 (Reference)

• 1 김태환 ; 정병훈 ; 김강윤 ; 전익현 ; 서경률 ; 김응권 ; 김태임, "펨토초레이저 백내장수술 후 건성안에 대한 0.15% 무보존제 히알루론산나트륨의 임상적 효과" 대한안과학회 62 (62): 922-930, 2021
• 2 유애리 ; 황형빈 ; 김현경 ; 정성근, "싸이클로스포린 0.05% 점안액이 백내장 수술 후 발생하는 눈물분비 감소에 미치는 영향" 대한안과학회 54 (54): 1013-1018, 2013
• 3 양순원 ; 변용수 ; 노창래 ; 김수영 ; 조양경 ; 김은철 ; 정성근 ; 주천기, "사이클로스포린 A 0.05% 투여군 간 안전성 및 유효성을 비교평가하기 위한 제3상 임상시험" 대한안과학회 57 (57): 1849-1856, 2016
• 4 이승현 ; 전연숙 ; 문남주 ; 김경우, "백내장수술 후 눈물 내 기질 금속단백분해효소 9 및 안구 표면불편감의 단기 변화" 대한안과학회 62 (62): 463-471, 2021
• 5 최원 ; 윤경철, "백내장 수술 후 0.1% 히알우론산과 0.05% 사이클로스포린 A가 눈물막에 미치는 효과" 대한안과학회 52 (52): 800-806, 2011
• 6 박재영 ; 양상철 ; 박영민 ; 이지은 ; 박철용 ; 이종수, "건성안의 정도에 따른 백내장수술 후 싸이클로스포린과 스테로이드 점안액의 병합 치료 효과" 대한안과학회 60 (60): 821-828, 2019
• 7 Methodologies to diagnose, "report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop(2007)" 5 : 108-152, 2007
• 8 Donnenfeld E, "Topical ophthalmic cyclosporine : pharmacology and clinical uses" 54 : 321-338, 2009
• 9 Stern ME, "The role of the lacrimal functional unit in the pathophysiology of dry eye" 78 : 409-416, 2004
• 10 정연웅 ; 오태훈 ; 정성근, "The Effect of Topical Cyclosporine 0.05% on Dry Eye after Cataract Surgery" 대한안과학회 27 (27): 167-171, 2013
• 11 Lam H, "Tear cytokine profiles in dysfunctional tear syndrome" 147 : 198-205, 2009
• 12 Lallemand F, "Successfully improving ocular drug delivery using the cationic nanoemulsion, novasorb" 2012 : 604204-, 2012
• 13 Park Y, "Observation of influence of cataract surgery on the ocular surface" 11 : e0152460-, 2016
• 14 Sutu C, "Mechanisms and management of dry eye in cataract surgery patients" 27 : 24-30, 2016
• 15 Matsuda S, "Mechanism of action of cyclosporine" 47 : 119-125, 2000
• 16 Park JY, "Matrix metalloproteinase 9point-of-care immunoassay result predicts response to topical cyclosporine treatment in dry eye disease" 7 : 31-, 2018
• 17 Messmer EM, "Matrix metalloproteinase 9 testing in dry eye disease using a commercially available point-of-care immunoassay" 123 : 2300-2308, 2016
• 18 Cho H, "Management of ocular inflammation and pain following cataract surgery : focus on bromfenac ophthalmic solution" 3 : 199-210, 2009
• 19 현준영 ; 김효명 ; 이도 ; 정의상 ; 송종석 ; 최철영 ; 이정복 ; the Korean Corneal Disease Study Group, "Korean Guidelines for the Diagnosis and Management of Dry Eye: Development and Validation of Clinical Efficacy" 대한안과학회 28 (28): 197-206, 2014
• 20 Rajendrababu S, "Incidence and risk factors for postoperative intraocular pressure response to topical prednisolone eye drops in patients undergoing phacoemulsification" 41 : 3999-4007, 2021
• 21 Kasetsuwan N, "Incidence and pattern of dry eye after cataract surgery" 8 : e78657-, 2013
• 22 Jun JH, "Importance of tear volume for positivity of tear matrix metalloproteinase-9 immunoassay" 15 : e0235408-, 2020
• 23 Bron AJ, "Grading of corneal and conjunctival staining in the context of other dry eye tests" 22 : 640-650, 2003
• 24 Kim J, "Efficacy of switching from cyclosporine A 0.05% anionic emulsion to cyclosporine A 0.1% cationic emulsion in patients with dry eye associated with Sjogren's syndrome" 37 : 472-478, 2021
• 25 Yao K, "Efficacy of 1% carboxymethylcellulose sodium for treating dry eye after phacoemulsification : results from a multicenter, open-label, randomized, controlled study" 15 : 28-, 2015
• 26 Pflugfelder SC, "Effects of seqeuntial artifical tear and cyclosporine emulsion therapy on conjunctival goblet cell density and transforming growth factor-β2production" 27 : 64-69, 2008
• 27 Priani D, "Effectiveness of topical cyclosporin-A 0.1% compared to combined topical cyclosporin-A 0.1% with topical sodium hyaluronate on interleukin-6 levels in the tears of patients with dry eye disease" 7 : 31-, 2023
• 28 Linna TU, "Effect of myopic LASIK on corneal sensitivity and morphology of subbasal nerves" 41 : 393-397, 2000
• 29 Sheppard JD, "Effect of loteprednol etabonate 0.5% on initiation of dry eye treatment with topical cyclosporine 0.05%" 40 : 289-296, 2014
• 30 Mencucci R, "Effect of a hyaluronic acid and carboxymethylcellulose ophthalmic solution on ocular comfort and tear-film instability after cataract surgery" 41 : 1699-1704, 2015
• 31 De Paiva CS, "Dry eye-induced conjunctival epithelial squamous metaplasia is modulated by interferon-gamma" 48 : 2553-2560, 2007
• 32 조양경 ; 김만수, "Dry Eye After Cataract Surgeryand Associated Intraoperative Risk Factors" 대한안과학회 23 (23): 65-73, 2009
• 33 Kaçmaz RO, "Cyclosporine for ocular inflammatory diseases" 117 : 576-584, 2010
• 34 Lallemand F, "Cyclosporine A delivery to the eye : a comprehensive review of academic and industrial efforts" 117 : 14-28, 2017
• 35 Daull P, "Benefits of cetalkonium chloride cationic oil-in-water nanoemulsions for topical ophthalmic drug delivery" 66 : 531-541, 2014
• 36 Kim M, "Assessment of reliability and validity of the 5-scale grading system of the point-of-care immunoassay for tear matrix metalloproteinase-9" 11 : 12394-, 2021
• 37 Starr CE, "An algorithm for the preoperative diagnosis and treatment of ocular surface disorders" 45 : 669-684, 2019
• 38 Rhim JW, "05% cyclosporine a topical nanoemulsion in dry eyes with obstructive meibomian gland dysfunction" 66 : 254-263, 2022
• 39 신은혜 ; 임동희 ; 양찬민 ; 정태영, "0.05% 사이클로스포린 마이크로에멀젼과 나노에멀젼에서 치료 후 건성안 지표 및 점안감 비교" 대한안과학회 60 (60): 239-245, 2019
• 40 지만 ; 최철영 ; 김성재 ; 정진호, "0.05% 사이클로스포린 나노 에멀젼과 0.1% 양이온 에멀젼에서 유효성 및 안전성 비교 연구" 대한안과학회 63 (63): 834-840, 2022