www.koreanglaucoma.org
13
9ROXPH_1XPEHU
서 론
࠭ஔಠ࠾ਊࠉਁઅനࣳਉܟણԞਁކऀથࠋऀਐ
ઍ੶ౄؘଖ൝੶ܾࣳࣛ೩٩ޅਐӴҋৈౌ
ԇ৩਼ࡘԇ৩ഗࡘ࠾࠹ઊઔدഥ࠾ਁઅനࣳ५ઊ֢
࣏ޏઍ੶ే़ઔؘૻଖ൝ઊد೩٩ޅਐਁઅഡ१ܲࣛ
५ઊ൝ઘઅࣖઅଖਁѿણૻفഡਕല߸ௗؘٙनऀޏ ޅേӚਐઊಡଛહઊد५ఽܾڙ࠾ઊ܅Ӌ٩ݼؘҫਁࣳ٩
़্ઔڡઊࣳ৩ࡂدؘഡӵӘઍࡅࡻ݄ഡৈ१ৈૻٳ
ૻനӵѿਁࣳއઊࠋࣥടؘٙ੭ഠહ੶ܾ+/$%51
ൌӘӚܳઊઔد࠭ஔಠ೩٩ޅਐࡂ౿࠭ஔಠ࠾ࠋ࠾൲
24ךઊ֢ࣳࠋࣥടކ೩٩ޅਐघܾ࠾ࠒߚട
ਉଔزٻؘӄੌ٩ઔدԞਁഡୄਁކ೩٩ޅਐ ઊ֢ౌ़֧٩ઔކفґؘ৩ਁ֢ౌ֢Ԟڹߚਁ৩५
੶ܾઊৰଖ़ઔد൙ਐઊ७ഡӄੌࠒஸઊ֢ౌ֧
़ઔؘٙ )LJ1 ࠭ஔಠ൝ઘਁࣳৗ೩٩ޅਐކ֢ౌֳؘӄ
ੌؘ1015ી٩ܾ֯੶فґؘޏޅേӚਐٳࠉഡஔ
೩٩ޅਐઊࠋࣥടਉਕӴહઌ१ܲࣛ५ઍ੶ెد1
ഡפֳણ१ৡछࣛઍ੶ౄؘଔരऀ१३ӄ࠾੶
ܾࣳࣛ०ളേਐڢઅد৩ഡઌઊӚਉടؘଖ൝ ઊ܅Ӌഢ़ઔؘٙ೩٩ޅਐ൝ઘਁࣳפֳણઊ܅Ӌട
ઍࠉહ੶ܾ१३ӄ࠾ਁفഡҩ࣏৺ઊࣛ०Әңઅ
Ҏઅ߸ܾ࣏ੋٻؘӄੌѿއدઑࣛહ੶ܾ࠭ஔಠ೩٩ ޅਐ൝ઘਁࣳ१३ӄ࠾೩٩ޅਐઘஔਁઅഡ३ӄछࣛ
Әࣛ०੶ܾઌഡҫઊഥٻৰ֢ౌؘ֢ٙڅ࣏ઊݴ
Ӵ࠺ടԞѿৰܶد
೩٩ޅਐ൝ઘਁࣳઊୱפֳણਐઅԞҁӘી٩ਁࡻ
ܺഡد࠭ஔಠ೩٩ޅਐކऀથࠋऀઌӄੌѿއ੶ޏޅ
േӚਐӘ࠭ஔಠ࠾ਁઅഡ१३ӄ࠾ਁઅനࣳࣛ०ਁ
ઊ߸ৢടدӋഢ़ઔدചઘઅ೩٩ޅਐీݼئਁࣳ٩
࠭ஔಠ࠾ਁઅഡ१ܲࣛ५ઊࣛ०ӘӚܳټ१३ӄछࣛ
ઊઌઌӄੌѿઔدઊࠤԞ൦ݴ౿ന࠭ஔಠ೩٩ޅ ਐઊدݳֳઌऀ೩٩ޅਐӘӴ࠺ٻؘಡଛӘ࠭ஔಠ൝ઘਁ
ࣳࣛ०ӘפֳણऀछࣛઅৢऀԓݼӋઊୱפֳણ
ਁفഡௗݑਁفനࣳીݼനࡂӋઘഡد
본 론
߬ನب݄ౠ
࠭ஔಠ೩٩ޅਐدݳֳઌऀ೩٩ޅਐӘدݳ࠾ઌѿ ಡଙ
࠭ஔಠ࠾Әפֳણௗݑ
੭ൌӍ ᕽᬙ᮹ݡ
Fig. 1.࠭ஔಠ೩٩ޅਐઅࠒஸ KWWS ZZZRFXOLVWQHW
Journal of The Korean Glaucoma Society
JOURNAL OF THE KOREAN GLAUCOMA SOCIETY 14
ؘҫ੶্ܾܱدӴֳਐઅࠋࣥԞӘ࣏ઊ౸
ઌڢӴֳਐࠉ٩Ӵ࠺ٻؘٙं೩٪ऀਐࠉઊ
ҋടࠉفܾਊӚܳࠉৢടد25࠭ஔಠ೩٩ ޅਐઊدݳֳઌऀ೩٩ޅਐਁࡻടਉથࠋੰӘކऀӄ Әݴ֢ౌֳӋਕӴહઌଓछࣛӘ१ܲસടѿઍৰؘ֢Ԫ صઊઊܟഡਊഠહઌࠋࣥԞઅୱઊਁઅനࣹࣳٽ़
ઔدۙഡ࠭ஔಠ൝ઘڝઊਐਁӚܳټ੭ഠહઌಡऀ
ѿӋઔؘҫ੶্ܾܱӋઔد6گ܅ࣳࠃ
ࠒ़੭ӘӚܳઊઔؘଓڝઊ೩٩ޅਐਁઅനࣳਕӴહ ઌछࣛࠊѿ؟ऀઊًدӋઊനഢ़ઔد
߬ನب݄җदन࢚҃ࣚ
࠭ஔಠ ೩٩ޅਐ ޏޅേӚਐ३ࣥേӚ ޏޅࡘ ޏޅ
േӚनޏޅӧ࣏ڢޏޅഥ࠾ઊಡଛઊކ१३ӄਐઊ
ز٪੶ܾ֢ౌ़֧ઔد )LJ2 ޏޅਐӘӚټસ࣒घ
K\SR[LD Әਐऀ࣏ઊ౸ઌ LQIODPPDWRU\F\WRNLQH ਁઅ നࣳޏޅӘ१३ӄ੭ڂڢਕӴહઌ३ӄछࣛઊࠋࣥഡد7
10گ܅ࣳ࠭ஔಠ೩٩ޅਐ൝ઘਁࣳ१३ӄפֳણऀछࣛ
ਁࡂدৢടدӋഢ़ઔدઊҎ࠭ஔಠ൝ઘઅ१३ ӄ੭ڂઅৢऀ൙ਐڢৗ೩٩ޅਐ൝ઘਁ֢ࣳౌؘ֢
ઊୱפֳણӘӴ࠺ٻؘૻഡୱઊઽઊ܅Ӌഢ़ઔد10
߬ನب݄җউ࢚थ
೩٩ޅਐ൝ઘਁࣳࣛ०ઊࣛ०ٻؘࡻੰઍࠉહ੶ܾ
1020ܾࡂӋٻӋઔ੶֢އҲؘ46ԪࡂӋٻӋઔد11 ೩٩ޅਐਁࣳઅࣛ०ਁӚӆټઌ੶ؘܾ७ഡਐކ
ऀਐӋܹԓݼӋVWHURLG࣏ੋڢઊ্ܱد11فґؘٳ
ӖनਁઅഡԞࡂدؘਐਁઅഡേࠒ़ણ࠸અಶӧ
ܾਐं೩ڝઊࠒ੶ܾ੭ٻӋઊܟഡਐं೩ڝߜ ݼહ੶ܾࣼ੭ݴޅң֢F\WRWR[LFDJHQWݴ౿നࣳࣼ੭ಹ Әֳഗं೩ਁਕӴહઌछࣛඥҲٻӋઊܾઌനࣳࠒ़
੭ܾઅસധઊѿടԞڹߚਁࠋࣥഡدӋ্ܱઔد1213
೩٩ޅਐઅௗݑݴഡफ़౫ܾઊڙѿࣼ੭ଓઅं೩
٪ऀ൭Әਁઅനࣳࣛ०ઍ੶ే़ઔކफ़౫ܾઊڙ
ৢઊࠒઅਐৱૂടؘ൭ӘѿઔԞڹߚਁણԞહ੶
ܾफ़౫ܾઊڙઅહഡ࣏ੋઊਠඥܱਁً٩ઊ
ٻؘӄੌѿއدԓܟ֢ઊܟഡफ़౫ܾઊڙૂથઅਁف ഡઊૻહઌ൭Әݴઑࣛહ੶ܾಹزടԞѿৰܶԞڹߚਁڹ ڹܾڨܩބਁࢆҲټدഡ൙੭୲੶ܾઌഡनҀפ
ֳણӘӴളേӘേӚ३ࣥઌઘઅਕല੶ܾ३ࣥേӚפֳણ ઊࠋࣥഢ़ઔؘٙઊܟഡӄੌਁਙ൲ѿًܞടد
%XUJR\QH14פֳણઅ࠾ઌਁࣳࣛ०ઊԞӆહઌफ़ಠܩ फ़ਭതՌളേਁ٩ҁાહઌਕല߸دӋણഡࠅઔد
࠭ஔಠ࠾ӘҎਐऀפֳણਁࣳઊਭҎץݼݴહੋഡ دࣛ०ઊԞӆહઌफ़ಠܩफ़ਭതՌ१३ӄਁઊ߸
ਕലӋઔؘളേӘਐ੍ً൛१ై੶ܾঅ१३ӄ छࣛѿङ൛ടӋ१३ӄࣛ०ਁޓੌৢടҲކڝ
़ઔدӋѿીനࡆ़ઔدઊܟഡѿࣹ࠭ஔಠ࠾અણԞહ
ਙ൲ਁࣳࣛ०ઊޓੌૻഡਊഢടؘҫਁفഡࣹ
ઊٽ़ઔد५ૂܾ࠭ஔಠ൝ઘਁࣳ१ܲҿӘѿ֢ࣃӄੌ
ਁࣛ०અ࠾ܲઊઔؘӄੌݴඕടҲࡆ़ઔد
߬ನب݄җदঠ࢚ࣚद۱ೞ
࠭ஔಠ೩٩ޅਐਁࣳ१ৡछࣛઊࠋҽٻң֢१ܲસടѿ֢
Fig. 2.࠭ஔಠ೩٩ޅਐ൝ઘઅસേӚਕҩ࣏અ࣏ଔઊد൜࣒ൌઊേӚਭ१३ӄ੭ڂ $ ਭൠࠉ % ਁࣳӚ୵ټد
A B
www.koreanglaucoma.org
15
9ROXPH_1XPEHU
ౌ֭دേӚਐേӚनൠࠉࡘڢઅޏޅഥ࠾અથ ࠋਁفഡҩ࣏ਭതՌפֳણऀ१ৡछࣛઅѿ؟ऀതՌ
Ӌܱടਉৡഡدಡඥ೩٩ޅਐ൝ઘઅਐઅી٩
ਁگ܅ࣳਠݱ܆ֳݼ܆ടԞڹߚਁ਼ܑਁࣳഡࠤҩ࣏ഡ
ઊԓ൝ઘઅઊ܅Ӌزીഢ़৺دഡפֳણઊ
৺ً܅٩ޏޅ३ӄࣼ੭અंേӚਁनѿઍৰ֢פ
ֳણਁࣳࡂઍ़ઔؘޏޅ३ӄࣼ੭ҿछ੶ܾࡂઍ़ઔ ԞڹߚਁേӚਐઊઔؘ൝ઘਁࣳޏޅ३ӄࣼ੭ܾಶઍ
നࣴതਁઔৰࣳઅѿചടد
֣߬ղܐ
ਐऀפֳણઅௗݑؘҀӄੌބدंࡘહ੶ܾدݴ़
ઔކઍୱહ੶ܾࣛ०અઌઊٻؘ೩٩ޅਐ
ത੶ܾঅࣛ०߸ݼਙࠒടؘҫઊًૻടدӋ
ഢ़ઔدࣛ०ઊ֢ౌ֥ӄੌؘ१३ӄઊઊ߸ৢട ԞڹߚਁࠋऀפֳણࡂدًહԔહ੶ܾઊച
ടد೩٩ޅਐ൝ઘઅࣛ०߸ݼਙௐടԞѿৰܶ
Ԟڹߚਁടҋૂݴ੭ടң֢ࣳࣳඥਉ֢ѿৡഡ دԓݼӋણԞહ੶ؘܾ೩٩ޅਐ൝ઘਁࣳ֯
Ҳടؘҫઊ੭ઋഢ़٩ઔކৈଓઑࣛહઌӴѿًച
ടد
ਐ നؘࣳ फ़౫ܾઊڙ 7FHOO VXSSUHVVRUV
F\WRWR[LFDJHQWڢઊ࣏ੋټدफ़౫ܾઊڙؘૻӴਭ२ं
೩અઊٳৱૂടӋހӴઅ൞ऀ൛ݴޅؘԞ੶ܾઙ
ੋഡدफ़౫ܾઊڙؘઍୱહ੶ܾ࣏ੋٻؘധਐৢߜܾࣳ
ԚऀԞઅਐࠉࢉݼৱૂടؘ൭Әѿઔކ࠭ஔಠ൝ ઘਁࣳણԞહ੶ܾफ़౫ܾઊڙܾࣳਐടؘҫৰ
ܶدޢؘৢઊ֢ીޔؘ࣏ۙઽৢ࣏ङ
࣏ڢد৩ഡӄܾݴ౿ടਉ࣏ੋഢ़ઔدफ़౫ܾઊڙؘԚ
ऀ࠭ஔಠ࠾ௗݑടؘٙ൭Әહઊކથࠋޅ߆ ടؘӄੌѿއӋӋੋܞણԞҁ࣏ੋഢ़৺Ԟڹߚਁ
فࡘ࡚અӄੌدݳਊৱૂૂਭതՌ࣏ੋټد&\FORVSRULQ Ә7DFUROLPXVؘ7ހӴਁઙੋടਉਊৱૂടؘٙԚ
ऀ೩٩ޅਐઅ७ഡી٩ਭࠋ࠾൫़ݴઍ़ઔد15ԓࠇ
ਁ&ROFKLFLQدݳৢૂਭതՌ࣏ੋടਉدݳৢૂઅ࣏ੋ
ܞ҆घ१ౄң֢થࠋࠒടؘહ੶ܾ࣏ੋഡد࠭ஔ ಠ೩٩ޅਐਐઅી٩ѿ७ടӋކऀ੶ܾଔരടਉ५
ઍ੶ౄؘӄੌѿއԞڹߚਁமԕ,QIOL[LPDEӘҎ
71)DOSKDԢധૂݴࡘౡ࠭ஔಠ೩٩ޅਐਁࣳௗ
ݑܾ࣏ੋടؘஷंਁઔد16ԓܟ֢ౌԱҲ٩ӵֳਁؘࣳ
ৈଓ࣏ੋઊളѿٻৌӋઔؘ५ીઊد
ӵघௗݑֳܾफ़౫ܾઊڙ࣏ݴ࣏ੋടਉણԞહઌਐ
൭Әݴࡆ़ઔؘٙ17ਠસٚफ़ҎVORZUHOHDVLQJ
LPSODQWѿ٩ઊٽ़ઔدفԐࡻӯӴਁࣳਠસٚफ़
࣏ੋ੶ܾઌടਉઊ25PP+Jઊࣛ੶ܾѿടؘࡻੰ
ઊ10ਁࣳઔৼކفґৢഡѿܾઊٻৼ Ӌ़ीઊചഡӄੌؘ৺ৼدӋࡂӋടਔد18ԓܟ֢५
ૂઑࣛਁؘࣳઊ߸ࣛ०અ࠾ܲઊઔؘӄੌѿއԞڹ ߚਁࣛ०ਁفനࣳઅԩӚ୵ઊചടد
ടҋௗݑؘৢߜௗݑݴޣસӋܱടӋઊݴ౿ടਉ
ઊா࡚ടৌڹ़ीહઌௗݑݴഡدԞਁ
ؘৢߜܾٻؘӄੌѿއӋਐઅથࠋӘӚٻৰ
ઊࣛ०ടң֢֯ৈކކऀ൛ٽ़ܿৢߜਁસധࡂઊ Ҳټد0LRWLFVؘਐऀפֳણਁؘࣳേࠒ़ણ࠸ً
ಶӧ१ే़ઔԞڹߚਁઍࠉહ੶ܾ࣏ੋടৌؘد़ी
હௗݑؘৢߜௗݑݴமفഡ࣏ੋടਉ٩ઊٻৌ
ڹӋܱٻৰৡഡدઍࠉહ੶ؘܾԚऀਐઊઔڹؘޣ સ७ഡਐഡ൲ਁ़ी१രഡد़ीૻਁ٩൙
ڢӴֳଓछࣛமघ൛ത੶ܾঅ़ीӘٳࠉټਐ
ઊࠋࣥടৌ٩ܿഡد़ी१രടؘ१ઽਁفനࣳӘ ңਁؘਯඥਐઊ࣏܅ଔ൲3ґਖ਼ӄӘഡ൲ਁടؘҫ
ԃ੭ടਔކ़ًीઍ୩१രഡӄੌਁ٩ҿӘ ڝࡂӋടӋઔد1922ਠඥ़ܱीઊׂߗؠৰଘ੶ܾঅ
ਁઅഡࡻѿਊહઌछࣛઊࠋࣥടؘҫਁઅടਉৡഢҫ
੶ܾࣥҀഡد೩٩ޅਐ൝ઘؘࠕֳણѿӋઔؘӄੌѿ
ඕഡٙࣼ੭ૂीӘٳ१ਁ१രഢ़ઔد23ۙഡޏޅഥ
࠾ਁٳࠉټࣛ०અӄੌ੭ݼஔૂीӘࣼ੭ૂी
ٳ१ਁ१രടؘҫ٩Ӌܱനࡆ़ઔد24
결 론
࠭ஔಠ೩٩ޅਐઅௗݑݴനࣳਉܟѿહԔહઌਊ ৱૂௗݑѿґࠋٻӋ१٩ٻӋઔކਉඥ࠭ஔಠ೩٩ޅ ਐ൝ઘઅ१ܲਙ൲ؘৌઊدࣳف࠾અ೩٩ ޅਐీݼئਁࣳ࠭ஔಠ࠾ஔ೩٩ޅਐ൝ઘઅ55ી٩ ݴୱടӋઔી٩ܾੌݼ֢܅ਁࣳ࠭ஔಠ೩٩ޅਐ५
੭ࠋടؘ೩٩ޅਐ੶ܾࣳૻഡௗݴୱടӋઔد
࠭ஔಠ೩٩ޅਐਁࣳࣛ०ඕഡഥ࠾અട֢ܾࣳ१
ܲࣛ५ઍ੶ౄؘࠨઊٽ़ઔԞڹߚਁࡂدஎસഡ
ടҋৢߜௗݑਭઊா࡚ടৌڹؘפֳણ
़ीહԔહ੶ܾӋܱനৡടددരඥ൵ݰഡפֳણࣷ
ࣥتڝઊڛڛടҲਗਁӆऋ࣏ࣳ҆ഢگݵઊد
Journal of The Korean Glaucoma Society
JOURNAL OF THE KOREAN GLAUCOMA SOCIETY 16
참고문헌
1. Mamo JG. Treatment of Behcet disease with chlorambucil.
A follow-up report. Arch Ophthalmol 1976;94:580-3.
2. Yu HG, Lee DS, Seo JM, et al. The number of CD8+ T cells and NKT cells increases in the aqueous humor of patients with Behçet’s uveitis. Clin Exp Immunol 2004;137:437-43.
3. Ahn JK, Yu HG, Chung H, Park YG. Intraocular cytokine environment in active Behçet uveitis. Am J Ophthalmol 2006;142:429-34.
4. Ahn JK, Chung H, Lee DS, et al. CD8brightCD56+ T cells are cytotoxic effectors in patients with active Behcet’s uveitis. J Immunol 2005;175:6133-42.
5. Ahn JK, Seo JM, Yu J, et al. Down-regulation of IFN-gam- ma-producing CD56+ T cells after combined low-dose cy- closporine/prednisone treatment in patients with Behçet’s uveitis. Invest Ophthalmol Vis Sci 2005;46:2458-64.
6. Kim SJ, Lee S, Park C, et al. Targeted resequencing of candidate genes reveals novel variants associated with severe Behçet’s uveitis. Exp Mol Med 2013;45:e49.
7. Feuerstein G, Wang X, Barone FC. Cytokines in brain ischemia--the role of TNF alpha. Cell Mol Neurobiol 1998;18:695-701.
8. De A, Krueger JM, Simasko SM. Glutamate induces the expression and release of tumor necrosis factor-alpha in cultured hypothalamic cells. Brain Res 2005;1053:54-61.
9. Ghezzi P, Dinarello CA, Bianchi M, et al. Hypoxia increas- es production of interleukin-1 and tumor necrosis factor by human mononuclear cells. Cytokine 1991;3:189-94.
10. Yu HG, Kim MJ, Oh FS. Fluorescein angiography and visual acuity in active uveitis with Behçet disease. Ocul Immunol Inflamm 2009;17:41-6.
11. Herbert HM, Viswanathan A, Jackson H, Lightman SL.
Risk factors for elevated intraocular pressure in uveitis. J Glaucoma 2004;13:96-9.
12. Freddo TF, Patterson MM, Scott DR, Epstein DL. Influ- ence of mercurial sulfhydryl agents on aqueous outflow pathways in enucleated eyes. Invest Ophthalmol Vis Sci 1984;25:278-85.
13. Roth M, Simmons RJ. Glaucoma associated with pre-
cipitates on the trabecular meshwork. Ophthalmology 1979;86:1613-9.
14. Burgoyne CF, Downs JC, Bellezza AJ, et al. The optic nerve head as a biomechanical structure: a new para- digm for understanding the role of IOP-related stress and strain in the pathophysiology of glaucomatous optic nerve head damage. Prog Retin Eye Res 2005;24:39-73.
15. Lee SH, Chung H, Yu HG. Clinical outcomes of cyclospo- rine treatment for noninfectious uveitis. Korean J Oph- thalmol 2012;26:21-5.
16. Lindstedt EW, Baarsma GS, Kuijpers RW, van Hagen PM.
Anti-TNF-alpha therapy for sight threatening uveitis. Br J Ophthalmol 2005;89:533-6.
17. Park UC, Park JH, Yu HG. Long-term outcome of intravit- real triamcinolone acetonide injection for the treatment of uveitis attacks in Behçet disease. Ocul Immunol In- flamm 2014;22:27-33.
18. Lowder C, Belfort R Jr, Lightman S, et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol 2011;129:545-53.
19. Papadaki TG, Zacharopoulos IP, Pasquale LR, et al. Long- term results of Ahmed glaucoma valve implantation for uveitic glaucoma. Am J Ophthalmol 2007;144:62-9.
20. Rachmiel R, Trope GE, Buys YM, et al. Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients. Can J Ophthalmol 2008;43:462-7.
21. Ceballos EM, Parrish RK 2nd, Schiffman JC. Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma. Ophthalmology 2002;109:2256- 60.
22. Vuori ML. Molteno aqueous shunt as a primary surgi- cal intervention for uveitic glaucoma: long-term results.
Acta Ophthalmol 2010;88:33-6.
23. Park UC, Ahn JK, Park KH, Yu HG. Phacotrabeculectomy with mitomycin C in patients with uveitis. Am J Ophthal- mol 2006;142:1005-12.
24. Kim BH, Shin JY, Lee MJ, et al. Long-Term Outcomes Fol- lowing Trabeculectomy Combined with 25-Gauge Trans- conjunctival Sutureless Vitrectomy in Uveitis Patients.
Ocul Immunol Inflamm 2014. [Epub ahead of print].
