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Journal of The Korean Glaucoma Society

JOURNAL OF THE KOREAN GLAUCOMA SOCIETY

2010ך فഡؽ׸࠾ഠ൦ ࡂӋਁ گݱ޷ 30ं ઊࣛ ӵߺઅ 10.1%

ઌ ৢ 3,200,000અ ൝ઘѿ ؽ׸ݴ ৐Ӌ ઔدӋ ട޵, 19.9%ѿ ؽ

׸࠾અ ઺زӆઌ Ӗࡃേؽણ৘܅Ӌ ഡد. மԕ ਉܟ ѿ଒ ൝ӄ ੄ ઌ ࠃ ࣥ൞।Ӛઅ ࠹൛ਭ Ӛܳടਉ ؽ׸ ੭࠾ݬ੸ ֢֧ઊ ଑ѿ ടӋ ઔৰ, 2030ךਁؘ 14%ઌ 7,000,000޻અ ൝ઘѿ ؽ׸ݴ ѿ ଖ ҫ੶ܾ ࣥҀٻৰ 20ך ࣏ઊਁ ңઅ ڂ ࠔ ѿԪઊ ଑ѿഢ ҫ੶

ܾ ࣥҀټد. ޏޅ઺ߚઅܾࣳ ކؘ֢ فد़અ ൝ઘѿ ؽ׸࠾੹

ѿ଒Ӌ ઔدؘ ऽ޻੹ ࠊৈڝਉৡ ട֢, ചઘݴ ೩തഡ އ੸ ޏ ޅ઺ߚઅڝਁҲ ؽ׸൝ઘؘ ࣛؽඥ Ԫدܾ੎ فࣛઊ܅ ਉҺଔ د. އ੸ ൝ઘڝઊ ३ણ ڢ ઺३ౖࣛѿ ૝଒ ৌৈ ৢ ஋ࠒ٩ ৰܶ

Ӌ, ़ीഢ ڹ ଒േ٩ ৰܱੌ޵, ़ी ൲ ҆ਐ ൜ݬ٩ ીࣛઌਁ ࡻ ന ׬د. ۙഡ, ଑२ؽ׸ޏޅ࠾଑൝ઘਁࣳ ੭ݼஔ઻ૂीઊ ऀӖ હઊৼدӋ ࣥҀٻৰ٩, ी ൲ १३ӄઊ ୺ࠕന଒޷ࣳ, १ܲઊ ઝ

৊ ֢ਠؘ ӄੌ٩ ઔد. ധࣛ ൙୼േӚ३ࣥઊ ࣥԞ଒ؘ ৌؘ଒ ૒ ७फ़ܤҲ ࡂҲ ٻ޵, ٻ٩ܿ פֳણ൝ઘܾ ކڝ଒ ৌҲ ടԞ ੥ന ߗ஌ އ੸ ףܲ੹ Ԟ੏ઌد.

ؽ׸ѿ פֳણ ࠋࣥઅ ੥സઌઘઌ଒ਁ فനؘࣳ ץ܇ઊ ઔ੹

़ ઔҸ੶֢, ؽ׸ਭ פֳણઊ Ӗ౿અ ੥സઌઘ ࠃ ੭࣏ഡ ࠋࣥԞ

઺੹ Ҍؘدؘ ࡂӋѿ ઔৰ, ؽ׸ݴ פֳણઅ ੥സઌઘܾ ࡂؘ ୄ ઊ ً ੌंഡ ڡടد. ஢Ԟ ਊഠ਌Ӵ(Beaver Dam1, Rotterdam2, Blue Mountain Eye Study3) ڢ فԐ޾અ ઑࣛ਌Ӵਁؘࣳ ؽ׸

൝ઘਁࣳ ґࠒҀפֳણઅ ࠋࣥ ѿ؟ऀઊ ׬دӋ ࡂӋടਔ੶֢, Baltimore Eye Survey4, மԕઅ Rotterdam Study5, Framingham Eye Study6,7 ਁؘࣳ ؽ׸ਭ פֳણઅ ਌Ӛऀઊ ৺دӋ ࡂӋٻৼ د. ҿӘѿ ࣛઊടҲ ֢ਢ ઊ੭ؘ Ҁ ਌Ӵބد ଔزԞ૴, ೤ѿࠒ

ࠩ, ౿ӆ࡚ࣴ ڢઊ ش܌Ԟ ڹߚઍ ҫઊد. فࣛӶઅ ࣷ౗ઊ֢ ଔ زԞ૴ ڢઊ د৩ഢ ़ ઔدؘ ਊഠ਌Ӵઅ ഡӆઽ੹ Ӌܱഢ ڹ, ५ૂ ؽ׸ѿ פֳણઅ ࠋࣥ ѿ؟ऀ੹ ׬ઊؘ଒ਁ فഡ غ੹ ਊഠ

਌Ӵਁࣳ ୻ؘ ҫ੸ ৰܱ੏ ڡ ടد. ઊਁ ઑࣛહઌ ԕң ࠃ ٳߜ५ സ ڢ Ԟ஢਌Ӵਁࣳ ؽ׸ਭ פֳણઅ ਌Ӛऀ੹ ୻ৈ ࡂӋ, ؽ׸ޏ ޅ࠾଑ਁࣳ ࠋࣥടؘ ३ࣥേӚפֳણਁ فന ্ৈࡂӋઘ ഡد.

ؽ׸ਭ פֳણ੸ ޼޼ Ӗ౿હઌ Ԟ઺੶ܾ ਌Ӛऀઊ ࡂӋٻӋ ઔد. Ӌേؽਁ અഡ ଒ࠒઅ ؽ൛(glycation) ࠃ ଒ࠒ ف࣏અ ઊࣛ

ઊ ࣒൛ फ़ಠܩफ़ ࠃ ं೩ ઘࣔ(cellular apoptosis)੹ ઍ੶ౄؘ

ٙ, ઊؘ ޏޅ ३ӄ઻ं೩(retinal ganglion cell)અ घ५੹ ઍ੶ఇ פֳણ੹ ઍ੶ే ़ ઔد. ҋܲഡ േӚ൜ણ؟ࢻ ৈإ܅, ं೩ ઘ

ࣔ੹ ૒઻ടؘ nitric oxideઅ ଑ѿ ۙഡ ڂ ଖ൝ ࠋࣥਁ ޾ڂ Ӛ ਉടؘ ҫ੶ܾ ্ܱ૊ ઔد.8-11ۙഡ, Protein kinase C (PKC)ؘ

   અ matrix metalloproteinase ઊࣛ੹ ઍ੶

ఇ ࠒ़ ੭஺ܾઅ ઊࣛ੹ ઍ੶ౄӋ,12,13 matrix metalloprotein- ase-9 ଑ѿؘ १३ӄ੭ڂઅ Ӵ૒હઌ ઊࣛ੹ ઍ੶ఇ ؽ׸൝ઘਁ

ࣳ פֳણ ࠋࣥਁ ௃ৢടҲ ކڛد.14,15

േӚ૲੥ं೩ घ५ܾ ઌഡ േӚ ૒઻ઊࣛ੸ ؽ׸൝ઘݴ ੍ً

פֳણ ࠋࣥਁ ௃ৢടҲ ކڝ ़ ઔد. ಡඥ, ીࣛ ৊৒੹ ѿଔ ӄੌ, ৊ӴӚݩઅ સടؘ פֳણ ࠋࣥਁ ૻ੄ഡ ਊഢ੹ ഢ ़ ઔ

د.16,17 ؽ׸ޏޅ࠾଑൝ઘਁࣳ ੭ݼஔ઻ૂी ൲ ৊৒ઊ ׬଒ ৌ੸

ӄੌਁ٩, ളേछࣛਁ અഡ פֳણऀ १३ӄ੭ڂ ࠹൛ѿ ࠋࣥഢ

़ ઔ੶إ, ૲અѿ ച੄ടҸد. ۙഡ, மԕਁؘ anti-VEGF agents

֢ ੭ݼஔҋֳ फ़౫ܾઊڙ ૲઒ઊ ଑ѿടӋ ઔؘٙ, ؽ׸൝ઘਁ

ؘࣳ േӚઅ ઘԞ૒઻(autoregulation) Ԟ؟ઊ ҆घٻৰ ઔৰ, ੭ ݼஔҋֳ ૲઒ ൲ ࠋࣥടؘ ઙ੸ ৊৒ ࣛ०ਁ٩ ௃ৢഢ ़ ઔد.

ऀࣛӯं೩(astrocyte)ਭ Ҏ੸ glial cell੸ ૻஷ३ӄӆ ࠃ ޏޅ, १३ӄ੹ ଒଒ടӋ ࡂ൑ടؘ Ԟ؟੹ ടؘٙ, ؽ׸અ ٳߜ޾ٜਁ

ࣳ ऀࣛӯं೩અ ઊࣛઊ ޏޅ ३ӄ઻ं೩અ ઘࣔ੹ ੭٩ഢ ़ ઔ دӋ ഡد.18-20 ۙഡ, ޏޅ ३ӄ઻ं೩અ ࣥ૔ਁ ૻ੄ഡ ਊഢ੹ ട

ؘŸ   ֢ neurotrophin-3ਭ Ҏ੸ ३ӄਕ৩

1HZ3HUVSHFWLYH

ؽ׸ਭפֳણ

김 태 완 ᕽᬙ᮹ݡ

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www.koreanglaucoma.org

ઌઘઅ ࠋെ ઊࣛઊ axonal transportઅ ણ৘ݴ ѿ૊ਭ ३ӄ಄൛ (neurodegeneration)ݴ ઍ੶ే ़ ઔد.21,22

மԕਁؘ ؽ׸ޏޅ଑ਁࣳ ֢ౌؘ֢ ߸ंേӚ ࠹൛ਁ ࣷരനࣳ

३ӄ಄൛ѿ ޣસ ࠋࣥഡدؘ ࡂӋ٩ ઔد. மԕ ࢅҁࣽز௖஬ਕ

੹ ઊੋഡ ਌Ӵਁ અട޷, ؽ׸ޏޅ࠾଑ઊ ৺ң֢ ޓੌ ӄ߸ഡ ൝ ઘਁࣳ ३ӄࣼ੭௖Ә ३ӄ઻ं೩௖, ֳޏࣛ௖અ घ५ઊ Ӛ୵ٻৼ Ӌ, ࣥ૿ݴ ઊੋഡ streptozocin ੭ࠋ ؽ׸޾ٜਁࣳ٩ ੭࣏ഡ ৩

ࣛઊ ࡂӋٻৼد.23ࢅҁࣽز௖஬ਕ੹ ઊੋഡ އ੸ ਌Ӵڝਁࣳ

ؽ׸ޏޅ࠾଑ઊ ֢ౌ֢Ԟ ઺ زӆਁࣳ ३ӄࣼ੭௖ ڂՌઅ ҆घ ݴ ࡂਉ૲ৼؘٙ,24,25 ઊؘ ؽ׸൝ઘઅ ؁ઊ פֳણ ࠋࣥਁ ௃ৢ

ടدؘ ԕңઍ ़ ઔد. ؽ׸൝ઘઅ ࣏൲਌Ӵਁࣳ٩ ३ӄ઻ं೩ ࠃ ३ӄࣼ੭௖ֳਁࣳ hyaline bodyѿ Ӛ୵ٻৼؘٙ,26 ઊؘ ֳௐ ޏޅਁ ૔થടؘ ं೩ڝઊ छࣛ ࠊ৔੻੹ १࣏ടܾ߳, ؽ׸ޏޅ

࠾଑ਁࣳ ࠋࣥടؘ ઊࣛघҽڝઊ פֳણऀ ࠹൛ݴ ٳ१ਁ ઍ੶

ే ़ ઔدؘ ҫ੹ અ߸ടҸد.

३ࣥേӚפֳણઅ ੘ઌ ૻ ؽ׸ਁ અഡ ३ࣥേӚפֳણ੸ ৢ 1/3 ી٩ܾ ѿણ ඕഡ ੘ઌઊد. ಡඥ ൙୼േӚ३ࣥӘ ३ࣥേӚפ

ֳણઊ ৩৊ਁ ࡂઊؘ ӄੌ ңઅ فࡘ࡚ઊ ؽ׸ޏޅ࠾଑ઊ ੘ઌ ઊ ټد. ৗ੭ݼஔޅઊ֢ ़ીஔ൲֮੸ ৊Ӵ൲ࡘܾࡘౡ േӚൌ

ऀઌઘѿ ৊Ӵ઺ࡘܾ ൜࣒ٻؘ ҫ੹ ୱزടؘ ਊഢ੹ ടؘٙ, ৗ ੭ݼஔޅઊ֢ ़ીஔ൲֮ઊ ಶ਍ٻ޷ ൙୼േӚ३ࣥઊ֢ ३ࣥേ

Ӛפֳણઊ ࠋࣥഢ ѿ؟ऀઊ ً ׬ৈ଒ܾ߳,27 ଑२ؽ׸ޏޅ࠾଑

અ ൞ऀઊ ׬੸ ൝ઘઅ ࠕֳણ ़ीઊ֢ ܩઊસ ൲֮઻ґी੸ ૲ અѿ ച੄ടد. ३ࣥേӚפֳણ੸ ஢Ԟઅ ґࠒҀפֳણ زӆਁ

ࣳ ޏޅളേਁ અഡ ࣼ੭േӚޅઅ ़ஸ੶ܾ ൙୼઺੭୲ઊ ࣥԞ

ؘ ೥नҀפֳણઊ ٻؘٙ, ઊ߸ ੭୲ਁ અന ೥नҀઊ ٻ޷ ৊

৒੹ ીࣛ൛१ౄԞ ৰܶҲ ٻܾ߳, ૒Ԟਁ ࠋҽടؘ ҫઊ ૻ੄ട د. અ७ٻؘ ൝ઘਁؘࣳ ࠉڙ१ ࣒ٳ ઺ਁ ंԔڢെ߸ӄҩ࣏, Ӵ ७ऀٳӖࠉ࣏ ࠃ ઺ࠒҀӄ ҩ࣏ݴ ౿ന ३ࣥേӚઅ ੭ߗݴ ࣔೞ ৡ ഡد. േ৙؁ણ࠸(blood-ocular barrier)અ ઊࣛ੶ܾ ઺ࠒֳं

೩ѿ ࡂઊؘ ӄੌਁؘ ೩٩ޅਐ੶ܾ ਠઌٻԞ٩ ഡد. மԕਁؘ

Ÿ  „ ઊ ґࠋٻৰ ora serrate ԕ஋અ ૲࠹

ࡘ ޏޅਕࣛ٩ ѿ؟ന૏د. ҁ൒ conventional imaging system

ਁؘࣳ ࡂઊ଒ ৌَ ૲࠹ࡘઅ ३ࣥേӚઊ֢ ७ഡ ޾ंേӚࡻӚ ݩѿŸ  „ ੶ܾ Ӛ୵ٻؘ ӄੌ٩ ઔؘٙ, ઊܡ ણࡻઅ ࣏ੋઊ ؙৰ֢޷ ؽ׸ਁ અഡ ३ࣥേӚפֳણઅ ૒ Ԟଔزਁ٩ ٩੒੹ ૵ ़ ઔ੹ ҫ੶ܾ Ԟفټد. ଑२ؽ׸ޏޅ

଑Ә ਌Ӛټ ൙୼േӚ३ࣥઅ ৢ 26% ી٩ਁࣳ ઘ਌಄൛ѿ ࡂӋ ٻԞ٩ ട֢,28 ѿ؟ഡ ґࠒҀ ౖࣛਁࣳ ௗݑݴ നৡ ਙ൲ѿ ૝੶

ܾ߳, ൙୼േӚ३ࣥઊ ࡂઊ޷ ஢Ԟਁ ௗݑഡد. േӚֳഗं೩ऀ

ણઌઘਭ Ҏ੸ േӚൌऀઌઘѿ ૲ټ ਊഢ੹ ടܾ߳ anti-VEGF

agentsઅ ࣏ੋઊ ؙৰ֢Ӌ ઔؘٙ, ३ࣥേӚઅ ࢆݳ ಄൛ݴ ੭٩ ഢ ़ ઔدؘ ણઽઊ ઔ੶֢ ३ࣥേӚפֳણઅ Ԟસ ࠾ݼઌ ޏޅ ളേ੹ ਕӴહ੶ܾ ৺৛ ़ؘ ৺੶ܾ߳, ࠨޏޅӠ੾Ӌௗݑઅ ൭ Әѿ ֢ౌ֧ १ҁ(1-2૲) ٳ৊ ઍ१હ੶ܾ ൙୼֢ ઺ࠒҀઅ ३ࣥ

േӚ੹ ಄ര१ౄӋ ৊৒੹ ֯ஷؘ ൭Әݴ Ԟفഢ ़ ઔ੹ ڡട د. ࠨޏޅӠ੾Ӌௗݑ֢ anti-VEGF agentsઅ ௗݑ ൲ਁؘ ंԔڢ

െ߸ӄҩ࣏ ࠃ ઺ࠒҀӄ੹ ઊੋനࣳ ٳӖ਌ઊ֢ ઺ࠒҀ੹ Ӛ୵ന

ௗݑ ࠉ੾੹ ੭७ඥ ࡅد. ҁ൒, anti-VEGF agents ૲࣏ ઊ൲ ३ࣥ

േӚઅ ࢆݳ ࣼ੭ऀ ࠹൛ܾ ઌന ޏޅֳ ҽઌܲઊ ੍ً ं૊ ҽઌ ޏޅࠆݼѿ ଔരടؘ ӄੌ٩ ઔؘٙ, ൙୼֢ ઺ࠒҀઅ ३ࣥേӚ੹

҆घ१ే ޿હ੶ܾ ࣏ੋഢ ӄੌ, ৊સҩ࣏ݴ ՞՞ඥ ടਉ ޏޅֳ

ҽઌܲઊ ઙੋടؘ ࡘ੥ѿ ઔؘ଒ ं७ඥ ࣔച ച੄ѿ ઔد.

ؽ׸ѿ ५޻અ ૂઍ ࡽ٩ѿ ׬੸ ଖ൝ઌ ކు, ৊Әઅ࣏܅޷ އ

੸ ؽ׸൝ઘݴ ࡂৈৡ ഢ ҫઊد. ട଒ކ, ؽ׸ؘ פֳણ ઺ߚઅ

ࣷࣥتڝਁҲ٩ ކކௗ ৌ੸ ଖ൝ઍ ڡടد. ੭ݼஔ஺േܾ ઌന

৊સ ࠃ १३ӄ੭ڂҩ࣏ѿ ੋઊട଒ ৌ੹ ़ ઔӋ, ࠨޏޅӠ੾Ӌ

ௗݑѿ ټ ӄੌ १ৡҩ࣏ നࣴઊ ৰܱ੏ ़٩ ઔ੶޵, ؽ׸ޏޅ࠾

଑ਁࣳ ֢ౌؘ֢ Ÿ  ѿ ઔَ ઘݼਁࣳ १ҁઊ ӄ Әതਁ گ܅ १३ӄࣼ੭௖ ҿछઊ ࡂઍ ़ ઔৰ פֳણऀ ࠹൛ਭ ੭࣏ടҲ ࡂઍ ़٩ ઔد. ۙഡ, ؽ׸൝ઘਁࣳ ඕඥ ࠋࣥടؘ Ԛ

ऀ ളേऀ १३ӄ࠾଑Ә ؽ׸ޏޅ࠾଑અ ௗݑܾ ࠨޏޅӠ੾Ӌௗ

ݑݴ ࠊ੸ ൝ઘਁࣳ٩ ३ӄࣼ੭௖ઊ ৥ৈଘӘ തՌ १३ӄ੭ڂ ത߂ઊ ࡂઍ ़ ઔৰ פֳણӘઅ ҆࠺ઊ ച੄ടد.29,30 د़અ ޏ ޅ਍Ӗ੹ ٳࠉഡ ޏޅࠆݼѿ ഥ࠾ټ ӄੌ, ࡜ѿഗടҲ Ӗޅڂݱ Ԟѿ ച੄ഡ ӄੌѿ ઔؘٙ, ٭ݰઅ ׬ઊѿ ׂߗ ׬੸ ӄੌ ઺৊

ࡘ ളേઊ ࣥҺ ৊৒ઊ ࣛ०ٽ ़٩ ઔد. ৰଶ޷ ޏޅӘ פֳણ અ ࣏Ҁ଒فਁ ׭ઌ ઊܡ ൝ઘڝ੹ ৰۍҲ ࢉݼ ଔزന ௗݑഢ ҫ ઌѿਁ فഡ ߚૂѿ ޏޅ઺ߚઅਭ פֳણ઺ߚઅ ࣏ઊਁ ଒ङહ ઌ ൉અѿ ച੄ഡ ࡘ࡚ઊ ৈبԪ ࣥҀټد.

ؽ׸ਭ פֳણ੸ ૻ੄ഡ ӖӖࡂҥ ઊक़ઊد. ਉܟ ਌Ӵݴ ౿ന ؽ׸൝ઘਁࣳ פֳણ ࠋࣥ ѿ؟ऀઊ ׬੶޵, ؽ׸ਭ פֳણઊ Ӗ

౿અ ੥സઌઘ ࠃ ੭࣏ഡ ࠋࣥԞ઺੹ ҌؘدӋ ഡد. ؽ׸ਭ פֳ

ણઅ ਌Ӛऀઊ ޻൜ന଒޷ ؽ׸൝ઘਁࣳ פֳણઅ ҩଔઅ ૻ੄ऀ

ઊ ੍ً ௵ଖ ҫઊ޵, ֥ௗऀ ൲Ԟ ३ࣥേӚפֳણ੶ܾ ઌഡ ५޻

੹ ૵ઍ ़ ઔؘ ܾࣝ੎ ௗݑૂ ґࠋਁ٩ ૻ੄ ౸فѿ ٽ ҫ੶ܾ

ࣥҀټد.

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Journal of The Korean Glaucoma Society

JOURNAL OF THE KOREAN GLAUCOMA SOCIETY

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—^' • ‡ ‘¨  $#ˆ  ‹  'X Œ

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