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 ؽݴ 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 7,000,000અ ൝ઘѿ ؽݴ ѿ ଖ ҫ੶ܾ ࣥҀٻৰ 20ך ࣏ઊਁ ңઅ ڂ ࠔ ѿԪઊ ѿഢ ҫ੶
ܾ ࣥҀټد. ޏޅߚઅܾࣳ ކؘ֢ فد़અ ൝ઘѿ ؽ࠾
ѿӋ ઔدؘ ऽ ࠊৈڝਉৡ ട֢, ചઘݴ ೩തഡ އ ޏ ޅߚઅڝਁҲ ؽ൝ઘؘ ࣛ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, २ؽޏޅ࠾൝ઘਁࣳ ੭ݼஔૂीઊ ऀӖ હઊৼدӋ ࣥҀٻৰ٩, ी ൲ १३ӄઊ ࠕനࣳ, १ܲઊ ઝ
֢ਠؘ ӄੌ٩ ઔد. ധࣛ ൙േӚ३ࣥઊ ࣥԞؘ ৌؘ ७फ़ܤҲ ࡂҲ ٻ, ٻ٩ܿ פֳણ൝ઘܾ ކڝ ৌҲ ടԞ ന ߗ އ ףܲ Ԟઌد.
ؽѿ פֳણ ࠋࣥઅ സઌઘઌਁ فനؘࣳ ץ܇ઊ ઔ
़ ઔҸ੶֢, ؽਭ פֳણઊ Ӗ౿અ സઌઘ ࠃ ੭࣏ഡ ࠋࣥԞ
Ҍؘدؘ ࡂӋѿ ઔৰ, ؽݴ פֳણઅ സઌઘܾ ࡂؘ ୄ ઊ ً ੌंഡ ڡടد. Ԟ ਊഠӴ(Beaver Dam1, Rotterdam2, Blue Mountain Eye Study3) ڢ فԐઅ ઑࣛӴਁؘࣳ ؽ
൝ઘਁࣳ ґࠒҀפֳણઅ ࠋࣥ ѿ؟ऀઊ دӋ ࡂӋടਔ੶֢, Baltimore Eye Survey4, மԕઅ Rotterdam Study5, Framingham Eye Study6,7 ਁؘࣳ ؽਭ 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 ਊഠӴઅ ഡӆઽ Ӌܱഢ ڹ, ५ૂ ؽѿ פֳણઅ ࠋࣥ ѿ؟ऀ ઊؘਁ فഡ غ ਊഠ
Ӵਁࣳ ؘ ҫ ৰܱ ڡ ടد. ઊਁ ઑࣛહઌ ԕң ࠃ ٳߜ५ സ ڢ ԞӴਁࣳ ؽਭ פֳણઅ Ӛऀ ৈ ࡂӋ, ؽޏ ޅ࠾ਁࣳ ࠋࣥടؘ ३ࣥേӚפֳણਁ فന ্ৈࡂӋઘ ഡد.
ؽਭ 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 ३ӄं೩(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 ੭ܾઅ ઊࣛ ઍ੶ౄӋ,12,13 matrix metalloprotein- ase-9 ѿؘ १३ӄ੭ڂઅ Ӵહઌ ઊࣛ ઍ੶ఇ ؽ൝ઘਁ
ࣳ פֳણ ࠋࣥਁ ৢടҲ ކڛد.14,15
േӚं೩ घ५ܾ ઌഡ േӚ ઊࣛ ؽ൝ઘݴ ੍ً
פֳણ ࠋࣥਁ ৢടҲ ކڝ ़ ઔد. ಡඥ, ીࣛ ѿଔ ӄੌ, ӴӚݩઅ સടؘ פֳણ ࠋࣥਁ ૻഡ ਊഢ ഢ ़ ઔ
د.16,17 ؽޏޅ࠾൝ઘਁࣳ ੭ݼஔૂी ൲ ઊ ৌ
ӄੌਁ٩, ളേछࣛਁ અഡ פֳણऀ १३ӄ੭ڂ ࠹൛ѿ ࠋࣥഢ
़ ઔ੶إ, અѿ ചടҸد. ۙഡ, மԕਁؘ anti-VEGF agents
֢ ੭ݼஔҋֳ फ़౫ܾઊڙ ઊ ѿടӋ ઔؘٙ, ؽ൝ઘਁ
ؘࣳ േ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 ࡂടؘ Ԟ؟ ടؘٙ, ؽઅ ٳߜٜਁ
ࣳ ऀࣛӯं೩અ ઊࣛઊ ޏޅ ३ӄं೩અ ઘࣔ ੭٩ഢ ़ ઔ دӋ ഡد.18-20 ۙഡ, ޏޅ ३ӄं೩અ ࣥਁ ૻഡ ਊഢ ട
ؘ ֢ neurotrophin-3ਭ Ҏ ३ӄਕ৩
1HZ3HUVSHFWLYH
ؽਭפֳણ
김 태 완 ᕽᬙ᮹ݡ
www.koreanglaucoma.org
ઌઘઅ ࠋെ ઊࣛઊ axonal transportઅ ણݴ ѿਭ ३ӄ಄൛ (neurodegeneration)ݴ ઍ੶ే ़ ઔد.21,22
மԕਁؘ ؽޏޅਁࣳ ֢ౌؘ֢ ߸ंേӚ ࠹൛ਁ ࣷരനࣳ
३ӄ಄൛ѿ ޣસ ࠋࣥഡدؘ ࡂӋ٩ ઔد. மԕ ࢅҁࣽزਕ
ઊੋഡ Ӵਁ અട, ؽޏޅ࠾ઊ ৺ң֢ ޓੌ ӄ߸ഡ ൝ ઘਁࣳ ३ӄࣼ੭Ә ३ӄं೩, ֳޏࣛઅ घ५ઊ Ӛ୵ٻৼ Ӌ, ࣥ૿ݴ ઊੋഡ streptozocin ੭ࠋ ؽٜਁࣳ٩ ੭࣏ഡ ৩
ࣛઊ ࡂӋٻৼد.23ࢅҁࣽزਕ ઊੋഡ އ Ӵڝਁࣳ
ؽޏޅ࠾ઊ ֢ౌ֢Ԟ زӆਁࣳ ३ӄࣼ੭ ڂՌઅ ҆घ ݴ ࡂਉৼؘٙ,24,25 ઊؘ ؽ൝ઘઅ ઊ פֳણ ࠋࣥਁ ৢ
ടدؘ ԕңઍ ़ ઔد. ؽ൝ઘઅ ࣏൲Ӵਁࣳ٩ ३ӄं೩ ࠃ ३ӄࣼ੭ֳਁࣳ hyaline bodyѿ Ӛ୵ٻৼؘٙ,26 ઊؘ ֳௐ ޏޅਁ થടؘ ं೩ڝઊ छࣛ ࠊ १࣏ടܾ߳, ؽޏޅ
࠾ਁࣳ ࠋࣥടؘ ઊࣛघҽڝઊ פֳણऀ ࠹൛ݴ ٳ१ਁ ઍ੶
ే ़ ઔدؘ ҫ અ߸ടҸد.
३ࣥേӚפֳણઅ ઌ ૻ ؽਁ અഡ ३ࣥേӚפֳણ ৢ 1/3 ી٩ܾ ѿણ ඕഡ ઌઊد. ಡඥ ൙േӚ३ࣥӘ ३ࣥേӚפ
ֳણઊ ৩ਁ ࡂઊؘ ӄੌ ңઅ فࡘ࡚ઊ ؽޏޅ࠾ઊ ઌ ઊ ټد. ৗ੭ݼஔޅઊ֢ ़ીஔ൲֮ Ӵ൲ࡘܾࡘౡ േӚൌ
ऀઌઘѿ Ӵࡘܾ ൜࣒ٻؘ ҫ ୱزടؘ ਊഢ ടؘٙ, ৗ ੭ݼஔޅઊ֢ ़ીஔ൲֮ઊ ಶٻ ൙േӚ३ࣥઊ֢ ३ࣥേ
Ӛפֳણઊ ࠋࣥഢ ѿ؟ऀઊ ً ৈܾ߳,27 २ؽޏޅ࠾
અ ൞ऀઊ ൝ઘઅ ࠕֳણ ़ीઊ֢ ܩઊસ ൲֮ґी અѿ ചടد. ३ࣥേӚפֳણ Ԟઅ ґࠒҀפֳણ زӆਁ
ࣳ ޏޅളേਁ અഡ ࣼ੭േӚޅઅ ़ஸ੶ܾ ൙੭୲ઊ ࣥ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
ઊ ґࠋٻৰ ora serrate ԕઅ ࠹
ࡘ ޏޅਕࣛ٩ ѿ؟നد. ҁ conventional imaging system
ਁؘࣳ ࡂઊ ৌَ ࠹ࡘઅ ३ࣥേӚઊ֢ ७ഡ ंേӚࡻӚ ݩѿ ੶ܾ Ӛ୵ٻؘ ӄੌ٩ ઔؘٙ, ઊܡ ણࡻઅ ࣏ੋઊ ؙৰ֢ ؽਁ અഡ ३ࣥേӚפֳણઅ Ԟଔزਁ٩ ٩ ़ ઔ ҫ੶ܾ Ԟفټد. २ؽޏޅ
Ә Ӛټ ൙േӚ३ࣥઅ ৢ 26% ી٩ਁࣳ ઘ಄൛ѿ ࡂӋ ٻԞ٩ ട֢,28 ѿ؟ഡ ґࠒҀ ౖࣛਁࣳ ௗݑݴ നৡ ਙ൲ѿ ੶
ܾ߳, ൙േӚ३ࣥઊ 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੶ܾ ৺ ़ؘ ৺੶ܾ߳, ࠨޏޅӠӋௗݑઅ ൭ Әѿ ֢ౌ֧ १ҁ(1-2) ٳ ઍ१હ੶ܾ ൙֢ ࠒҀઅ ३ࣥ
േӚ ಄ര१ౄӋ ֯ஷؘ ൭Әݴ Ԟفഢ ़ ઔ ڡട د. ࠨޏޅӠӋௗݑ֢ anti-VEGF agentsઅ ௗݑ ൲ਁؘ ंԔڢ
െ߸ӄҩ࣏ ࠃ ࠒҀӄ ઊੋനࣳ ٳӖઊ֢ ࠒҀ Ӛ୵ന
ௗݑ ࠉ ੭७ඥ ࡅد. ҁ, anti-VEGF agents ࣏ ઊ൲ ३ࣥ
േӚઅ ࢆݳ ࣼ੭ऀ ࠹൛ܾ ઌന ޏޅֳ ҽઌܲઊ ੍ً ं ҽઌ ޏޅࠆݼѿ ଔരടؘ ӄੌ٩ ઔؘٙ, ൙֢ ࠒҀઅ ३ࣥേӚ
҆घ१ే હ੶ܾ ࣏ੋഢ ӄੌ, સҩ࣏ݴ ՞՞ඥ ടਉ ޏޅֳ
ҽઌܲઊ ઙੋടؘ ࡘѿ ઔؘ ं७ඥ ࣔച ചѿ ઔد.
ؽѿ ५અ ૂઍ ࡽ٩ѿ ଖ൝ઌ ކు, Әઅ࣏܅ އ
ؽ൝ઘݴ ࡂৈৡ ഢ ҫઊد. ടކ, ؽؘ פֳણ ߚઅ
ࣷࣥتڝਁҲ٩ ކކௗ ৌ ଖ൝ઍ ڡടد. ੭ݼஔേܾ ઌന
સ ࠃ १३ӄ੭ڂҩ࣏ѿ ੋઊട ৌ ़ ઔӋ, ࠨޏޅӠӋ
ௗݑѿ ټ ӄੌ १ৡҩ࣏ നࣴઊ ৰܱ ़٩ ઔ੶, ؽޏޅ࠾
ਁࣳ ֢ౌؘ֢ ѿ ઔَ ઘݼਁࣳ १ҁઊ ӄ Әതਁ گ܅ १३ӄࣼ੭ ҿछઊ ࡂઍ ़ ઔৰ פֳણऀ ࠹൛ਭ ੭࣏ടҲ ࡂઍ ़٩ ઔد. ۙഡ, ؽ൝ઘਁࣳ ඕඥ ࠋࣥടؘ Ԛ
ऀ ളേऀ १३ӄ࠾Ә ؽޏޅ࠾અ ௗݑܾ ࠨޏޅӠӋௗ
ݑݴ ࠊ ൝ઘਁࣳ٩ ३ӄࣼ੭ઊ ৈଘӘ തՌ १३ӄ੭ڂ ത߂ઊ ࡂઍ ़ ઔৰ פֳણӘઅ ҆࠺ઊ ചടد.29,30 د़અ ޏ ޅӖ ٳࠉഡ ޏޅࠆݼѿ ഥ࠾ټ ӄੌ, ѿഗടҲ Ӗޅڂݱ Ԟѿ ചഡ ӄੌѿ ઔؘٙ, ٭ݰઅ ઊѿ ׂߗ ӄੌ
ࡘ ളേઊ ࣥҺ ઊ ࣛ०ٽ ़٩ ઔد. ৰଶ ޏޅӘ פֳણ અ ࣏Ҁفਁ ઌ ઊܡ ൝ઘڝ ৰۍҲ ࢉݼ ଔزന ௗݑഢ ҫ ઌѿਁ فഡ ߚૂѿ ޏޅߚઅਭ פֳણߚઅ ࣏ઊਁ ङહ ઌ અѿ ചഡ ࡘ࡚ઊ ৈبԪ ࣥҀټد.
ؽਭ פֳણ ૻഡ ӖӖࡂҥ ઊक़ઊد. ਉܟ Ӵݴ ౿ന ؽ൝ઘਁࣳ פֳણ ࠋࣥ ѿ؟ऀઊ ੶, ؽਭ פֳણઊ Ӗ
౿અ സઌઘ ࠃ ੭࣏ഡ ࠋࣥԞ ҌؘدӋ ഡد. ؽਭ פֳ
ણઅ Ӛऀઊ ൜ന ؽ൝ઘਁࣳ פֳણઅ ҩଔઅ ૻऀ
ઊ ੍ً ௵ଖ ҫઊ, ֥ௗऀ ൲Ԟ ३ࣥേӚפֳણ੶ܾ ઌഡ ५
ઍ ़ ઔؘ ܾࣝ ௗݑૂ ґࠋਁ٩ ૻ ౸فѿ ٽ ҫ੶ܾ
ࣥҀټد.
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