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난치성 습성 나이관련황반변성에서 브롤루시주맙의 치료 효과와 눈속염증의 임상 경과

Clinical Outcomes of Intravitreal Brolucizumab Injection for Refractory Neovascular Age-related Macular Degeneration

변익수|권한조|박성후|이준영|박노해
대한안과학회 (The Korean Ophthalmological Society)|2024.09|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제65권 제9호|pp. 596-604|DOI https://doi.org/10.3341/jkos.2024.65.9.596

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키워드

InflammationAge-related macular degenerationBrolucizumabVascular endothelial growth factor A
주제분류안과학

초록

목적: 난치성 습성 나이관련황반변성으로 유리체강 내 브롤루시주맙(brolucizumab) 주사를 받은 환자에서 눈속염증의 임상적 특징 및 치료 예후에 대해 조사하였다. 대상과 방법: 이전 유리체강 내 항혈관내피성장인자 주사에 반응이 적어 유리체강 내 브롤루시주맙 주사를 받은 습성 나이관련황반변성 환자의 의무기록을 후향적으로 분석하였다. 주사 전, 후 망막하/내액의 변화를 빛간섭단층영상으로 평가하였고, 세극등검사, 안저검사로 눈속염증 발생과 침범 범위를 조사하였다. 결과: 총 75명(남자 56명, 여자 19명), 76안 중 망막하/내액은 첫 주사 후 55.3% (42안/76안), 세 번째 주사 후 52.3% (23안/44안)에서 소실되었다. 주사간격은 평균 5.6주에서 9.6주로 늘어났다(p<0.001). 시력 변화는 없었다. 11안(14.5%)에서 눈속염증이 발생하였는데, 전방에 국한된 염증 2안, 유리체염 9안, 망막혈관염 1안이었고, 망막혈관폐쇄는 없었다. 모든 눈속염증은 경구 및 점안 스테로이드를 사용하여 평균 3.8주 후 호전되었다. 3안은 테논낭하 스테로이드 주사를 함께 시행하였고 빠른 회복을 보였다(1.67 ± 0.58주 vs 4.63 ± 2.97주, p=0.048). 평균최대교정시력(logMAR)은 0.51에서 눈속염증 발생 시 0.67로 감소하였으나(p=0.018), 치료 후 0.52로 회복되었다. 결론: 난치성 습성 나이관련황반변성 환자에서 브롤루시주맙은 약 50%에서 망막하/내액의 소실을 보였다. 눈속염증은 높은 빈도로 발생하였으나 적극적인 스테로이드 치료로 성공적으로 회복될 수 있었다.

Abstract

Purpose: To investigate the clinical outcomes and intraocular inflammation (IOI) following intravitreal brolucizumab injection for the treatment of refractory neovascular age-related macular degeneration (nAMD). Methods: This retrospective study reviewed the medical records of nAMD patients who received intravitreal brolucizumab injection that was switched from other anti-vascular endothelial growth factor (anti-VEGF) agents due to limited responses. The changes in subretinal/intraretinal fluid (SRF/IRF) and development of IOI were evaluated using slit lamp examination, fundoscopy, and optical coherence tomography. Results: The study included 76 eyes of 75 patients (56 males, 19 females). SRF and IRF disappeared in 55.3% (42/76 eyes) after the first injection and in 52.3% (23/44 eyes) of the remaining eyes after the third injection. The mean treatment interval increased from 5.6 to 9.6 weeks (p < 0.001). Visual acuity did not change. Eleven eyes (14.5%) developed IOI: an anterior chamber reaction in two eyes, vitritis in nine eyes, retinal vasculitis in one eye, and no retinal vascular occlusion. All IOI was treated with steroid eye solution or oral medication and recovered within 3.8 weeks. Three eyes also underwent subtenon steroid injection. Early recovery from IOI was observed in the subtenon steroid injection group (1.67 ± 0.58 vs. 4.63 ± 2.97 weeks, p = 0.048). Visual acuity (logMAR) decreased from 0.51 to 0.67 when IOI developed (p = 0.018), but increased to 0.52 after recovery from IOI. Conclusions: Approximately half of the eyes with refractory nAMD showed complete resolution of SRF/IRF when receiving brolucizumab. IOI had a high incidence, but recovery was successful, with careful monitoring and intensive steroid treatment.

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