난치성 습성 나이관련황반변성 환자에서 2배 용량 애플리버셉트의 임상 결과
Clinical Outcomes of Double-dose Aflibercept Treatment for Refractory Wet Age-related Macular Degeneration
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목적: 난치성 습성 나이관련황반변성 환자에서 애플리버셉트 용량을 2배로 증량하여 치료한 임상 경과에 대해 알아보고자 하였다. 대상과 방법: 8주 간격의 유리체강내 애플리버셉트(2 mg/0.05 mL) 주사 치료에 반응이 적은 습성 나이관련황반변성에 대하여 2배 용량(4 mg/0.1 mL)으로 치료를 시행한 환자들의 의무 기록을 분석하였다. 치료 8주째 망막하/내액의 변화를 평가, 치료 반응에 영향을 미치는 인자(중심망막두께, 중심맥락막두께, 맥락막신생혈관 크기, 맥락막신생혈관 아형, 망막하/내액의 최대높이 등)를 분석하였다. 결과: 총 95명, 95안 중 61안(64.2%)의 망막하/내액이 감소하거나 사라졌다. 치료 반응이 있는 군은 없는 군에 비해 중심맥락막두께는 두껍고(290.4 μm vs 194.0 μm, p<0.001), 중심망막두께는 얇고(251.2 μm vs 311.1 μm, p=0.018), 맥락막신생혈관 크기가 작고(2.718 mm2 vs 3.964 mm2, p=0.034), 맥락막신생혈관 1형이 많았다(85.2% vs 58.8%, p=0.011). 다변량 로지스틱 회귀분석에서 두터운 중심맥락막두께(p<0.001, OR=1.016), 얇은 중심망막두께(p=0.014, OR=0.988), 크기가 작고(p=0.015, OR=0.662) 1형인 맥락막신생혈관(p=0.001, OR=0.061)이 좋은 치료 반응과 관련 있었다. 결론: 난치성 습성 나이관련황반변성에 애플리버셉트 2배 용량은 64%에서 치료 반응을 보였다. 특히 두터운 맥락막, 크기가 작은 1형 맥락막신생혈관을 가진 증례에서 효과가 좋았다.
Abstract
Purpose: To evaluate the clinical outcomes and prognostic factors of double-dose aflibercept in patients with refractory neovascular age-related macular degeneration (nAMD). Methods: We reviewed the medical records of nAMD patients treated with a double dose of aflibercept (4 mg/0.1 mL) due to an inadequate response to standard 8-weekly intravitreal injections of 2 mg/0.05 mL aflibercept. The assessment at week 8 after treatment included changes in subretinal/intraretinal fluid (SRF/IRF) and best-corrected visual acuity, with patients showing absence or reduction in SRF/IRF classified as the response group. Baseline factors influencing clinical outcomes were analyzed, including central macular thickness (CMT), central choroidal thickness (CCT), size of choroidal neovascularization (CNV), CNV subtype, and maximum height of SRF and IRF. Results: The study included 95 eyes of 95 subjects, with 61 eyes (64.2%) categorized as the response group following double- dose treatment. Responders exhibited thicker CCT (290.4 μm vs. 194.0 μm, p < 0.001), thinner CMT (251.2 μm vs 311.1 μm, p = 0.018), smaller CNV area (2.718 mm2 vs. 3.964 mm2, p = 0.034), and a higher prevalence of type 1 CNV (85.2% vs. 58.8%, p = 0.011) compared to the non-response group. Multivariate binary logistic regression analysis identified thicker CCT (p < 0.001, r = 1.016), thinner CMT (p = 0.014, r = 0.988), smaller CNV area (p = 0.015, r = 0.662), and type 1 CNV (p = 0.001, r = 0.061) as factors associated with better anatomical outcomes. Conclusions: Double-dose aflibercept was effective in 64% of patients with refractory nAMD, suggesting it may be considered for those with small CNV areas, thinner CMT, and thicker CCT.
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