결절맥락막혈관병증에서 유리체강 내 애플리버셉트 치료 저항성과 연관된 초기인자 연구
Initial Factors Associated with Resistance to Intravitreal Aflibercept Injection in Polypoidal Choroidal Vasculopathy
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목적: 유리체강 내 애플리버셉트 주사에 치료 저항성을 보이는 결절맥락막혈관병증에서 저항성과 관련된 초기인자를 확인하고자 한다. 대상과 방법: 애플리버셉트로 치료를 시작하고 최소 24개월 이상 경과 관찰한 결절맥락막혈관병증 환자들을 대상으로 하였고, 치료 저항성은 3회 이상 4주 간격의 연속된 치료에도 망막내액 또는 망막하액의 감소가 100 μm 이상 관찰되지 않으며 치료 간격이 8주 이상으로 연장되지 않는 경우로 정의하였다. 첫 치료 전과 3회 치료 후의 최대교정시력과 빛간섭단층촬영 영상에서 중심와의 전체 맥락막두께를 조사하였고, 전체 맥락막두께는 다시 두 층으로 구분하여 거대맥락막혈관층의 두께와 전체 맥락막두께에서 이를 제외한 혈관의 두께(중간맥락막혈관층/맥락막모세혈관층 두께)로 나누어 측정하였다. 추가로 망막내액, 망막하액, 망막하고반사물질, 망막색소상피박리의 부피를 분석하였다. 로지스틱 회귀분석을 통해 저항성과 연관된 인자를 확인하였다. 결과: 총 76안이 연구에 포함되었으며 39안은 애플리버셉트 치료 저항성을 보이지 않은 군, 37안은 저항성 군에 해당하였다. 나이와 성별을 보정한 다중 로지스틱 회귀분석 결과, 주사 전 중간맥락막혈관층/맥락막모세혈관층 대 전체 맥락막두께의 비율이 작을수록 애플리버셉트 치료에 높은 저항성을 나타나는 것으로 확인되었다. 결론: 애플리버셉트로 주사를 시작한 결절맥락막혈관병증에서, 주사 전 중간맥락막혈관층/맥락막모세혈관층 대 전체 맥락막두께의 비율과 같은 치료 초기의 맥락막 세부 구조는 주사에 대한 반응 정도를 예측할 수 있는 인자로 활용될 수 있을 것이다.
Abstract
Purpose: To identify initial factors contributing to the resistance against intravitreal aflibercept treatment in polypoidal choroidal vasculopathy (PCV) patients. Methods: This study included PCV patients initially treated with aflibercept. Resistance was defined when treatment did not reduce subretinal fluid (SRF) or intraretinal fluid (IRF) by 100 μm or more after three consecutive 4-week intervals, and the treatment interval could not be extended beyond 8 weeks. To identify initial factors associated with resistance to aflibercept treatment, we examined visual acuity and central choroidal thickness before initial treatment and after three treatments. Choroidal thickness was divided into the thickness of the large choroidal vessel layer and the layer that includes choriocapillaris and medium choroidal vessel thickness (termed medium choroidal vessel/choriocapillaris layer thickness, MCCT). Additionally, the volume of SRF, IRF, subretinal hyperreflective material, and pigment epithelial detachment in optical coherence tomography (OCT) images was investigated. The statistical significance of each factor was assessed through logistic regression analysis. Results: The study included 39 eyes showing no resistance to aflibercept and 37 eyes that exhibited resistance. Multiple logistic regression analysis, adjusted for age and sex, indicated that a lower initial ratio of MCCT to choroidal thickness at the fovea was associated with resistance to aflibercept. Conclusions: In patients with PCV treated with aflibercept, early OCT anatomical structures, such as the initial MCCT-choroidal thickness ratio at the fovea, may predict response to treatment injections.
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