망막분지정맥폐쇄 환자의 주사 치료 후 시력 및 중심황반두께와 맥락막혈관지수 관련성 분석
Choroidal Vascularity Index and Treatment Outcomes in Branch Retinal Vein Occlusion Patients with Macular Edema
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목적: 황반부종을 동반한 망막분지정맥폐쇄 환자의 유리체 내 주사 치료 이후 황반부종의 감소 및 시력 개선 정도와 맥락막혈관지수의 관련성을 알아보고자 한다. 대상과 방법: 2017년 1월부터 2020년 10월까지 망막분지정맥폐쇄를 진단받고 유리체 내 항혈관내피성장인자 주사 치료(27안) 혹은덱사메타손 이식제 치료(23안)를 한 환자들을 대상으로 후향 분석하였다. 빛간섭단층촬영을 이용해 해당안과 반대안의 중심황반두께, 황반하 맥락막두께 및 맥락막혈관지수를 측정하여 주사 치료 이후 6개월째 중심황반두께 및 시력 호전 정도와의 상관성을 분석하였다. 결과: 주사 치료 후 6개월째 시력과 중심황반두께가 호전되었다. 다중선형회귀분석상 6개월 후 시력 개선 정도와 관련 있는 인자는반대안 맥락막혈관지수(표준베타계수=0.346, p=0.008), 빛수용체 타원체구역 온전성 정도(표준베타계수=0.398, p=0.001) 및 초기시력(표준베타계수=0.590, p<0.001)이었다. 6개월 후 중심황반두께 감소 정도와 관련 있는 인자는 초기 중심황반두께였다(표준베타계수=0.563, p<0.001). 결론: 황반부종이 심한 경우 빛간섭단층촬영에서 신호 가려짐으로 인해 정확한 맥락막혈관에 대한 평가가 어려울 수 있다. 본 연구에서는 반대안의 맥락막혈관지수가 클수록 황반부종을 동반한 망막분지정맥폐쇄 환자에서 치료 후 시력 개선 정도가 큰 것으로 나타났다. 맥락막혈관지수는 망막분지정맥폐쇄의 치료 예후를 예측하는 데 도움이 될 수 있으며, 이는 맥락막혈관 상태가 망막분지정맥폐쇄의 병태생리에 관여할 수 있음을 시사한다.
Abstract
Purpose: To explore the association between the visual and anatomical outcomes and the choroidal vascularity index (CVI) post-intravitreal injection in patients with macular edema associated with branch retinal vein occlusion (BRVO). Methods: We conducted a retrospective review of medical records of 50 patients (27 eyes treated with anti-vascular endothelial growth factor and 23 eyes treated with a dexamethasone implant) with BRVO and macular edema who underwent intravitreal injections from January 2017 to October 2020. We measured the central macular thickness (CMT), subfoveal choroidal thickness, and CVI of the BRVO eyes and the fellow eyes using optical coherence tomography and then analyzed the correlation between these measurements and visual and anatomical outcomes. Results: After six months of treatment, the best corrected visual acuity improved, and CMT decreased. Multiple linear regression analysis revealed that factors associated with best corrected visual acuity improvement at six months were fellow eye CVI (standardized β = 0.346, p = 0.008), ellipsoid zone integrity (standardized β = 0.398, p = 0.001), and initial best corrected visual acuity (standardized β = 0.590, p < 0.001). Initial CMT (standardized β = 0.563, p < 0.001) was the only factor associated with the decrease in CMT at six months. Conclusions: In cases of severe macular edema, accurate evaluation of choroidal vessels can be challenging due to shadowing. We discovered that a larger CVI in the fellow eye was associated with greater visual improvement in patients with BRVO and macular edema. CVI could be a prognostic factor for predicting treatment outcomes in BRVO patients, suggesting that the choroidal vascular status may play a role in the pathophysiology of BRVO.
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