1형 미숙아망막병증의 유리체 내 라니비주맙 첫 주사 치료 후 재치료의 예측인자
Predictive Factors for Retreatment after Intravitreal Ranibizumab Injection to Treat Type 1 Retinopathy of Prematurity
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목적: 1형 미숙아망막병증의 첫 치료로 라니비주맙 주사 후 재치료를 예측할 수 있는 요인들을 알아보고자 하였다. 대상과 방법: 1형 미숙아망막병증 진단 후 첫 치료로 라니비주맙 0.2 mg을 유리체 내로 주사한 환아들의 의무기록을 후향적으로 분석하였다. 첫 주사 직전 미숙아망막병증이 더 심한 눈만 포함하였고 재활성화되어 다시 1형 미숙아망막병증의 기준을 충족하거나 추가징후(plus sign)를 동반한 stage 3 병변이 출현한 경우 재치료하였다. 주사 전 및 직후의 다양한 인자들을 분석하여 재치료 유무에영향을 미쳤는지 조사하였다. 결과: 총 44명 환아의 44안에 유리체 내 라니비주맙을 주사하였다. 평균 재태연령과 출생체중은 각각 27.8주 및 1,046.6 g이었다. 평균 월경후연령 37.2주에 첫 주사 이후 평균 8.9주 후 21안(47.7%)에서 재치료를 하였다. 재치료군은 단일 주사 치료군에 비해 이른재태연령, 더 낮은 1분 및 5분 Apgar 점수, 주사 전 더 넓은 사분면의 추가 징후, 첫 주사 후 더 오랜 산소 투여 기간 및 추가 징후의소실 기간, 첫 주사 후 더 오랜 퇴행 기간을 나타냈다. 재치료 가능성은 1분 Apgar 점수가 낮을수록(p=0.010, odds ratio [OR]=2.04) 첫 치료 후 추가 징후 소실이 늦을수록(p=0.013, OR=1.44) 증가하였다. 결론: 유리체 내 라니비주맙 주사로 처음 치료한 1형 미숙아망막병증의 약 반에서 2개월 후 재치료가 필요할 수 있다. 첫 주사 후추가 징후 소실 지연은 재치료 가능성이 높아 주사 이후 주의 깊은 경과 관찰이 필요하다.
Abstract
Purpose: To investigate predictive factors for retreatment after intravitreal ranibizumab injection as first-line treatment for retinopathy of prematurity (ROP). Methods: The medical records of consecutive infants diagnosed with type 1 ROP from 2013 to 2021 who received 0.2 mg intravitreal ranibizumab as their first treatments were retrospectively reviewed. Only eyes with severe ROP were included. Retreatment was performed if eyes again met the criteria for type 1 ROP or presented with stage 3 ROP and the plus sign. Factors around the time of first injection that predicted retreatment were assessed. Results: Intravitreal ranibizumab was injected into 44 eyes of 44 infants. The mean gestational age (GA) and body weight were 27.8 weeks and 1,046.6 g, respectively. Retreatment was required by 21 eyes (47.7%) at an average of 8.9 weeks after the first injection, thus at 37.2 weeks of mean postmenstrual age. The retreatment group exhibited a lower GA (p = 0.036), lower 1 minute (min) (p = 0.014) and 5 min (p = 0.029) Apgar scores, and more quadrants with plus signs (p = 0.044) before the first injections; they also had a longer period of oxygen requirement (p = 0.001), more loss of the plus sign (p = 0.014), and more ROP involution (p = 0.003) after the first injections. The risk of needing retreatment increased with a lower 1 min Apgar score (p = 0.010, odds ratio [OR] = 2.04) and later disappearance of the plus sign (p = 0.013, OR = 1.44) after the first injection. Conclusions: About half of patients with type 1 ROP may require retreatment 2 months after the first ranibizumab injection. Delayed loss of the plus sign increases the risk of retreatment; careful fundus examination is recommended after the first injection.
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