급성 중심장액맥락망막병증에서 질병 활성도에 따른 맥락막 특성 변화
Relationships Between Choroidal Characteristics and Disease Activity in Acute Central Serous Chorioretinopathy
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목적: 급성 중심장액맥락망막병증 환자에서 활성 상태와 안정 상태의 맥락막 특성을 비교 분석하여 맥락막 특성이 질병의 경과에미치는 영향을 알아보고자 하였다. 대상과 방법: 급성 중심장액맥락망막병증 33안과 연령-대응한 정상 대조군 35안의 빛간섭단층촬영 결과를 비교하였다. 대상의 기본정보 및 황반을 통과하는 수평의 빛간섭단층촬영 이미지를 획득하여 분석에 활용하였다. 망막하액의 높이, 황반하 맥락막두께를 측정하였으며, 전체 맥락막 범위(total choroidal area, TCA), 혈관성 맥락막 범위(luminal choroidal area, LCA), 간질성 맥락막 범위(stromal choroidal area, SCA)를 측정하여 LCA와 TCA의 비를 맥락막혈관 지표(choroidal vascularity index, CVI)로 지칭하였다. 약 5.6개월 후 망막하액이 모두 흡수된 안정 상태에서 동일한 분석을 재시행하여, 초기 활성 상태와 비교하였다. 결과: 중심장액맥락망막병증군에서 대조군에 비해 유의하게 두꺼운 맥락막두께와 함께 증가된 TCA, LCA, CVI를 보였다. 안정 상태에서는 활성 상태에 비해 유의하게 감소된 맥락막두께를 나타냈다. 안정 상태에서 TCA, LCA, SCA 모두 활성 상태에 비해 감소하였으나, SCA의 감소폭이 LCA의 감소폭보다 더 커서 CVI는 유의한 증가를 보였다(CVI, 68.6 ± 3.2 to 71.6 ± 3.0; p<0.001). 결론: 중심장액맥락망막병증 환자에서 CVI를 확인함으로 질병 활성도를 유추해볼 수 있으며, 치료 및 경과 관찰 여부를 결정하는 데도움이 될 수 있다.
Abstract
Purpose: To investigate choroidal characteristics during active and resolved (presence and absence of subretinal fluid, respectively) central serous chorioretinopathy (CSC), and to clarify their relationships with disease activity. Methods: The choroidal characteristics of 33 CSC and 35 age-matched control eyes were analyzed using optical coherence tomography (OCT). The CSC group included eyes with subretinal fluid at baseline. Horizontal OCT images passing through the macula, and data for age, sex, visual acuity, and refractive error, were acquired. The subretinal fluid height and subfoveal choroidal thickness were measured. The total choroidal area (TCA), luminal choroidal area (LCA), and stromal choroidal area (SCA) were measured using ImageJ software. The choroidal vascularity index (CVI) was defined as the ratio of LCA to TCA. The measurements were repeated after 5.6 months following complete absorption of the subretinal fluid. The choroidal characteristics were compared between the active and resolved phases. Results: The CSC group had significantly greater choroidal thickness, TCA, LCA, and CVI values compared to the control group. The choroidal thickness, TCA, LCA, and SCA were significantly reduced after resolution compared to active CSC. However., the decrease in SCA was greater than that in LCA, which led to a significant increase in CVI (68.6 ± 3.2 vs. 71.6 ± 3.0, p < 0.001) after CSC resolution. Conclusions: CVI measurements may allow estimation of CSC disease activity. TCA, LCA, SCA, and CVI changes may indicate whether the disease is active or resolved, and thus guide CSC treatment.
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