중심망막정맥폐쇄의 장기 결과와 황반부종 소실과 연관된 인자
The Long-term Outcomes of Central Retinal Vein Occlusion and Factors Associated with Resolution of Macular Edema
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목적: 중심망막정맥폐쇄에 동반된 황반부종 환자의 장기 결과를 보고하고 치료 과정 중 황반부종이 소실되는 빈도와 이에 관련된 인자를분석하고자 한다. 대상과 방법: 중심망막정맥폐쇄에 동반된 황반부종으로 진단된 환자를 대상으로 후향적 연구를 시행하였다. 진단 시 시력과 최종 추적관찰 시 시력을 서로 비교하였다. 치료 과정 중 황반부종이 소실되는 빈도와 시기를 분석하였으며, 황반부종이 소실된 경우와 그렇지않은 경우 사이에 시력 결과를 서로 비교하였다. 추가적으로 황반부종의 소실을 예측할 수 있는 인자를 분석하였다. 결과: 전체 79명을 대상으로 결과를 분석하였으며, 평균 추적 관찰 기간은 50.1 ± 14.3개월이었다. LogMAR (logarithm of minimal angle of resolution) 시력은 진단 시 평균 0.94 ± 0.75, 최종 추적 관찰 시 평균 1.00 ± 0.84였으며(p=1.000), 28명(35.4%)에서logMAR 0.3 이상의 시력 악화가 나타났다. 추적 관찰 기간 중 40명(50.6%)에서 평균 16.9 ± 17.4개월에 황반부종의 소실이 나타났는데, 황반부종 소실군에서는 비소실군에 비해 더 큰 폭의 시력 호전이 나타났다(p<0.001). 60세 미만의 연령(p=0.039)과 진단 시 망막하액이 관찰되지 않은 경우(p<0.001) 황반부종의 소실 빈도가 높게 나타났다. 결론: 중심망막정맥폐쇄에 동반된 황반부종에서 고령의 환자와 진단 시 망막하액이 관찰된 경우 장기간 황반부종이 지속적으로 재발할가능성이 높으므로 보다 면밀한 추적 관찰과 적극적인 치료가 필요할 것이다.
Abstract
Purpose: To report the long-term outcomes of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO) and to explore the ME incidence and factors associated with ME resolution. Methods: We retrospectively studied patients with ME secondary to CRVO. The visual acuity at baseline was compared to that at the final visit. The incidence and timing of ME resolution during treatment were evaluated and the visual outcomes of patients who did and did not experience ME resolution were compared. We also identified factors predictive of ME resolution. Results: We included 79 patients; the mean follow-up time was 50.1 ± 14.3 months. The mean logarithm of the minimal angle of resolution (logMAR) of visual acuity was 0.94 ± 0.75 at diagnosis and 1.00 ± 0.84 at the final visit (p = 1.000). A logMAR visual loss of 0.3 or greater was noted in 28 patients (35.4%). During follow-up, ME resolution was evident in 40 eyes (50.6%) at a mean of 16.9 ± 17.4 months. Visual improvement was greater in patients who evidenced ME resolution than in those who did not (p < 0.001). The ME resolution rate was higher in patients younger than 60 years (p = 0.039) and in those who lacked subretinal fluid at diagnosis (p < 0.001). Conclusions: In patients with ME secondary to CRVO, the risk of long-term recurrent ME was higher in older patients and those evidencing subretinal fluid at diagnosis indicating that such patients require close follow-up and aggressive treatment.
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