베바시주맙 주사 후 남아있는 망막분지정맥폐쇄로 인한 부종에서 덱사메타손 반응 예측인자
Predictors of Dexamethasone Response of Residual Edema by Branch Retinal Vein Occlusion after Bevacizumab Injection
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목적: 망막분지정맥폐쇄로 인한 황반부종이 베바시주맙 주사 치료 후에도 남아있는 경우, 유리체강 내 덱사메타손삽입물 주사 치료의반응과 예측인자에 대해서 알아보고자 한다. 대상과 방법: 황반부종으로 베바시주맙을 한 달 간격으로 3차례 시행받았으나 한 달 뒤(주사 결정 시기)에도 부종이 남아서 추가적인주사 치료(덱사메타손 또는 베바시주맙)를 받은 63안을 대상으로 후향적으로 분석하였다. 추가 치료 약제에 따라 두 군을 나누었고, 진단 후 6개월 시점에서 황반부종의 소실 여부로 충분 반응과 부분 반응군으로 나누어 군 간 중심망막두께, 황반하 맥락막두께, 고반사점과 그 값들의 변화량에 대해 분석하였다. 결과: 32안의 덱사메타손군과 31안의 베바시주맙군이 분석에 이용되었다. 주사 결정 시기에서 덱사메타손 충분 반응군이 덱사메타손부분 반응군보다 중심망막두께가 두껍고 중심망막두께의 변화가 작았다(p＜0.05). 그리고 주사 결정 시기에 덱사메타손 충분 반응군이 베바시주맙 충분 반응군보다 황반하 맥락막두께의 변화가 적고, 중심망막두께가 두꺼우며, 중심망막두께 변화가 유의하게 작았다(p＜0.05). Youden index를 통해 구한 절단값은 중심망막두께 409 μm, 중심망막두께 변화량 62.5 μm였다(각각 p=0.002, p=0.011). 결론: 세 차례의 베바시주맙 주사 치료 후에도 황반부종이 남아있는 경우, 중심망막두께가 두껍거나(약 400 μm 이상) 중심망막두께변화량이 작으면(약 62 μm) 베바시주맙에서 덱사메타손삽입물로 약제를 변경하는 것이 황반부종을 감소시키는 데 효과적일 수 있다.
Abstract
Purpose: To predict the response to intravitreal dexamethasone (IVD) implant injection in cases where macular edema (ME) caused by branch retinal vein occlusion persists despite intravitreal bevacizumab injection. Methods: Three consecutive (monthly) bevacizumab injections were given to treat ME caused by branched retinal vein occlusion (BRVO) 63 eyes that received additional dexamethasone or bevacizumab injection 1 month later to treat residual ME were retrospectively studied. Each injection group was divided into two subgroups according to ME disappearance status by 6 months after diagnosis. Initial central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and hyperreflective focus status were compared among the subgroups, as were the changes in these values. Results: At the decision point, the dexamethasone good response subgroups exhibited thicker CRTs and smaller CRT changes than the dexamethasone partial response subgroups (all p < 0.05). The good dexamethasone response subgroup showed smaller SFCT changes, a thicker CRT, and smaller CRT changes than the bevacizumab good response subgroup (all p < 0.05) at the decision point. The cutoff values of the Youden index were 409 μm for the CRT and 62.5 μm for the CRT change (p = 0.002 and p = 0.011, respectively). Conclusions: If ME persists after three bevacizumab injections, IVD more effectively reduces edema if the CRT is thick or if the CRT change is small.
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