근시성 맥락막신생혈관에서 유리체 내 베바시주맙 주입술 후 망막층간분리 악화의 위험인자
Risk Factors for Aggravation of Myopic Retinoschisis after Intravitreal Bevacizumab Injection in Myopic Choroidal Neovascularization
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 베바시주맙 주입술을 시행받은 근시성 맥락막신생혈관 환자에서 망막층간분리를 발생 혹은 진행시키는 인자를 밝히고자 한다. 대상과 방법: 근시성 맥락막신생혈관으로 진단된 후 유리체 내 베바시주맙 주입술을 시행받고 12개월 이상 경과 관찰이 된 54안을대상으로 후향적 의무기록 분석을 시행하였다. 초진 시와 최종 방문 시 빛간섭단층촬영 결과를 비교하여 망막층간분리의 발생 및진행 여부를 평가하고, 망막층간분리 발생 및 진행의 위험인자를 분석하였다. 결과: 평균 42.82 ± 27.12개월의 경과 관찰 기간 동안 11안(20.3%)에서 망막층간분리가 악화되었으며(발생 7안, 진행 4안) 망막층간분리가 악화되지 않은 군에서 안축장은 29.21 ± 1.64 μm였고 악화된 군에서는 31.21 ± 2.52 μm로 통계적으로 유의한 차이를 보였다(p=0.011). 망막층간분리의 악화에 영향을 미치는 요인을 분석한 결과, 단변량 로지스틱 회귀분석에서는 안축장(p=0.041) 및 빛간섭단층촬영에서 외측 망막층간분리가 있는 경우(p=0.018)가 연관된 인자로 나타났다. 다변량 분석에서는 안축장(p=0.038, odds ratio =2.63)이 망막층간분리의 악화와 연관된 인자로 나타났다. 결론: 근시성 맥락막신생혈관 환자에서 안축장이 증가할수록 베바시주맙 주입술 후 망막층간분리 발생 및 진행의 위험도가 증가되는것으로 확인되었다. 안축장이 긴 근시성 맥락막신생혈관 환자에서 베바시주맙 주입술을 시행할 경우 망막층간분리에 대해서도 주의깊은 관찰이 필요할 것으로 생각된다.
Abstract
Purpose: We evaluated the factors associated with the development and progression of retinoschisis in patients with myopic choroidal neovascularization (CNV) treated with intravitreal bevacizumab injections. Methods: We conducted a retrospective analysis of 54 eyes with myopic CNV treated with intravitreal bevacizumab injections. We compared optical coherence tomography findings at baseline and final follow-up visits to assess the occurrence and progression of retinoschisis. Furthermore, we analyzed potential risk factors associated with the occurrence and progression of retinoschisis. Results: During a mean follow-up of 42.82 ± 27.12 months, retinoschisis worsened in 11 eyes (20.3%), including 7 eyes with new-onset disease and 4 with progression. The aggravated group demonstrated a significantly longer baseline axial length compared to the non-aggravated group (31.21 ± 2.52 μm vs. 29.21 ± 1.64 μm, p = 0.011). Univariate logistic regression analysis identified axial length (p = 0.041) and pre-existing outer retinoschisis (p = 0.018) as potential predictors of retinoschisis aggravation. In a multivariate analysis, axial length remained significantly associated with retinoschisis aggravation (p = 0.038, odds ratio = 2.63). Conclusions: Our study emphasized that a longer axial length is a risk factor for the development or progression of retinoschisis in myopic CNV patients treated with intravitreal bevacizumab injections. Therefore, closer monitoring during treatment may be warranted for myopic CNV patients with long axial length at baseline.
참고문헌 (32)
- Ohno-Matsui K, "IMI pathologic myopia", Invest Ophthalmol Vis Sci, 62, pp.5~ (2021)
- Steidl SM, "Macular complications associated with posterior staphyloma", Am J Ophthalmol, 123, pp.181~187 (1997)
- Panozzo G, "Optical coherence tomography findings in myopic traction maculopathy", Arch Ophthalmol, 122, pp.1455~1460 (2004)
- Shimada N, "Macular detachment after successful intravitreal bevacizumab for myopic choroidal neovascularization", Jpn J Ophthalmol, 55, pp.378~382 (2011)
- Kamal-Salah R, "Relationship between paravascular abnormalities and foveoschisis in highly myopic patients", Eye(Lond), 29, pp.280~285 (2015)
- Gaucher D, "Long-term follow-up of high myopic foveoschisis : natural course and surgical outcome", Am J Ophthalmol, 143, pp.455~462 (2007)
- Wu PC, "Factors associated with foveoschisis and foveal detachment without macular hole in high myopia", Eye(Lond), 23, pp.356~361 (2009)
- Huang J, "Retinoschisis and intravitreal ranibizumab treatment for myopic choroidal neovascularization", Chin Med J(Engl), 127, pp.2053~2057 (2014)
- Takano M, "Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma", Am J Ophthalmol, 128, pp.472~476 (1999)
- Benhamou N, "Macular retinoschisis in highly myopic eyes", Am J Ophthalmol, 133, pp.794~800 (2002)
- Fujimoto M, "Features associated with foveal retinal detachment in myopic macular retinoschisis", Am J Ophthalmol, 150, pp.863~870 (2010)
- García-Ben A, "Relationship between macular bending and foveoschisis in myopic patients", Optom Vis Sci, 91, pp.497~506 (2014)
- Kobayashi H, "Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis", Ophthalmology, 110, pp.1702~1707 (2003)
- Polito A, "Spontaneous resolution of a shallow detachment of the macula in a highly myopic eye", Am J Ophthalmol, 135, pp.546~547 (2003)
- Kumagai K, "Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis", Retina, 30, pp.874~880 (2010)
- Sun CB, "Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes", Eye(Lond), 24, pp.1787~1791 (2010)
- Ripandelli G, "Macular vitreoretinal interface abnormalities in highly myopic eyes with posterior staphyloma : 5-year follow-up", Retina, 32, pp.1531~1538 (2012)
- Qi Y, "Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia", Retina, 35, pp.351~357 (2015)
- Shimada N, "Natural course of myopic traction maculopathy and factors associated with progression or resolution", Am J Ophthalmol, 156, pp.948~957 (2013)
- Wolf S, "RADIANCE : a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia", Ophthalmology, 121, pp.682~692 (2014)
- Ikuno Y, "Intravitreal aflibercept injection in patients with myopic choroidal neovascularization : The MYRROR study", Ophthalmology, 122, pp.1220~1227 (2015)
- Ceklic L, "Visual acuity outcomes of ranibizumab treatment in pathologic myopic eyes with macular retinoschisis and choroidal neovascularization", Retina, 37, pp.687~693 (2017)
- Zhou Y, "Progression and new onset of macular retinoschisis in myopic choroidal neovascularization eyes after Conbercept therapy : a post-hoc analysis", Eye(Lond), 34, pp.523~529 (2020)
- Tsui MC, "Vitreoretinal interface changes after anti-vascular endothelial growth factor treatment in highly myopic eyes : a real-world study", Ophthalmol Ther, 12, pp.1693~1710 (2023)
- Wei Q, "Vitreous proteomics provides new insights into antivascular endothelial growth factor therapy for pathologic myopia choroid neovascularization", J Interferon Cytokine Res, 39, pp.786~796 (2019)
- Ng DSC, "Safety review of anti-VEGF therapy in patients with myopic choroidal neovascularization", Expert Opin Drug Saf, 21, pp.43~54 (2022)
- Veloso CE, "Vitreomacular interface after anti-vascular endothelial growth factor injections in neovascular age-related macular degeneration", Ophthalmology, 122, pp.1569~1572 (2015)
- Bando H, "Ultrastructure of internal limiting membrane in myopic foveoschisis", Am J Ophthalmol, 139, pp.197~199 (2005)
- Kim KH, "Clinical effect of intravitreal bevacizumab injection in myopic choroidal neovascularization", J Korean Ophthalmol Soc, 51, pp.359~365 (2010)
- Henaine-Berra A, "Prevalence of macular anatomic abnormalities in high myopia", Ophthalmic Surg Lasers Imaging Retina, 44, pp.140~144 (2013)
- Hayashi K, "Posterior vitreous detachment in highly myopic patients", Invest Ophthalmol Vis Sci, 61, pp.33~ (2020)
- Shimada N, "Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment", Am J Ophthalmol, 142, pp.497~500 (2006)