분지망막동맥폐쇄의 장기 임상 경과와 예후인자
Long-term Clinical Course and Prognostic Factor of Branch Retinal Artery Occlusion
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목적: 분지망막동맥폐쇄의 장기 임상 경과와 예후인자를 분석하고자 한다. 대상과 방법: 분지망막동맥폐쇄로 진단된 환자를 대상으로 후향적 의무기록 분석을 시행하였다. 진단 당시의 시력과 중심망막두께를최종 추적 관찰 시의 값과 서로 비교하였다. 최종 추적 관찰 시의 decimal 시력이 0.6 이상인 환자(좋은 예후군)와 0.5 이하인 환자(나쁜 예후군) 사이에 인자들을 서로 비교하였다. 결과: 55명의 환자가 포함되었으며, 평균 추적 관찰 기간은 45.8 ± 27.8개월이었다. 평균 logarithm of minimum angle of resolution 시력은 진단 시 0.53 ± 0.57에서 최종 추적 관찰 시 0.36 ± 0.61로 유의하게 호전되었다(p=0.026). 진단 시 decimal 시력 0.1 이하는13명(23.6%), 0.2 이상 0.5 이하는 16명(29.1%), 0.6 이상은 26명(47.3%)이었고, 최종 추적 관찰 시 각각 9명(16.4%), 8명(14.5%), 38명(69.1%)이었다. 중심망막두께는 진단 시 평균 273.9 ± 34.7 μm에서 최종 추적 관찰 시 248.9 ± 27.0 μm로 감소하였다(p<0.001). 나쁜 예후군(n=17)은 좋은 예후군(n=38)에 비해 환자의 나이가 더 많았으며(p=0.044) 진단 시 시신경유두황반다발이 침범된 빈도가더 높았다(p<0.001). 결론: 분지망막정맥폐쇄 환자들은 비교적 좋은 장기 결과를 보였으나 16.4%에서는 최종 시력 0.1 이하의 좋지 않은 예후가 나타났다. 예후가 나쁠 가능성이 높은 환자들에서 예후 호전을 위한 추가적인 치료 방침 확립이 필요할 것으로 생각된다.
Abstract
Purpose: To investigate the long-term clinical course and prognostic factors of branch retinal artery occlusion (BRAO). Methods: The medical records of patients diagnosed with BRAO were reviewed retrospectively. Visual acuity (VA) and central retinal thickness (CRT) at diagnosis were compared with those measured at the final visit. Patients with a decimal VA ≥ 0.6 (good prognosis group) were compared with those with a decimal VA ≤ 0.5 (poor prognosis group) at the final visit. Results: Fifty-five patients were enrolled and the mean follow-up period was 45.8 ± 27.8 months. The mean logarithm of minimum angle of resolution improved from 0.53 ± 0.57 at diagnosis to 0.36 ± 0.61 at the final visit (p = 0.026). The decimal VA was ≤ 0.1 in 13 (23.6%) patients, ≥ 0.2 and ≤ 0.5 in 16 (29.1%) patients, and ≥ 0.6 in 26 (47.3%) patients at diagnosis; the respective values were 9 (16.4%), 8 (14.5%), and 38 (69.1%) at the final visit. The mean CRT significantly decreased from 273.9 ± 34.7 μm at diagnosis to 248.9 ± 27.0 μm at the final visit (p < 0.001). The poor prognosis group (n = 17) was older (p = 0.044) and had a higher incidence of papillomacular bundle involvement (p < 0.001) than the good prognosis group (n = 38). Conclusions: Patients with BRAO generally showed relatively favorable long-term outcomes. However, the final VA was ≤ 0.1 in 16.4% of them, suggesting the need for further treatment modalities to improve the outcome of patients with a poor prognosis.
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