급성 앞시신경염에서 빛간섭단층촬영을 이용한 시력 예후인자 분석
Prognostic Factors for Visual Outcomes in Acute Anterior Optic Neuritis Using Optical Coherence Tomography
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목적: 고용량 스테로이드 치료를 받은 급성 앞시신경염 환자들의 임상 양상과 빛간섭단층촬영을 이용한 시력 예후인자를 알아보고자한다. 대상과 방법: 본 연구는 후향적 연구로 급성 앞시신경염으로 진단받고 고용량 스테로이드 정맥 치료 후 3개월 이상 경과 관찰을 한환자 34명을 최종시력에 따라 20/32 이상(1군, n=23), 20/32 미만(2군, n=11)으로 분류하여 두 군 사이의 임상적 특징을 비교하고빛간섭단층촬영을 이용하여 시력 예후에 영향을 미치는 인자를 분석하고자 하였다. 결과: 진단 시 각 군의 인구학적 특성은 유의미한 차이를 보이지 않았으나 1군에서 2군에 비해 초기 시신경유두부종의 정도가 심하지않았고(p=0.015) 시신경유두부종이 안정화되기까지의 기간이 길었다(p=0.016). 다중회귀분석상, 시신경유두부종의 안정화 기간이 길수록, 황반 신경절세포-내망상층 두께 변화율이 적을수록, 그리고 재발하지 않을 경우 최종시력 예후가 좋은 것을 확인할 수 있었다(p=0.002, 0.016, 0.035). 결론: 급성 앞시신경염에서 고용량 스테로이드 정맥 치료를 시행한 후 경과 관찰을 하였을 때 시신경유두주위 망막 신경 섬유층 두께감소 속도가 느릴수록, 황반 신경절세포-내망상층의 두께 변화율이 적을수록, 그리고 재발하지 않은 경우 시력 예후가 좋았다. 본결과는 급성 앞시신경염에서 스테로이드 치료 후 안구단층촬영의 지표 및 재발 여부가 시력 예후의 표지자가 될 수 있음을 시사한다.
Abstract
Purpose: To identify the clinical characteristics and predictors of visual outcomes in acute anterior optic neuritis patients treated with high-dose steroid pulse therapy using spectral domain optical coherence tomography (SD-OCT). Methods: In this study, the medical records of 34 acute anterior optic neuritis patients treated with intravenous high-dose steroid pulse therapy and followed-up for at least 3 months were retrospectively reviewed. The patients were divided into two groups based on the final best-corrected visual acuity (BCVA); group 1 (n = 23) had a final BCVA ≥20/32, while group 2 (n = 11) had a final BCVA <20/32. Clinical characteristics and optical parameters obtained using SD-OCT were evaluated to identify factors influencing the final visual outcome. Results: There were no statistically significant differences in clinical or demographic data between the two groups. Peripapillary retinal nerve fiber layer (pRNFL) swelling at initial presentation was less common (p = 0.015), and the time to pRNFL thickness stabilization was longer (p = 0.016), in group 1. Multivariate logistic regression demonstrated better final visual acuity for patients in whom pRNFL thickness stabilization took longer, as well as in those with a smaller reduction in macular ganglion cell-inner plexiform layer (mGCIPL) thickness, and those without recurrence (p = 0.002, 0.016, and 0.035, respectively). Conclusions: Intravenous high-dose steroid pulse therapy much improved long-term visual outcomes in acute anterior optic neuritis patients with delayed pRNFL thickness stabilization, a smaller mGCIPL thickness reduction, and no recurrence. This suggests that inner retinal layer thickness and recurrence after stabilization may serve as biomarkers for final visual acuity after intravenous steroid treatment in acute anterior optic neuritis.
참고문헌 (21)
- Abel A, "Critical review : typical and atypical optic neuritis", Surv Ophthalmol, 64, pp.770~779 (2019)
- Woung LC, "A Comparison of optic neuritis in Asian and in Western countries", Neuroophthalmology, 35, pp.65~72 (2011)
- Choy BNK, "Clinical characteristics of optic neuritis in Hong Kong population : 10-year review", Int Ophthalmol, 38, pp.557~564 (2018)
- Beck RW, "A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The optic neuritis study group", N Engl J Med, 326, pp.581~588 (1992)
- Optic Neuritis Study Group, "Multiple sclerosis risk after optic neuritis : final optic neuritis treatment trial follow-up", Arch Neurol, 65, pp.727~732 (2008)
- Meltzer E, "Updates and controversies in the management of acute optic neuritis", Asia Pac J Ophthalmol(Phila), 7, pp.251~256 (2018)
- Toosy AT, "Optic neuritis", Lancet Neurol, 13, pp.83~99 (2014)
- HyoJeong Kim, "Association of Optic Neuritis with Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis in Korea", Korean Journal of Ophthalmology, 33(1), pp.82~90 (2019), 대한안과학회
- "Visual function 5 years after optic neuritis: experience of the optic neuritis treatment trial. The optic neuritis study group", Arch Ophthalmol, 115, pp.1545~1552 (1997)
- Wakakura M, "Baseline features of idiopathic optic neuritis as determined by a multicenter treatment trial in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG)", Jpn J Ophthalmol, 43, pp.127~132 (1999)
- Du Y, "The etiology of optic neuritis in Asian population", Med Hypotheses, 71, pp.821~822 (2008)
- 차동민, "한국인 시신경염 환자의 임상 양상 및 고용량 스테로이드 치료 효과", 대한안과학회지, 52(9), pp.1083~1088 (2011), 대한안과학회
- Optic Neuritis Study Group, "Visual function 15 years after optic neuritis : a final follow-up report from the optic neuritis treatment trial", Ophthalmology, 115, pp.1079~1082 (2008)
- Walter SD, "Ganglion cell loss in relation to visual disability in multiple sclerosis", Ophthalmology, 119, pp.1250~1257 (2012)
- Syc SB, "Optical coherence tomography segmentation reveals ganglion cell layer pathology after optic neuritis", Brain, 135(Pt 2), pp.521~533 (2012)
- Tian G, "Evaluation of retinal nerve fiber layer and ganglion cell complex in patients with optic neuritis or neuromyelitis optica spectrum disorders using optical coherence tomography in a Chinese cohort", J Ophthalmol, 2015, pp.832784~ (2015)
- Huang-Link YM, "Acute optic neuritis : retinal ganglion cell loss precedes retinal nerve fiber thinning", Neurol Sci, 36, pp.617~620 (2015)
- Gabilondo I, "Dynamics of retinal injury after acute optic neuritis", Ann Neurol, 77, pp.517~528 (2015)
- Britze J, "Retinal ganglion cell analysis in multiple sclerosis and optic neuritis : a systematic review and meta-analysis", J Neurol, 264, pp.1837~1853 (2017)
- Siuko M, "The clinical spectrum and prognosis of idiopathic acute optic neuritis : a longitudinal study in Southern Finland", Mult Scler Relat Disord, 35, pp.215~220 (2019)
- Sanchez-Dalmau B, "Early retinal atrophy predicts long-term visual impairment after acute optic neuritis", Mult Scler, 24, pp.1196~1204 (2018)