망막대동맥류에서 유리체내 베바시주맙주입술 및 레이저광응고술 병합요법의 치료 효과
Combined Intravitreal Bevacizumab and Laser Photocoagulation to Treat Retinal Arterial Macroaneurysms
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목적: 망막대동맥류에서 유리체내 베바시주맙주입술과 레이저광응고술 병합요법의 치료 효과에 대하여 알아보고자 하였다. 대상과 방법: 망막대동맥류로 인해 시력저하를 호소하는 환자 21명의 21안에 대하여 후향적 연구를 시행하였다. 비슷한 양상의 황반부종 및 출혈을 동반할 수 있는 질환이 동반된 경우 연구 대상에서 제외하였다. 유리체내 베바시주맙주입술과 레이저광응고술을 병합하여 치료한 11안(병합치료군)과 유리체내 베바시주맙주입술 혹은 레이저광응고술을 단독 치료한 10안(단일치료군)을 비교 분석하였다. 시력, 중심망막두께의 변화, 대동맥류의 크기 및 위치, 혈압, 지질 수치에 대하여 분석하였다. 결과: 평균 나이는 74.0 ± 10.5세, 평균 경과 관찰 기간은 7.0 ± 5.3개월이었다. 망막대동맥류의 크기는 병합치료군, 단일치료군에서 480.00 ± 292.30 μm, 328.75 ± 87.09 μm로 병합치료군이 유의하게 컸다(p=0.002). 경과 관찰 4개월째 시력은 0.33 ± 0.26, 0.17 ± 0.29로 병합치료군에서만 유의한 호전을 보였다(p=0.042). 4개월째 경과 관찰에서 중심황반두께는 293.60 ± 46.10 μm, 269.00 ± 48.34 μm로 병합치료군에서만 유의한 감소를 보였다(p=0.043). 초진과 비교하여 최종 시력이 두 줄 이상 호전된 환자의 비율은 각각 73%, 40%로 유의한 차이가 있었다(p<0.001). 결론: 망막대동맥류에서 유리체내 베바시주맙주입술과 레이저광응고술 병합치료요법은 시력의 개선과 황반부두께의 감소를 보이는 효과적인 치료 방법이다.
Abstract
Purpose: To investigate the effects of intravitreal bevacizumab injection combined with laser photocoagulation in patients with retinal microaneurysms. Methods: We retrospectively reviewed the medical records of 21 eyes of 21 patients who underwent intravitreal bevacizumab injection and/or laser photocoagulation to treat retinal macroaneurysms. Eleven eyes received the combination therapy (CT) and 10 eyes monotherapy (MT) (either bevacizumab injection or laser photocoagulation). Changes in visual acuity, central macular thickness, macroaneurysm size and location, blood pressure, and the lipid level were compared between the two groups. Results: The mean patient age was 74.0 ± 10.5 years and the mean study period 7.0 ± 5.3 months. The mean macroaneurysm diameter of the CT group was 480.00 ± 292.30 μm and that of the MT group 328.75 ± 87.09 μm. The diameter was significantly larger in the CT group (p = 0.002). The initial visual acuities were 0.91 ± 0.66 and 0.88 ± 0.83 in the CT and MT groups, respectively. At the 4-month follow-up, the visual acuities were 0.33 ± 0.26 and 0.17 ± 0.29 in the CT and MT groups, respectively, and had significantly improved only in the CT group (p = 0.042). The initial central macular thicknesses were 441.82 ± 226.81 and 541.63 ± 401.97 μm in the CT and MT groups, respectively. At the 4-month follow-up, the figures were 293.60 ± 46.10 and 269.00 ± 48.34 μm in the CT and MT groups, respectively, and had significantly decreased only in the CT group (p = 0.043). Compared to the initial findings, the proportion of patients whose final visual acuities improved by more than two lines were 73% and 40%, respectively, thus significantly higher in the CT group (p < 0.001). Conclusions: Combined intravitreal bevacizumab injection and laser photocoagulation treatment of retinal macroaneurysms improve visual acuity and decrease macular thickness.
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