제2형 황반부 모세혈관 확장증으로 진단된 국내 환자들의 장기 임상 경과
Long-term Clinical Course of Korean Patients Diagnosed with Macular Telangiectasia Type 2
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목적: 제2형 황반부 모세혈관 확장증 환자들의 장기 시력예후 및 망막 미세구조의 변화에 대해 분석하고자 한다. 대상과 방법: 제2형 황반부 모세혈관 확장증으로 진단된 61안(32명)을 대상으로 후향적 의무기록 분석을 시행하였다. 최초 진단 시 시력을 최종 추적 관찰 시의 시력과 비교하였다. 추가적으로 빛간섭단층촬영 결과를 바탕으로 아래와 같이 세 군으로 분류하였다: 1단계=내망막 공동만 관찰된 경우, 2단계=외망막 공동, 타원체구역 손상이 관찰된 경우, 3단계=타원체구역 손상과 망막색소상피 증식이 관찰된 경우. 추적 관찰 기간 동안 단계의 변화를 확인하였으며, 단계 변화를 보인 안과 그렇지 않은 안 사이의 시력 변화 정도를 서로 비교하였다. 결과: 평균 경과 관찰 기간은 41.5 ± 33.2개월이었다. 시력은 진단 시 logarithm of minimal angle of resolution 평균 0.23 ± 0.26에서 최종 추적 관찰 시 평균 0.31 ± 0.31로 유의하게 악화되었다(p<0.001). 빛간섭단층촬영상 단계는 진단 시 65.6%에서 1단계, 22.9%에서 2단계, 11.5%에서 3단계로 분류되었으며, 최종 추적 관찰 시에는 각각 47.5%, 36.1%, 16.4%로 분류되었다. 전체의 22.9%에서 단계의 진행이 나타났으며, 진행을 보인 안은 그렇지 않은 안보다 큰 폭의 시력악화를 보였다(p=0.002). 결론: 제2형 황반부 모세혈관 확장증 환자에서는 지속적인 시력악화가 나타났으나 장기간의 경과 관찰에도 그 폭은 크지 않았다. 망막 미세구조 손상의 진행이 시력악화의 원인으로 생각된다.
Abstract
Purpose: To evaluate long-term visual prognosis and changes in the retinal microstructure in patients with macular telangiectasia type 2. Methods: Retrospective analysis of medical records were performed for 61 eyes (32 patients) diagnosed with macular telangiectasia type 2. The visual acuity at diagnosis was compared with that at the final visit. In addition, cases were classified into three grades based on optical coherence tomography (OCT) findings: grade 1, inner retinal cavities only; grade 2, outer retinal cavities with ellipsoid zone disruption; and grade 3, ellipsoid zone disruption with proliferation of retinal pigment epithelium. Change in the grade during the follow-up was verified. In addition, visual acuities were compared between eyes with and without a change in grade. Results: The mean follow-up period was 41.5 ± 33.2 months. Visual acuity had deteriorated significantly from the mean logarithm of the minimal angle of resolution 0.23 ± 0.26 at diagnosis to a mean of 0.31 ± 0.31 at the final visit (p < 0.001). When classified using OCT, 65.6%, 22.9%, and 11.5% were grades 1, 2, and 3, respectively, at diagnosis and 47.5%, 36.1%, and 16.4% at the final visit. Progression of grade was noted in 22.9%. A higher degree of visual deterioration was noted in eyes showing progression than in eyes without (p = 0.002). Conclusions: During the long-term follow-up period, visual deterioration was noted in patients with macular telangiectasia type 2. However, the degree of deterioration was not high. Progression in the disruption of the retinal microstructure was the likely cause of visual deterioration.
참고문헌 (19)
- Gass JD, "Idiopathic juxtafoveolar retinal telangiectasis. Update of classification and follow-up study", Ophthalmology, 100, pp.1536~1546 (1993)
- Charbel Issa P, "Macular telangiectasia type 2", Prog Retin Eye Res, 34, pp.49~77 (2013)
- Klein R, "The prevalence of macular telangiectasia type 2 in the Beaver Dam eye study", Am J Ophthalmol, 150, pp.55~62 (2010)
- Powner MB, "Loss of Müller's cells and photoreceptors in macular telangiectasia type 2", Ophthalmology, 120, pp.2344~2352 (2013)
- Kim YH, "Optical coherence tomographic features of macular telangiectasia type 2: Korean macular telangiectasia type 2 study-report no. 1", Sci Rep, 10, pp.16594~ (2020)
- Heeren TFC, "Macular telangiectasia type 2 : visual acuity, disease end stage, and the mactel area : mactel project report number 8", Ophthalmology, 127, pp.1539~1548 (2020)
- Heeren TF, "Progression of vision loss in macular telangiectasia type 2", Invest Ophthalmol Vis Sci, 56, pp.3905~3912 (2015)
- 장용익, "중심오목부근 모세혈관확장증의 임상양상 및 치료", 대한안과학회지, 45(4), pp.8~8 (2004), 대한안과학회
- 김숙진, "양안 황반부 모세혈관 확장증과 연관된 양안 황반 원공 1예", 대한안과학회지, 54(9), pp.1458~1462 (2013), 대한안과학회
- 김성현, "Demographic Features of Idiopathic Macular Telangiectasia in Korean Patients", Korean Journal of Ophthalmology, 29(3), pp.155~159 (2015), 대한안과학회
- Oh JH, "Characteristics of cystoid spaces in type 2 idiopathic macular telangiectasia on spectral domain optical coherence tomography images", Retina, 34, pp.1123~1131 (2014)
- Park YG, "Quantitative analysis of retinal microvascular changes in macular telangiectasia type 2 using optical coherence tomography angiography", PLoS One, 15, pp.e0232255~ (2020)
- Meyer-ter-Vehn T, "Long-term course in type 2 idiopathic macular telangiectasia", Graefes Arch Clin Exp Ophthalmol, 251, pp.2513~2520 (2013)
- Heeren TFC, "Longitudinal correlation of ellipsoid zone loss and functional loss in macular telangiectasia type 2", Retina, 38(Suppl 1), pp.S20~S26 (2018)
- Peto T, "Correlation of clinical and structural progression with visual acuity loss in macular telangiectasia type 2: mactel project report no. 6-the Mactel research group", Retina, 38(Suppl 1), pp.S8~S13 (2018)
- Cai CX, "Retinal cavitations in macular telangiectasia type 2(MacTel) : longitudinal structure-function correlations", Br J Ophthalmol, 105, pp.109~112 (2021)
- Sigler EJ, "Comparison of observation, intravitreal bevacizumab, or pars plana vitrectomy for non-proliferative type 2 idiopathic macular telangiectasia", Graefes Arch Clin Exp Ophthalmol, 251, pp.1097~1101 (2013)
- Chew EY, "Ciliary neurotrophic factor for macular telangiectasia type 2 : results from a phase 1 safety trial", Am J Ophthalmol, 159, pp.659~666 (2015)
- Lavinsky D, "Functional and structural effects of nondamaging retinal laser therapy for macular telangiectasia type 2 : a randomized sham-controlled clinical trial", Retina, 41, pp.487~494 (2021)