만성 비활성 망막분지정맥폐쇄의 빛간섭단층혈관조영 소견 특징
Characteristics of Optical Coherence Tomography Angiography Findings in Chronic Inactive Branch Retinal Vein Occlusion
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목적: 만성 비활성 망막분지정맥폐쇄의 빛간섭단층혈관조영 결과를 정량 분석하고 그 특징을 알아보고자 하였다. 대상과 방법: 단안 허혈성 급성 망막분지정맥폐쇄로 진단되어 급성기 치료 이후 6개월 동안 재발하지 않은 48안의 의무기록을 후향적으로 분석하였다. 황반부 빛간섭단층혈관조영 영상으로부터 표층 및 심부모세혈관총 이상혈관영역과 심부모세혈관총 울혈영역을 분할한 후 각 영역의 면적, 혈관밀도, 망막평균두께를 측정하였다. 분할 영역의 빛간섭단층혈관조영 인자들과 기본 인자와의 연관성을분석하였다. 결과: 평균 나이는 63.8세로 고혈압은 56.3%에서 동반되었다. 심부모세혈관총 이상혈관영역은 표층보다 모든 환자에서 넓게 측정되어(p<0.001) 그 사이 이행영역이 형성되었다. 심부모세혈관총 울혈영역은 2/3에서 이행영역에 분포하였고, 혈관밀도는 각 모세혈관총정상영역의 혈관밀도보다 높았으며(모두, p<0.001), 망막평균두께는 각 모세혈관총 이상혈관 영역보다 두꺼웠지만(모두, p<0.001) 정상혈관 영역과 차이가 없었다. 표층모세혈관총 이상영역에 심부모세혈관총 울혈영역이 더 많이 분포할수록 안정화 시점에 도달하는주사 회수가 작았다(r=-0.314, p=0.030). 결론: 만성 비활성 망막분지정맥폐쇄의 심부모세혈관총 울혈은 혈관밀도가 높고 이행영역에 주로 분포하였다. 심부모세혈관총 울혈은상승한 정맥내 압력에 대항하여 최소 저항으로 혈류를 배출하는 경로로 추정되며 이는 망막분지정맥폐쇄의 해부학적 안정성을 유지하는 데 중요한 역할을 하는 것으로 사료된다.
Abstract
Purpose: To investigate characteristics of optical coherence tomography angiography (OCTA) findings in chronic inactive branch retinal vein occlusion (BRVO) with quantitative analysis. Methods: The medical records of 48 eyes diagnosed with unilateral ischemic acute BRVO, and without recurrence for 6 months after the acute treatment, were reviewed retrospectively. We manually segmented the abnormal vessels of the superficial and deep capillary plexus (SCP-AV and DCP-AV, respectively) and vascular congestion of DCP (DCP-VC) from 6 × 6 mm2 macular OCTA images and automatically calculated the area, vessel density, and average retinal thickness of each corresponding region. Correlations were analyzed between the OCTA parameters of the segmentation area and the baseline characteristics. Results: The DCP-AV area was always wider than that of the SCP-AV (p < 0.001), with a transitional zone (TZ) between the two areas. About two-thirds of the DCP-VC area was distributed in the TZ. The vessel density of the DCP-VC was higher than that of the normal capillary plexus (all, p < 0.001). The average retinal thickness of the DCP-VC was greater than those of SCP-AV and DCP-AV areas (all, p < 0.001), but not different from the normal capillary plexus. The greater the extent of the DCP-VC distribution under the SCP-AV, the fewer the number of injections required to reach stabilization (r = -0.314, p = 0.030). Conclusions: DCP-VC in chronic inactive BRVO was mainly distributed in the TZ with high vessel density. DCP-VC seems to provide a drainage pathway with minimal resistance against elevated intravenous pressure, which may sustain the anatomical stability of chronic BRVO.
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