급성망막동맥폐쇄 환자에서 동맥 내 혈전용해술 효과: 임상 증례 및 문헌 고찰
The Effect of Intra-arterial Thrombolysis in Retinal Artery Occlusion: Case Series and Literature Review
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목적: 국내의 급성망막동맥폐쇄 환자들에게 동맥 내 혈전용해술을 6시간 이내에 시행하였고 그 효과에 대해서 외국의 증례와 비교하여 고찰해 보고자 한다. 대상과 방법: 2019년 6월부터 2019년 11월까지 본원에 급성망막동맥폐쇄로 내원한 5명의 환자에게 시력, 안압, 안저검사, 형광안저촬영을 시행 후 6시간 이내에 동맥 내 혈전용해술을 시행하였다. 이후 경과 관찰을 시행하며 시력 등의 예후를 확인하였다. 해외에서 동맥 내 혈전용해술을 시행한 6개의 연구들에서 연령, 성별, 시술 전후의 시력에 대하여 정리 및 비교하였다. 결과: 본원에서 시행한 5명의 연구에서 평균 연령은 63.4세였다. 남자가 3명, 여자가 2명이었으며 동맥 내 혈전용해술까지 걸린 평균시간은 4.8시간이었다. 시술 전 시력은 증례 1은 안전수동, 증례 2는 0.1, 증례 3은 안전수지 30 cm, 증례 4는 안전수동, 증례 5는 0.08이었다. 시술 후 시력은 증례 1은 0.9, 증례 2는 0.5, 증례 3은 안전수지 30 cm, 증례 4는 0.7, 증례 5는 1.2로 증례 3을 제외한 환자에서 모두 극적인 시력회복이 확인되었다. 해외에서 시행한 연구들의 평균 연령은 대부분 60세 이상이었다. 시술 전 시력은 대부분의 연구에서 빛 인지, 안전수동인 환자가 가장 많았다. 시술 후 시력은 전체에서는 경미한 회복(0.1 이하)이 가장 많았으나 세 가지 연구에서 부분적 회복(0.2-0.4)이상이 각각 65%, 32%, 43%를 보였다. 결론: 급성망막동맥폐쇄 환자가 발병 6시간 이내에 내원한 경우 동맥 내 혈전용해술을 시도해 볼 만하다.
Abstract
Purpose: We performed intra-arterial thrombolysis within 6 hours of presentation in Korean patients with acute retinal artery occlusion. The treatment outcomes of our patients were compared with those from a literature review of this procedure. Methods: Visual acuity, intraocular pressure, fundus photo, and fluorescein angiography were examined in five Korean patients who ultimately underwent intra-arterial thrombolysis due to central retinal artery occlusion. The visual acuity of patients was evaluated after the procedure. The treatment outcomes of our patients were compared with those presented in six foreign intra- arterial thrombolysis studies with respect to age, sex, and visual acuity before and after intra-arterial thrombolysis. Results: In our five cases (three males and two females), the average age was 63.4 years and the average time to the procedure of intra-arterial thrombolysis was 4.8 hours. In the five cases, the visual acuity before intra-arterial thrombolysis were hand movements, 0.1, finger counting at 30 cm, hand movements, and 0.08. Visual acuity after intra-arterial thrombolysis were 0.9, 0.5, finger counting at 30 cm, 0.7, and 1.2. The average age of patients in the six studies from the literature was 60 years, and the most common visual acuity before intra-arterial thrombolysis was light perception and hand movements. A slight improvement in visual acuity (>0 to 0.1) was common in most of the studies; however, three studies showed a partial recovery (from 0.2 to 0.4). Conclusions: For retinal artery occlusion, intra-arterial thrombolysis within 6 hours should be considered as a treatment option.
참고문헌 (29)
- Graefe A, "Embolism of the central retinal artery as the cause of sudden blindness", Arch Ophthalmol, 5, pp.136~157 (1859)
- Rumelt S, "Aggressive systematic treatment for central retinal artery occlusion", Am J Ophthalmol, 128, pp.733~738 (1999)
- Park SJ, "Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011", Ophthalmology, 121, pp.1933~1938 (2014)
- Hayreh SS, "Central retinal artery occlusion : visual outcome", Am J Ophthalmol, 140, pp.376~391 (2005)
- Chang YS, "Retinal artery occlusion and the 3-year risk of stroke in Taiwan : a nationwide population-based study", Am J Ophthalmol, 154, pp.645~652.e1 (2012)
- Beatty S, "Acute occlusion of the retinal arteries : current concepts and recent advances in diagnosis and management", J Accid Emerg Med, 17, pp.324~329 (2000)
- Singh S, "The central artery of the retina. I. Origin and course", Br J Ophthalmol, 44, pp.193~212 (1960)
- Hayreh SS, "Acute retinal arterial occlusive disorders", Prog Retin Eye Res, 30, pp.359~394 (2011)
- Cugati S, "Treatment options for central retinal artery occlusion", Curr Treat Options Neurol, 15, pp.63~77 (2013)
- Sharma RA, "Treatment of nonarteritic acute central retinal artery occlusion", Asia Pac J Ophthalmol(Phila), 7, pp.235~241 (2018)
- Varma DD, "A review of central retinal artery occlusion : clinical presentation and management", Eye(Lond), 27, pp.688~697 (2013)
- Battisti-Charbonney A, "The cerebrovascular response to carbon dioxide in humans", J Physiol, 589(Pt 12), pp.3039~3048 (2011)
- Dattilo M, "Update on the management of central retinal artery occlusion", Neurol Clin, 35, pp.83~100 (2017)
- Fowler SB, "Carbogen in the management of a central retinal artery occlusion", Insight, 37, pp.10~11 (2012)
- Mehta N, "Central retinal artery occlusion : acute management and treatment", Curr Ophthalmol Rep, 5, pp.149~159 (2017)
- Hadanny A, "Reversibility of retinal ischemia due to central retinal artery occlusion by hyperbaric oxygen", Clin Ophthalmol, 11, pp.115~125 (2016)
- Murphy-Lavoie H, "Central retinal artery occlusion treated with oxygen : a literature review and treatment algorithm", Undersea Hyperb Med, 39, pp.943~953 (2012)
- Schumacher M, "Intra-arterial fibrinolytic therapy in central retinal artery occlusion", Neuroradiology, 35, pp.600~605 (1993)
- Arnold M, "Comparison of intra-arterial thrombolysis with conventional treatment in patients with acute central retinal artery occlusion", J Neurol Neurosurg Psychiatry, 76, pp.196~199 (2005)
- Chen CS, "Efficacy of intravenous tissue-type plasminogen activator in central retinal artery occlusion : report from a randomized, controlled trial", Stroke, 42, pp.2229~2234 (2011)
- Astrup J, "Thresholds in cerebral ischemia-the ischemic penumbra", Stroke, 12, pp.723~725 (1981)
- Hayreh SS, "Central retinal artery occlusion. Retinal survival time", Exp Eye Res, 78, pp.723~736 (2004)
- Weber J, "Selective Intra-arterial fibrinolysis of acute central retinal artery occlusion", Stroke, 29, pp.2076~2079 (1998)
- Richard G, "Treatment of retinal arterial occlusion with local fibrinolysis using recombinant tissue plasminogen activator", Ophthalmology, 106, pp.768~773 (1999)
- Mercier J, "Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion : clinical experience in 16 patients", J Neuroradiol, 42, pp.229~235 (2015)
- Aldrich EM, "Local intraarterial fibrinolysis administered in aliquots for the treatment of central retinal artery occlusion : the Johns Hopkins Hospital experience", Stroke, 39, pp.1746~1750 (2008)
- Pettersen JA, "Intra-arterial thrombolysis for retinal artery occlusion : the calgary experience", Can J Neurol Sci, 32, pp.507~511 (2005)
- Butz B, "Selective intraarterial fibrinolysis of acute central retinal artery occlusion", Acta Radiol, 44, pp.680~684 (2003)
- Chronopoulos A, "Central retinal artery occlusion-a new, provisional treatment approach", Surv Ophthalmol, 64, pp.443~451 (2019)