망막정맥폐쇄 황반부종에서 항혈관내피성장인자와 덱사메타손 삽입물의 2차원 정량적 단기 효과 비교
Two-dimensional Quantitative Effects of Anti-vascular Endothelial Growth Factor and Dexamethasone Implants on Retinal Vein Occlusion
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목적: 망막정맥폐쇄로 인한 황반부종에서 유리체내 항혈관내피성장인자 및 덱사메타손 삽입물주입술의 치료 효과를 정량적으로 분석하고, 시력호전과 관련된 예후 인자를 알아보고자 하였다. 대상과 방법: 2009년 2월부터 2019년 8월까지 분지망막정맥폐쇄 및 중심망막정맥폐쇄로 진단받고, 황반부종으로 유리체내 항혈관내피성장인자 또는 덱사메타손 삽입물주입술을 받은 환자 83명 83안을 대상으로 후향적 의무기록 분석을 시행하였다. 주입술 전과 주입술 후 1개월째 빛간섭단층촬영에서 황반부단층을 추출한 뒤 망막내액과 망막하액 면적의 픽셀 수를 계산하여 두 주입술의 2차원적 정량적 효과를 비교하였다. 결과: 분지망막정맥폐쇄에서는 항혈관내피성장인자와 덱사메타손 삽입물 간 주사 후 1개월째 망막내액 변화량과 망막부종 소실률은 동일하였다. 반면, 중심망막정맥폐쇄에서는 덱사메타손 삽입물군이 항혈관내피성장인자군에 비해 망막내액 변화량 및 망막부종 감소율이 유의하게 높았다. 선형회귀분석에서는 분지망막정맥폐쇄의 경우 치료 전 망막부종량이 클수록, 주입술 1개월째, 3개월째 시력이 나쁠수록 최종 시력이 좋지 않았으며, 중심망막정맥폐쇄에서는 망막내액 변화량이 클수록, 주입술 3개월째 시력이 나쁠수록 최종 시력이 좋지 않았다. 결론: 분지망막정맥폐쇄에서 항혈관내피성장인자 주입술군과 덱사메타손 삽입물주입술군 간의 해부학적 및 시력호전 정도에 차이는 없었으나, 중심망막정맥폐쇄에서는 단기간 해부학적 호전은 덱사메타손 삽입물주입술군이, 시력호전 정도에서는 항혈관내피성장인자주입술군이 유의하게 컸다.
Abstract
Purpose: We quantitatively analyzed the therapeutic effects of intravitreal anti-vascular endothelial growth factor (anti-VEGF) and dexamethasone implants used to treat macular edema caused by retinal vein occlusion. Methods: Eighty-three patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) with macular edema treated from February 2009 to August 2019 via anti-VEGF injections or dexamethasone implants were enrolled. The medical records of 83 eyes were retrospectively analyzed. Horizontal B-scan spectral domain optical coherence tomography images spanning the foveal center were obtained before treatment and 1 month later. These were analyzed with the aid of Image J software and the numbers of pixels corresponding to intraretinal and subretinal fluids calculated. Results: In patients with BRVO, the retinal fluid changes were identical 1 month after injection in both the anti-VEGF injection and the dexamethasone implant groups. For CRVO cases, the dexamethasone implant group exhibited a significantly higher loss of retinal fluid and thus a greater reduction in retinal edema than the anti-VEGF group. Linear regression analysis revealed that in BRVO cases poor final visual acuity was associated with a large amount of fluid at baseline and poor visual acuity 1 and 3 months after treatment. In CRVO cases, poor final visual acuity was associated with a large change in the intraretinal fluid level and poor visual acuity 3 months after treatment. Conclusions: The extent of anatomical and visual acuity improvement did not differ between the anti-VEGF injection and the dexamethasone injection groups with BRVO. For CRVO patients, the short-term anatomical improvement was significantly greater in the latter group, but the extent of vision improvement was significantly higher in the former group.
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