높은 망막색소상피박리를 동반한 삼출성 황반변성에서 안내주사 후 망막색소상피파열의 예측인자
Predictors of Retinal Pigment Epithelial Tears in Exudative Macular Degeneration with High Pigment Epithelial Detachment
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목적: 망막색소상피박리의 높이가 400 μm 이상인 삼출성 노인황반변성 환자에서 유리체강내 항혈관내피성장인자 주입술 후 일어나는 망막색소상피파열에 관여하는 인자에 대하여 조사하고자 하였다. 대상과 방법: 2013년 1월부터 2017년 12월까지 본원에서 삼출성 노인황반변성을 진단받고 첫 치료로 유리체강내 항혈관내피성장인자 3회 loading dose를 시행하고 1년 이상 경과 관찰이 가능했던 환자 중 망막색소상피박리의 최대 높이가 400 μm 이상인 55명 55안의 의무기록을 후향적으로 조사하였다. 결과: 총 55안 중 9안(16.4%)에서 망막색소상피파열이 발생하였다. 맥락막신생혈관의 넓이와 망막색소상피박리의 넓이는 모두 파열군이 파열이 일어나지 않은 군보다 크게 측정되었다(p=0.004, p=0.029). 초진시 망막내액이 관찰되는 빈도는 파열군이 89%, 파열이 일어나지 않은 군이 28%로 파열군이 높았으며(p=0.001), 중심와밑맥락막두께는 파열군에서 유의하게 얇게 측정되었다(p=0.003). 나이, 성별, 편위성, 기저 질환 여부, 초기시력, 진단, 망막색소상피박리의 종류, 망막하액의 빈도는 두 군 사이에서 유의한 차이를 보이지 않았다. 다변수 로지스틱 회귀분석을 시행한 결과 망막내액의 유무가 망막색소상피파열과 연관관계가 있는 것으로 분석되었다(odds ratio=20.3, p=0.007). 결론: 망막내액의 존재 유무가 삼출성 황반변성에서 안내주사 후 발생하는 망막색소상피파열과 연관성을 보였다.
Abstract
Purpose: To evaluate the risk factors for retinal pigment epithelium (RPE) tear after intravitreal anti-vascular endothelial growth factor treatment in patients with exudative age-related macular degeneration, associated with high pigment epithelial detachment (PED) (>400 μm). Methods: Fifty-five treatment-naive patients with high PED (>400 μm) and exudative age-related macular degeneration, treated with an initial series of 3 monthly loading injections between January 2013 and December 2017, were retrospectively included. Results: The RPE tear rate was 16.4% (9/55). The areas affected by choroidal neovascularization and PED were significantly larger in the tear group compared with the no-tear group (p = 0.004, p = 0.029, respectively). The rate of intraretinal fluid (IRF) was 89% and 28% in the tear and no-tear groups, respectively (p = 0.001), and the subfoveal choroidal thickness was significantly thinner in the tear group (p = 0.003). There was no significant difference with respect to age, sex, laterality, underlying disease, baseline visual acuity, diagnosis, type of PED, or presence of subretinal fluid between the tear and no-tear groups. According to logistic regression analysis findings, the presence of IRF is associated with a higher risk of RPE tear (odds ratio = 20.3, p = 0.007). Conclusions: The presence of IRF was associated with RPE tear development after intravitreal injection for exudative age-related macular degeneration.
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