보크트-고야나기-하라다 병에서 동반된 전구 증상 유무에 따른 임상양상의 비교
Comparison of Clinical Characteristics in Vogt-Koyanagi-Harada Disease between Patients with and without Prodromal Manifestations
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목적: 보크트-고야나기-하라다 병에서 급성기에 동반된 전구 증상 유무에 따른 임상양상을 비교 분석하고자 한다. 대상과 방법: 보크트-고야나기-하라다 병으로 스테로이드 치료를 시행 받은 대상 환자 총 34명 68안 중, 초진 시 전구 증상이 동반된 환자는 incomplete type (18명 36안), 전구 증상이 없는 환자는 probable type (16명 32안)으로 분류하여, 두 군의 치료 전 최대교정시력, 중심황반두께, 최대 망막하액 높이, 전방 염증세포 정도, 치료 후 12개월째의 최대교정시력, 맥락막두께 및 재발 여부 등의 임상양상을 비교하였다. 결과: 최대교정시력은 logMAR 시력으로 치료 전 incomplete type군이 0.37 ± 0.26, probable type군이 0.35 ± 0.24, 치료 12개월째 각각 0.09 ± 0.17, 0.10 ± 0.18로, 두 군에서 유의한 호전을 보였으나(각각 p<0.05), 두 군 간 차이는 없었다. 맥락막두께는 치료 1주일째와 비교 시 치료 12개월째 두 군에서 유의하게 감소하였으나(각각 p<0.05), 군 간 차이는 없었다. 치료 전 중심황반두께, 최대망막하액 높이, 전방 염증세포 및 재발률 또한 두 군 간 비슷하였다. 결론: 보크트-고야나기-하라다 병에서 급성기 전구 증상의 동반 유무는 최대교정시력, 빛간섭단층촬영 소견 및 재발 여부 등의 임상양상에 영향을 미치지 않음을 알 수 있었다. 전구 증상 유무는 병을 분류하는 진단 기준에 국한되며, 시력예후에 영향을 끼치는 요인은 아님을 추측할 수 있겠다.
Abstract
Purpose: To compare the clinical characteristics of Vogt-Koyanagi-Harada (VKH) disease between patients with and without prodromal manifestations. Methods: We retrospectively reviewed the medical records of patients with VKH disease who were treated with systemic steroids. We grouped the patients into the incomplete type (36 eyes of 18 patients) and probable type (32 eyes of 16 patients) according to the presence of prodromal manifestations. We compared the following outcomes between groups: best-corrected visual acuity (BCVA), anterior chamber (A/C) cell, central foveal thickness (CFT), maximal subretinal fluid (SRF) height, choroidal thickness at baseline and 12 months after treatment, and recurrence rate. Results: BCVA logarithm of the minimum angle of resolution (logMAR) significantly improved from 0.37 ± 0.26 at baseline to 0.09 ± 0.17 at 12 months in the incomplete type group (p < 0.05) and from 0.35 ± 0.24 at baseline to 0.10 ± 0.18 at 12 months in the probable type group (p < 0.05); BCVA did not significantly differ between groups. Choroidal thickness significantly decreased at 12 months after treatment, compared with one week after treatment, in both groups (p < 0.05); choroidal thickness did not significantly differ between groups. There were no significant differences in clinical factors between groups, including baseline A/C cell, CFT, maximal SRF height, and recurrence rate. Conclusions: No associations were found between disease type and clinical outcomes (BCVA, OCT findings, and recurrence). These data suggested that categorization of disease according to prodromal manifestations has limited usefulness in terms of clinical outcomes of VKH disease.
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