습성 연령관련황반변성에서 재발 시 주사하는 방식에서 지속주사 방식으로 교체 후의 임상결과
Clinical Outcomes after Switching from As-needed to Proactive Injections in the Neovascular Age-related Macular Degeneration
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목적: 습성 연령관련황반변성 환자를 대상으로 재발 시 주사하는 방식(as-needed)으로 치료를 시작하였으나 치료 경과 도중 지속주사 방식(proactive)으로 변경한 환자들의 장기 임상결과를 보고하고자 한다. 대상과 방법: 본 후향적 연구는 습성 연령관련황반변성으로 진단 후 as-needed 방식으로 치료를 진행하던 중 proactive 방식으로 치료 방침을 변경하였던 23안을 대상으로 시행되었다. As-needed 기간과 proactive 기간을 서로 비교하였으며, 두 기간 사이에 연평균 주사 횟수 및 시력 변동의 정도를 추가적으로 비교하였다. 결과: 평균 as-needed 기간은 17.9 ± 8.3개월이었으며, 평균 proactive 기간은 31.3 ± 13.2개월로 proactive 기간이 더 길었다(p<0.001). Proactive 기간의 연평균 주사 횟수(4.4 ± 1.0회)는 as-needed (2.8 ± 1.0)의 기간에 비해 더 높았다(p<0.001). As-needed 기간 동안 나타난 연평균 시력저하의 정도(0.08 ± 0.14)는 proactive 기간에 나타난 정도(0.04 ± 0.08)에 비해 약간 높았으나 그 차이는 유의하지 않았다(p=0.229). 결론: Proactive 치료로 변경 후 장기간의 추적 관찰기간 동안 as-needed 기간에 비해 보다 많은 횟수의 주사가 시행되었으나 시력저하의 정도는 as-needed 기간에 비해 조금 낮은 경향을 보였다. 치료 방식 변화가 장기 예후에 미치는 영향을 보다 정확히 평가하기 위해서는 향후 보다 통제된 연구가 필요할 것이다.
Abstract
Purpose: To evaluate long-term clinical outcomes in patients with neovascular age-related macular degeneration (AMD) who were treated with an as-needed regimen but were switched to a proactive regimen during the course of treatment. Methods: This retrospective study included 23 eyes with neovascular AMD which were initially treated with an as-needed regimen, but switched to a proactive regimen during the course of treatment. The duration of the as-needed phase was compared to that of the proactive phase. In addition, the number of injections per year and the degree of visual deterioration per year were compared between the two phases. Results: The duration of the as-needed and proactive phases were 17.9 ± 8.3 months and 31.3 ± 13.2 months, respectively. The duration of the proactive phase was significantly longer (p < 0.001). The number of injections per year during the proactive phase (4.4 ± 1.0) was significantly more than that during the as-needed phase (2.8 ± 1.0) (p < 0.001). The degree of visual deterioration per year during the as-needed phase (0.08 ± 0.14) was slightly greater than that during the proactive phase (0.04 ± 0.08). However, the difference was not statistically significant (p = 0.229). Conclusions: The number of injections was higher after switching to the proactive regimen. However, the degree of visual deterioration was slightly lower than that noted during the as-needed phase. Further studies with a more controlled design are needed to determine more clearly the impact of switching treatment regimens on long-term clinical outcomes.
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