당뇨황반부종에서 유리체 내 주사제에 따른 치료 전후 고반사점 변화 비교
Comparision of Hyperreflective Foci after Treatment of Diabetic Macular Edema Patients between Intravitreal Injections
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목적: 당뇨황반부종환자의 빛간섭단층촬영에서 나타난 고반사점(hyperreflective foci)의 유리체내 덱사메타손삽입물과 유리체내 베바시주맙주입술 후 변화를 비교하고자 하였다. 대상과 방법: 당뇨황반부종환자 66명, 66안을 대상으로 유리체내 덱사메타손삽입물군(35명, 35안), 유리체내 베바시주맙주입술군(31명, 31안)으로 나누어 후향적 연구를 시행하였다. 빛간섭단층촬영에서 나타난 내망막, 외망막에 위치한 고반사점의 개수, 중심황반두께, 외경계막 및 광수용체 내외측 경계부의 상태, 시력 등의 치료 전후의 변화를 약제에 따라 각각 약 4주 후와 8주 후에 조사하였다. 결과: 고반사점의 개수는 덱사메타손군의 경우 치료 전 10.6 ± 11.8개에서 치료 후 6.3 ± 5.9개로(p=0.005), 베바시주맙주입술군의 경우 치료 전 11.6 ± 8.5개에서 7.7 ± 6.7개로(p<0.001) 두 군 모두에서 유의하게 감소하였다. 덱사메타손삽입물군은 평균 중심황반두께는 치료 전 586.8 μm에서 치료 후 297.7 μm로, 평균 시력은 치료 전 0.33 logMAR에서 치료 후 0.38 logMAR로 유의하게 호전되었다(각각, p<0.001, p=0.018). 베바시주맙군은 평균 중심황반두께는 치료 전 467.1 μm에서 치료 후 353.2 μm로 유의하게 감소했으나(p<0.001), 평균 시력은 치료 전 0.34 logMAR에서 치료 후 0.32 logMAR로 유의한 차이가 없었다(p=0.464). 결론: 유리체내 덱사메타손삽입물과 베바시주맙주입술 후 빛간섭단층촬영에서 나타난 고반사점은 유의하게 감소하였다.
Abstract
Purpose: To compare the outcomes in patients with diabetic macular edema (DME) treated with intravitreal dexamethasone implants and intravitreal bevacizumab injections. Methods: A retrospective cohort study was designed using 66 patients with DME treated with intravitreal dexamethasone (n = 35; 35 eyes) and intravitreal bevacizumab (n = 31; 31 eyes). Post-treatment changes in hyperreflective foci in the inner and outer retina were characterized using optical coherence tomography, central macular thickness, outer limiting membrane, and photoreceptor inner segment-outer segment junctions. Visual acuities were analyzed 4 weeks after bevacizumab injections and 8 weeks after dexamethasone injections. Results: Both groups showed a decrease in the number of hyperreflective foci after treatment: from 10.6 ± 11.8 to 6.3 ± 5.9 (p = 0.005) in the intravitreal dexamethasone implant group and from 11.6 ± 8.5 to 7.7 ± 6.7 (p < 0.001) in the intravitreal bevacizumab injection group. The mean central macular thickness in the dexamethasone group changed significantly from 586.8 μm to 297.7 μm after treatment and the visual acuity improved significantly from 0.33 logMAR to 0.38 logMAR after treatment (p < 0.001 and p = 0.018, respectively). The mean central macular thickness in the bevacizumab group showed a significant decrease from 467.1 μm to 353.2 μm after treatment (p < 0.001), but there was no significant change in the visual acuities: 0.34 logMAR to 0.32 logMAR after treatment (p = 0.464). Conclusions: Both intravitreal dexamethasone implants and bevacizumab treatments in patients with DME showed improved outcomes including a decrease in hyperreflective foci shown by optical coherence tomography.
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