당뇨황반부종에서 유리체강내 덱사메타손삽입물 치료의 1년 효과
One-year Outcome of Intravitreal Dexamethasone Implant for Diabetic Macular Edema Patients
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목적: 당뇨황반부종에서 유리체강내 덱사메타손삽입물 치료의 1년 효과를 알아보고자 하였다. 대상과 방법: 당뇨황반부종으로 유리체강내 덱사메타손삽입물주입술을 1년 동안 2회 이상 시행받은 67명(70안)의 의무기록을 후향적으로 분석하여 최대교정시력, 중심황반두께 및 안압의 1년간 변화를 관찰하였다. 백내장, 안압상승 등의 이상 반응 발생 여부도 확인하였다. 결과: 전체 환자의 평균 연령은 58.72 ± 9.91세였고, 남성이 38명이었다. 유리체강내 덱사메타손삽입물주입술의 평균 시행 횟수는 2.73 ± 0.65회였으며, 주입술 사이의 간격은 평균 21.52 ± 8.47주였다. 시술 전 평균 최대교정시력(logMAR)은 0.59 ± 0.30, 평균 중심황반두께는 457.17 ± 133.10 μm였다. 최대교정시력은 시술 후 3개월까지 통계적으로 유의한 호전을 보였으나, 1년째에는 시술전에 비해 유의한 차이를 보이지 않았다(p=0.055). 중심황반두께는 시술 후 1년 동안 지속적으로 유의하게 감소된 상태를 유지하였다(p<0.001). 치료 효과에 영향을 주는 요인에 대한 다변량분석에서 당화혈색소가 8.1% 미만인 군에서 시력이 유의하게 더 호전되었으며(p=0.044), 망막하액이 없는 군에서 통계적으로 유의하게 더 많은 중심황반두께의 감소가 있었다(p=0.009). 경과 관찰기간 동안 18명(24%)의 환자에서 안압상승이 관찰되었고, 10명(14%)에서는 백내장 진행이 있었다. 결론: 유리체강내 덱사메타손삽입물주입술은 당뇨황반부종에서 시력의 상승과 황반부종을 감소시키는 효과를 보였다.
Abstract
Purpose: The 1-year outcomes of intravitreal dexamethasone implants in diabetic macular edema (DME) patients were evaluated. Methods: The medical records of 67 patients (70 eyes) with DME were reviewed retrospectively. All patients were treated with intravitreal dexamethasone implants more than twice a year and followed up for at least 1 year from the first dexamethasone implant injection. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured at every visit after the first injection. Adverse effects, including cataract formation and elevation of IOP, were analyzed. Results: The mean patient age was 58.72 ± 9.91 years and 38 patients were male. The average number of injections was 2.73 ± 0.65 and the interval between injections was 21.52 ± 8.47 weeks. The average baseline BCVA and CMT were 0.59 ± 0.30 logMAR and 457.17 ± 133.10 μm, respectively. The BCVA was significantly improved from 3 months after the first injection, but this result did not last for 1 year. The CMT was significantly decreased compared to baseline for 1 year (p < 0.001). Group analysis revealed that the BCVA improved significantly in the group with HbA1c < 8.1% compared to the group with HbA1c ≥ 8.1% (p = 0.044), and the CMT improved significantly in the group with absent subretinal fluid compared to the group with the presence of subretinal fluid (p = 0.009). An elevated IOP was observed in 18 eyes (24%), and cataract formation was observed in 10 eyes (14%). Conclusions: Intravitreal dexamethasone implants resulted in visual acuity stabilization and macular edema reduction in patients with DME.
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