삼출 나이관련황반변성에 의한 황반하출혈에서 유리체강내 애플리버셉트 단독요법의 임상적 효과
Intravitreal Aflibercept Monotherapy for Treating Submacular Hemorrhage Secondary to Neovascular Age-related Macular Degeneration
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목적: 삼출 나이관련황반변성에 의한 황반하출혈에서 유리체강내 애플리버셉트 단독요법을 이용하여 치료한 6개월의 임상적 효과를 보고하고자 한다. 대상과 방법: 삼출 나이관련황반변성에 의한 황반하출혈로 진단 후 유리체강내 애플리버셉트 주입술로 치료받은 54명 54안을 대상으로 후향적 의무기록 분석을 시행하였다. 진단 후 1개월 간격으로 3회의 주사 후, 이후에는 재발하는 경우 추가 치료를 시행하였다. 치료 전 및 주사 후 3개월, 6개월째 최대 교정시력, 중심망막두께 및 황반하출혈 범위를 측정하여 비교하였다. 나이관련황반변성 유형에 따른 결과의 차이를 비교하였고, 6개월째 시력호전에 영향을 미치는 치료 전 인자에 대해 분석하였다. 결과: 치료 전 및 주사 후 3, 6개월에 측정한 최대 교정시력은 각각 0.79 ± 0.59 logMAR, 0.53 ± 0.46 logMAR, 0.48 ± 0.50 logMAR로 치료 전보다 주사 후 유의하게 호전된 결과를 보였다(p＜0.001, in both). 6개월 동안 49안(90.7%)에서 logMAR 3줄 이상의 시력호전 및 logMAR 3줄 이내의 시력유지를 보였다. 중심망막두께는 치료 전 454.4 ± 131.5 μm에서 6개월째 242.6 ± 39.7 μm로 유의하게 감소하였으며(p＜0.001), 황반하출혈 범위도 치료 전 6.4 ± 4.8 disc areas (DAs)에서 6개월째 0.8 ± 1.4 DAs로 유의하게 감소하였다(p＜0.001). 전형적 삼출 나이관련황반변성은 10안(18.5%), 결절맥락막혈관병증은 44안(81.5%)이었고, 6개월째 시력호전에 있어서 두 군 간의 유의한 차이를 보이지 않았다(p=0.616). 결론: 유리체강내 애플리버셉트 단독요법은 삼출 나이관련황반변성에 의한 황반하출혈에서 구조적 개선, 시력의 호전 및 유지에 효과적인 방법으로 생각된다.
Abstract
Purpose: To evaluate the effects of intravitreal aflibercept injection in the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration (nAMD). Methods: This retrospective, observational study included patients diagnosed with nAMD with submacular hemorrhage treated with intravitreal aflibercept monotherapy. A total of 54 eyes of 54 patients were treated with an initial series of three monthly intravitreal aflibercept injections followed by as-needed injections. At the 6 month follow-up, changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and submacular hemorrhage area (SMH) were evaluated. Results: The mean preoperative BCVA was 0.79 ± 0.59 logMAR, which improved significantly to 0.53 ± 0.46 logMAR at 3 months and 0.48 ± 0.50 logMAR at 6 months (p < 0.001, in both). The CMT significantly decreased in all eyes: preoperative, 454.4 ± 131.5 μm, to 242.6 ± 39.7 μm at 6 months. The SMH was also reduced in all eyes: preoperative, 6.4 ± 4.8 disc areas (DAs) to 0.8 ± 1.4 DAs at 6 months. Ten eyes were diagnosed with typical nAMD (18.5%) and 44 eyes were diagnosed polypoidal choroidal vasculopathy (81.5%). There was no significant difference at 6 months in the visual outcomes of the subgroups. Conclusions: Intravitreal aflibercept monotherapy is well-tolerated as a treatment in maintaining or improving vision in patients with SMH secondary to nAMD.
참고문헌 (22)
- Scupola A, "Natural history of macular subretinal hemorrhage in age-related macular degeneration", Ophthalmologica, 213, pp.97~102 (1999)[DOI]
- Toth CA, "Fibrin directs early retinal damage after experimental subretinal hemorrhage", Arch Ophthalmol, 109, pp.723~729 (1991)[DOI]
- Lewis H, "Intraoperative fibrinolysis of submacular hemorrhage with tissue plasminogen activator and surgical drainage", Am J Ophthalmol, 118, pp.559~568 (1994)[DOI]
- Sarks SH, "Ageing and degeneration in the macular region: a clinico- pathological study", Br J Ophthalmol, 60, pp.324~341 (1976)[DOI]
- Berrocal MH, "Variations in the clinical course of submacular hemorrhage", Am J Ophthalmol, 122, pp.486~493 (1996)[DOI]
- Schouten JS, "A systematic review on the effect of bevacizumab in exudative age-related macular degeneration", Graefes Arch Clin Exp Ophthalmol, 247, pp.1~11 (2009)[DOI]
- Heier JS, "Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration", Ophthalmology, 119, pp.2537~2548 (2012)[DOI]
- Browning DJ, "Aflibercept for age-related macular degeneration: a game-changer or quiet addition?", Am J Ophthalmol, 154, pp.222~226 (2012)[DOI]
- Seddon JM, "Evaluation of the clinical age-related maculopathy staging system", Ophthalmology, 113, pp.260~266 (2006)[DOI]
- 박규형, "국내의 나이관련황반변성에 대한 기초역학조사", 대한안과학회지, 51(4), pp.516~523 (2010), 대한안과학회
- Cho H, "Aflibercept for exudative AMD with persistent fluid on ranibizumab and", or bevacizumab, 2013, pp.97, 1032~1035
- 김종하, "베바시주맙과 라니비주맙에 반응 없는 삼출성 나이관련황반변성에서 애플리버셉트 주입술의 효과", 대한안과학회지, 56(9), pp.1359~1364 (2015), 대한안과학회
- Cho HJ, "Anti-vascular endothelial growth factor monotherapy in the treatment of submacular hemorrhage secondary to polypoidal choroidal vasculopathy", Am J Ophthalmol, 156, pp.524~531 (2013)[DOI]
- 김건해, "Clinical Outcomes of Eyes with Submacular Hemorrhage Secondary to Age-related Macular Degeneration Treated with Anti-vascular Endothelial Growth Factor", Korean Journal of Ophthalmology, 29(5), pp.315~324 (2015), 대한안과학회
- Kim HS, "Intravitreal anti-vascular endothelial growth factor monotherapy for large submacular hemorrhage secondary to neovascular age-related macular degeneration", Eye (Lond), 29, pp.1141~1151 (2015)[DOI]
- Cho HJ, "Intravitreal ranibizumab injections with and without pneumatic displacement for treating submacular hemorrhage secondary to neovascular age-related macular degeneration", Retina, 35, pp.205~212 (2015)[DOI]
- Holash J, "VEGF-Trap: a VEGF blocker with potent antitumor effects", Proc Natl Acad Sci U S A, 99, pp.11393~11398 (2002)[DOI]
- Zhang Y, "Effects of aflibercept for neovascular age-related macular degeneration: a systematic review and meta-analysis of observational comparative studies", Invest Ophthalmol Vis Sci, 58, pp.5616~5627 (2017)
- Kyung-Hoon Shin, "The Efficacy of Intravitreal Aflibercept in Submacular Hemorrhage Secondary to Wet Age-related Macular Degeneration", Korean Journal of Ophthalmology, 30(5), pp.369~376 (2016), 대한안과학회
- Yamamoto A, "One-year results of intravitreal aflibercept for polypoidal choroidal vasculopathy", Ophthalmology, 122, pp.1866~1872 (2015)[DOI]
- Iacono P, "Intravitreal ranibizumab for choroidal neovascularization with large submacular hemorrhage in age-related macular degeneration", Retina, 34, pp.281~287 (2014)[DOI]
- Kim JH, "Intravitreal anti-vascular endothelial growth factor for submacular hemorrhage from choroidal neovascularization", Ophthalmology, 121, pp.926~935 (2014)[DOI]