스테로이드 사용 후 발생한 중심장액맥락망막병증의 임상양상 비교
Clinical Manifestations of Steroid-associated Central Serous Chorioretinopathy
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목적: 스테로이드 제제 사용 후 발생한 중심장액맥락망막병증 환자에서의 특징을 알아보고 스테로이드 제제 사용 유무에 따른 단기경과를 비교 분석하고자 하였다. 대상과 방법: 2011년 1월부터 2017년 8월까지 본원에서 중심장액맥락망막병증으로 진단된 47명(55안)을 대상으로 의무기록을 후향적으로 분석하였다. 스테로이드 제재 사용 여부를 조사하여 스테로이드 과거력이 없었던 32명(36안)을 1군, 스테로이드 사용 후 증상이 발생한 15명(19안)을 2군으로 나누어서 초진 시 나이, 성별, 양안성, 누출점의 개수, 망막하액의 높이, 중심와아래 맥락막 두께, 할러층의 두께를 조사하여 차이를 알아보았다. 각 군 안에서 치료를 시행한 경우와 경과관찰만 한 경우에서 1달 후의 시력, 망막하액의 높이, 중심와아래 맥락막 두께와 할러층의 두께 변화를 비교 분석하였다. 결과: 두 군 사이에 환자들의 나이, 성별, 시력, 양안성, 누출점의 개수, 할러층의 두께는 차이가 없었고, 망막하액의 높이와 중심와아래 맥락막 두께는 스테로이드 과거력이 있는 군에서 유의미하게 증가되어 있었다(p=0.002, 0.005). 1달 후 1군에서는 치료를 받은 경우에서 망막하액의 높이와 맥락막 두께의 유의미한 감소를 보였고(p=0.001, 0.015), 2군에서는 경과관찰만 한 경우에 망막하액의 높이와 맥락막 두께의 유의미한 감소가 있었다(p=0.005, 0.002). 결론: 중심장액맥락망막병증 환자에서 스테로이드 복용력이 있는 경우에서 망막하액의 높이가 더 높고 중심와아래 맥락막 두께가 더 두껍고 스테로이드 제제를 중단 및 감량하면서 단기 경과관찰을 할 경우에 망막하액과 맥락막 두께의 호전이 있었다.
Abstract
Purpose: To evaluate the clinical differences between patients with central serous chorioretinopathy (CSC) developed after steroid use and CSC patients without a history of steroid use for short-term periods. Methods: We retrospectively analyzed the medical records of 47 patients (55 eyes) diagnosed with CSC from January 2011 to August 2017 by categorizing Group 1 (32 patients, 36 eyes) without a history of steroid use and Group 2 (15 patients, 19 eyes) with a history of steroid use within 6 months. We evaluated the differences in best-corrected visual acuity (BCVA), subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and Haller’s layer thickness in the two groups. We also analyzed the changes in the BCVA, SRF height, SFCT, and Haller’s layer thickness in each group for 1 month and compared them depending on the treatment. Results: There were no significant differences between the two groups with regard to age, sex, BCVA, bilaterality, number of leakage points, and Haller’s layer thickness. Group 2 showed significantly increased SRF height and SFCT than Group 1 (p = 0.002, p = 0.005, respectively). In Group 1, the level of SRF and SFCT were significantly more decreased after 1 month (p = 0.001, 0.015, respectively) in patients with treatment than in those without treatment. In Group 2, the height of the SRF and SFCT were significantly more decreased after 1 month (p = 0.005, 0.002, respectively) in untreated patients compared to treated patients. Conclusions: CSC patients with a prior history of steroid use have higher serous detachment and a thicker SFCT than those without prior history of steroid use. Therefore, termination of steroid treatment may reduce the SFCT and SRF in steroid-treated CSC patients.
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