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결절맥락막혈관병증의 혈관조영 분류에 따른 애플리버셉트와 라니비주맙 치료의 효과 비교

A Comparison of Efficacies of Aflibercept and Ranibizumab, Depending on the Angiographic Classification of Polypoidal Choroidal Vasculopathy

이준엽|노동현|사공민|류가형
대한안과학회 (The Korean Ophthalmological Society)|2017.12|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제58권 제12호|pp. 1356-1366

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키워드

AfliberceptPolypoidal choroidal vasculopathyRanibizumabAngiographic classificationPolyp closure
주제분류안과학

초록

목적: 결절맥락막혈관병증(polypoidal choroidal vasculopathy, PCV)을 혈관 조영 특징에 따라 분류하고 애플리버셉트와 라니비주맙주사 후 치료 효과를 비교하고자 하였다. 대상과 방법: PCV로 진단 받고 첫 치료로 라니비주맙(29명)과 애플리버셉트(26명) 주사를 시행 받은 환자 55명의 의무기록을 후향적으로 분석하였다. 인도사이아닌그린혈관조영술에서 분지혈관망의 공급혈관과 배수혈관이 명확히 구분되는 경우를 결절성 맥락막신생혈관(Type 1 PCV, 33명), 이들 구분 없이 주변 정상 맥락막혈관과 동시에 조영되는 경우를 전형적인 결절맥락막혈관병증(Type 2 PCV, 22명)으로 분류하였다. 첫 주사 후 3개월째 혈관조영 소견 변화와 3, 6개월째 최대교정시력과 해부학적 변화를 비교하였다. 결과: Type 1 PCV 환자에서 3개월째 완전 결절 폐쇄율(p=0.034)과, 최대교정시력의 호전(p=0.017)이 더 큰 것으로 나타났고, 6개월까지 시력 호전이 유지되었다. Type 1 PCV 중에서는 애플리버셉트 주사군에서 3개월째 완전 결절 폐쇄율(p=0.020)과 황반부종 소실률(p=0.027)이 유의하게 높았고, 시력 호전을 6개월까지 유의하게 유지하였다. Type 2 PCV에서 약제 간 치료 효과 차이는 없었다. 결론: Type 1 PCV는 Type 2 PCV보다 더 좋은 해부학적 및 기능적 호전을 보였으며, Type 1 PCV에서는 애플리버셉트 주사 후 치료효과가 더 좋았다. 따라서, 인도사이아닌그린혈관조영 소견에 따른 분류는 PCV 치료 및 예후 판단에 있어 중요하다.

Abstract

Purpose: To compare the short-term efficacy of intravitreal aflibercept and ranibizumab treatment according to the subtypes of polypoidal choroidal vasculopathy (PCV) based on indocyanine green angiography (ICGA). Methods: Fifty-five treatment naïve patients with PCV who underwent intravitreal anti-vascular endothelial growth factor (VEGF) (ranibizumab, 26 eyes; aflibercept, 29 eyes) injection were retrospectively analyzed. Based on ICGA, subjects with feeder and draining vessels were defined as type 1 PCV (33 eyes), and subjects who did not have either feeder or draining vessels, but had branch vascular networks were defined as type 2 PCV (22 eyes). The complete polyp regression was assessed at 3 months after the initial treatment using ICGA. Changes in best-corrected visual acuity (BCVA) and optical coherence tomographic parameters were evaluated at 3 and 6 months. Results: Patients with type 1 PCV showed a higher complete polyp regression percentage (p = 0.034) and better visual improvement (p = 0.017) after three monthly injections compared to patients with Type 2 PCV. At 3 and 6 months, the BCVA was significantly improved in type 1 PCV patients, but not in type 2 PCV patients. In patients with type 1 PCV, the aflibercept-treated group showed a better response in anatomical outcomes (p = 0.020), and complete polyp regression percentage (p = 0.027; dry macula) than the ranibizumab-treated group, and only the aflibercept-treated group showed a significant improvement of BCVA at 3 and 6 months. In patients with type 2 PCV, there were no significant differences in visual and anatomical outcome between the anti-VEGF agents. Conclusions: Type 1 PCV showed better visual improvement with a higher percentage of polyp regression than type 2 PCV. Anatomical changes were greater in patients treated with aflibercept than with ranibizumab, particularly in patients with type 1 PCV. These results suggest that a consideration of angiographic features is important in establishing a treatment strategy for patients with PCV.

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