1형 미숙아망막병증의 치료로서 일차 유리체강내 라니비주맙 주입술의 효과
Efficacy of Primary Intravitreal Ranibizumab Injection for Treatment of Type 1 Retinopathy of Prematurity
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목적: 미숙아망막병증의 일차 치료로서 유리체강내 라니비주맙 주입술의 효과 및 안전성을 평가해 보고자 하였다. 대상과 방법: 2013년 1월 1일부터 2016년 1월 1일까지 1형 미숙아망막병증의 첫 치료로 유리체강내 라니비주맙 주입술을 시행한 환자들을 대상으로 한 후향적 연구이다. 1형, 전문턱 기준에 준하여 일차 라니비주맙 주입술을 시행하였고, 치료 이후 경과관찰 기간이 9개월 이상인 환자를 연구대상으로 하였다. 재활성화 없이 추가적인 레이저치료를 시행한 환자는 연구대상에서 제외하였다. 결과: 21명(39안)의 환자 중 남자는 9명(16안), 여자는 12명(23안)으로 조사되었다. 치료 결정 이후 평균 2.1 ± 1.5일 이후 유리체강내 라니비주맙 주입술을 시행하였다. 평균 주사 18.2 ± 9.1일 이후에 plus 신호가 소실되었다. 1안에서 미숙아망막병증이 재활성화되어 범망막광응고술을 시행하였으며, 4안에서 미숙아망막병증이 재활성화되어 유리체강내 베바시주맙 주입술을 시행하였다. 총 87.1% (34/39)의 눈에서 한 차례의 라니비주맙주사로 미숙아망막병증이 경과관찰 기간 안에 재활성화 없이 안정적으로 유지되었다. 유리체강내 라니비주맙 주입술과 관련된 전신적인 합병증은 관찰되지 않았다. 결론: 미숙아망막병증의 일차 치료로서 유리체강내 라니비주맙 주입술은 단기간 경과관찰에서 좋은 유효성과 안전성을 보여주었다. 하지만 주사 이후 미숙아망막병증의 재활성화 혹은 악화에 대한 철저한 경과관찰이 필요할 것으로 사료되며, 장기간 경과관찰 결과에 대한 추후 연구가 필요할 것으로 생각된다.
Abstract
Purpose: To evaluate the effectiveness and safety of primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity. Methods: Retrospective analysis of the medical records of patients diagnosed with retinopathy of prematurity and treated with intravitreal ranibizumab injection from January 1, 2013 to January 1, 2016 was performed. We complied with the standards for ‘prethresold, type 1’ established by the Early Treatment of Retinopathy of Prematurity study for intravitreal ranibizumab injection. The follow-up period after injection was at least 9 months. Patients who received additional treatment such as laser photocoagulation or intravitreal injection without reactivation of retinopathy of prematurity were excluded. Results: A total of 21 patients (39 eyes) were included in this study. Nine (16 eyes) were male and 12 (23 eyes) were female. The average duration between treatment decision and intravitreal ranibizumab injection was 2.1 ± 1.5 days. Complete regression of the plus sign occurred 18.2 ± 9.1days after injection. One eye with reactivation was treated with panretinal laser photocoagulation while four other eyes with reactivation were treated with intravitreal bevacizumab injection. There were 87.1% (34/39) eyes that underwent primary intravitreal ranibizumab injection with stable results without any reactivation. There were no systemic complications related to intravitreal ranibizumab injection. Conclusions: Primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity showed good efficacy and safety. However, thorough evaluation is needed after primary intravitreal ranibizumab injection due to the potential for reactivation. Long-term monitoring is needed after intravitreal ranibizumab injection.
참고문헌 (25)
- Hartnett ME, "Mechanisms and management of retinopathy of prematurity", N Engl J Med, 367, pp.2515~2526 (2012)
- Hellström A, "Retinopathy of prematurity", Lancet, 382, pp.1445~1457 (2013)
- Sapieha P, "Retinopathy of prematurity:understanding ischemic retinal vasculopathies at an extreme of life", J Clin Invest, 120, pp.3022~3032 (2010)
- Early Treatment For Retinopathy Of Prematurity Cooperative Group, "Revised indications for the treatment of retinopathy of prematurity:results of the early treatment for retinopathy of prematurity randomized trial", Arch Ophthalmol, 121, pp.1684~1694 (2003)
- Good WV, "The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study", Pediatrics, 116, pp.15~23 (2005)
- Mintz-Hittner HA, "Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity", N Engl J Med, 364, pp.603~615 (2011)
- Chung EJ, "Combination of laser photocoagulation and intravitreal bevacizumab (Avastin) for aggressive zone I retinopathy of prematurity", Graefes Arch Clin Exp Ophthalmol, 245, pp.1727~1730 (2007)
- Lee JY, "Effects of intravitreal bevacizumab and laser in retinopathy of prematurity therapy on the development of peripheral retinal vessels", Graefes Arch Clin Exp Ophthalmol, 248, pp.1257~1262 (2010)
- Harder BC, "Intravitreal low ‐dosage bevacizumab for retinopathy of prematurity", Acta ophthalmol, 92, pp.577~581 (2014)
- Sato T, "Serum concentrations of bevacizumab (avastin) and vascular endothelial growth factor in infants with retinopathy of prematurity", Am J Ophthalmol, 153, pp.327~333 (2012)
- Castellanos MA, "Short-term outcome after intravitreal ranibizumab injections for the treatment of retinopathy of prematurity", Br J Ophthalmol, 97, pp.816~819 (2013)
- Baumal CR, "Primary intravitreal ranibizumab for high-risk retinopathy of prematurity", Ophthalmic Surg Lasers Imaging Retina, 46, pp.432~438 (2015)
- Chen SN, "Intravitreal anti-vascular endothelial growth factor treatment for retinopathy of prematurity:comparison between Ranibizumab and Bevacizumab", Retina, 35, pp.667~674 (2015)
- Hu J, "Reactivation of retinopathy of prematurity after bevacizumab injection", Arch Ophthalmol, 130, pp.1000~1006 (2012)
- Fierson WM, "Screening examination of premature infants for retinopathy of prematurity", Pediatrics, 131, pp.189~195 (2013)
- Wong RK, "Reactivation of retinopathy of prematurity after ranibizumab treatment", Retina, 35, pp.675~680 (2015)
- Erol MK, "Comparison of intravitreal ranibizumab and bevacizumab treatment for retinopathy of prematurity", Arq Bras Oftalmol, 78, pp.340~343 (2015)
- 김성은, "Stage 3 플러스 징후를 동반한 미숙아 망막병증에서 일차유리체강내 베바시주맙 주입술의 효과", 대한안과학회지, 56(1), pp.62~69 (2015), 대한안과학회
- Mintz-Hittner HA, "Clinical management of recurrent retinopathy of prematurity after intravitreal bevacizumab monotherapy", Ophthalmology, 123, pp.1845~1855 (2016)
- Yetik H, "Intravitreal bevacizumab monotherapy for type-1 prethreshold, threshold, and aggressive posterior retinopathy of prematurity - 27 month follow-up results from Turkey", Graefes Arch Clin Exp Ophthalmol, 253, pp.1677~1683 (2015)
- Hartnett ME, "Pathophysiology and mechanisms of severe retinopathy of prematurity", Ophthalmology, 122, pp.200~210 (2015)
- Hoerster R, "Serum concentrations of vascular endothelial growth factor in an infant treated with ranibizumab for retinopathy of prematurity", Acta Ophthalmol, 91, pp.e74~e75 (2013)
- Klufas MA, "Intravitreal anti-VEGF therapy as a treatment for retinopathy of prematurity: what we know after 7 years", J Pediatr Ophthalmol Strabismus, 52, pp.77~84 (2015)
- Honda S, "Acute contraction of the proliferative membrane after an intravitreal injection of bevacizumab for advanced retinopathy of prematurity", Graefes Arch Clin Exp Ophthalmol, 246, pp.1061~1063 (2008)
- Tolentino M, "Systemic and ocular safety of intravitreal anti-VEGF therapies for ocular neovascular disease", Surv Ophthalmol, 56, pp.95~113 (2011)