유리체내주사치료에 반응하지 않는 망막분지정맥폐쇄 황반부종환자에서 유리체절제술의 장기효과 분석
Long-term Efficacy of Vitrectomy for Macular Edema Secondary to Branch Retinal Vein Occlusion in Patients Treated with Intravitreal Injections
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목적: 망막분지정맥폐쇄에 의한 황반부종에서 스테로이드 또는 항혈관내피세포성장인자항체의 유리체내주사치료 후 반응이 없거나 지속적으로 재발하는 경우 시행한 유리체절제술의 장기간 효과를 알고자 하였다. 대상과 방법: 유리체내주사치료 병력이 있는 망막분지정맥폐쇄 황반부종 환자에서 유리체절제술을 시행 받고 12개월 이상 추적관찰이 가능했던 경우를 후향적으로 분석하였다. 수술 후 1, 3, 6, 12개월과 마지막 추적관찰 시의 최대교정시력과 중심황반두께 변화를 수술 전과 비교하였다. 유리체절제술 후 황반부종이 재발한 경우에는 주사치료를 추가로 시행하였으며, 수술 전후의 주사치료 빈도를 비교하였다. 결과: 총 41명 41안의 환자가 포함되었으며, 평균 추적관찰기간은 58.7 ± 30.0 (15-124)개월이었다. 술 전 평균 최대교정시력(logMAR)은 0.90 ± 0.47, 중심황반두께는 484.87 ± 112.80 μm였으며, 수술 후 1, 3, 6, 12개월과 마지막 추적관찰 시 평균 최대교정시력은 각각 0.52 ± 0.42, 0.46 ± 0.38, 0.41 ± 0.26, 0.50 ± 0.34, 0.49 ± 0.37, 중심황반두께는 각각 342.72 ± 84.10 μm, 365.02 ± 110.73 μm, 359.45 ± 119.28 μm, 360.96 ± 124.33 μm, 329.34 ± 119.69 μm로 모두 술 전에 비해 유의한 차이를 보였다(p<0.001). 유리체절제술 전 주사치료 빈도는 3.58 ± 2.05회/년에서 술 후 0.60 ± 0.83회/년으로 유의하게 감소하였다(p<0.001). 결론: 유리체내주사치료 후 반응이 없거나 재발한 망막분지정맥폐쇄 황반부종에서 유리체절제술은 유의한 시력 호전 및 중심황반두께 감소를 가져오고 재발 빈도를 낮추는 효과적인 치료다.
Abstract
Purpose: To evaluate the long-term efficacy of pars plana vitrectomy (PPV) on refractory or recurrent macular edema due to branch retinal vein occlusion (BRVO) after intravitreal steroid or anti-vascular endothelial growth factor injections. Methods: We retrospectively reviewed the medical records of patients with macular edema due to BRVO who underwent PPV after intravitreal triamcinolone acetonide or bevacizumab injections and followed-up for at least 12 months. The best corrected visual acuity (BCVA) and subfoveal macular thickness were measured at 1, 3, 6, 12 months postoperatively and were compared with the preoperative values. The patients received additional intravitreal injections if they had recurrence of macular edema after surgery. The frequency of intravitreal injections (per year) were compared pre- and postoperatively. Results: A total of 41 eyes of 41 patients were included and the mean duration of follow up was 58.7 ± 30.0 (15 -124) months. The BCVA (logMAR) at 1, 3, 6, 12 months postoperatively, and last follow up was 0.52 ± 0.42, 0.46 ± 0.38, 0.41 ± 0.26, 0.50 ± 0.34, and 0.49 ± 0.37, respectively, which was significantly different from the preoperative values (0.90 ± 0.47, p < 0.001). The subfoveal macular thickness at 1, 3, 6, 12 months postoperatively, and last follow up was 342.72 ± 84.10 μm, 365.02 ± 110.73 μm, 359.45 ± 119.28 μm, 360.96 ± 124.33 μm, and 329.34 ± 119.69 μm, respectively, which was also significantly different (p < 0.001) from the preoperative values (484.9 ± 112.8 μm, p < 0.001). The frequency of intravitreal injections was significantly decreased after surgery (3.58 ± 2.05 times/year vs. 0.60 ± 0.83 times/year, p < 0.001). Conclusions: Pars plana vitrectomy could improve BCVA, decrease subfoveal macular thickness, and decrease recurrence in BRVO patients with refractory or recurrent macular edema after intravitreal injection. PPV could be an effective treatment option for these patients.
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