국한성 맥락막혈관종에서 발생한 장액망막박리에 대한 치료결과
Treatment Outcome of Serous Macular Detachment in Circumscribed Choroidal Hemangioma
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목적: 장액망막박리가 발생한 국한성 맥락막혈관종에서 항혈관내피성장인자 주사와 광역학치료 결과를 알아보고자 하였다. 대상과 방법: 국한성 맥락막혈관종 환자 중에서 황반부 장액망막박리가 발생하여 치료가 필요했던 환자들의 치료방법과 결과를 의무기록을 통해 후향적으로 조사하였다. 종양의 진단과 치료경과는 안저사진, 인도사이아닌그린 혈관조영술, 빛간섭단층촬영, 안초음파검사를 시행하여 분석하였다. 결과: 총 9명 9안을 치료 후 평균 19.2개월 동안 경과관찰하였다. 평균 시력은 0.51 ± 0.52 (logMAR), 종양의 최대지름은 평균 6,154.4 ± 2,019.9 μm, 두께는 평균 2,224.4 ± 862.1 μm였다. 첫 치료로 항혈관내피성장인자 유리체내주사를 받은 6안 중 5안은 평균 3.16회의 치료에 반응이 없거나 재발하여, 추가적인 광역학치료와 경동공온열치료가 필요하였다. 광역학치료를 받은 3안은 평균 1.3회의 치료 후 망막내/하액이 소실되고 재발은 없었다. 최종적으로 8안에서 완전한 망막내/하액의 소실을 얻을 수 있었으나, 평균시력은 치료 전과 차이가 없었다. 결론: 국한성 맥락막혈관종에서 발생한 장액망막박리에 대하여 항혈관내피성장인자 유리체내주사의 효과는 제한적이었으며, 광역학치료가 적은 치료횟수로 망막하액의 소실을 얻을 수 있었다.
Abstract
Purpose: To determine the clinical outcome of anti-vascular endothelial growth factor (anti-VEGF) and photodynamic therapy (PDT) for circumscribed choroidal hemangioma (CCH) with serous retinal detachment. Methods: The medical records of patients having CCH with serous retinal detachment in macula were retrospectively reviewed. CCH and serous retinal detachment were evaluated via fundus photography, optical coherence tomography, indocyanine green angiography, and ultrasonography. Results: A total of 9 eyes were enrolled in this study. The average follow-up period was 19.2 months. The mean visual acuity was 0.51 ± 0.52 (logMAR) and the mean maximum diameter and thickness of the tumor were 6,154.4 ± 2,019.9 μm and 2,224.4 ± 862.1 μm, respectively. Of the 6 eyes receiving anti-VEGF (mean number of injections: 3.16) as the first treatment for serous retinal detachment, 5 had sustained or recurred intraretinal/subretinal fluid (IRF/SRF) and needed additional PDT and transpupillary thermotherapy. In the 3 eyes that received PDT (mean number of treatments: 1.3) as an initial treatment, IRF/SRF was completely resolved. Finally, 8 eyes achieved complete resolution of SRF and IRF; however visual recovery was limited. Conclusions: PDT, even with a small number of treatments, can alleviate IRF/SRF in CCH, while anti-VEGF did not.
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