안구표면 편평상피세포 암종의 일차 치료로 국소점안 화학요법의 효과
The Effectiveness of Topical Chemotherapy for the Primary Treatment of Ocular Surface Squamous Neoplasia
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목적: 안구표면 편평상피세포 암종의 일차 치료로 국소점안 화학요법의 효과를 알아보고자 하였다. 대상과 방법: 임상과 전안부 빛간섭단층촬영기로 안구표면 편평상피세포 암종으로 진단과 치료받은 10명(10안)의 환자를 대상으로 하였다. 대상환자는 0.02% Mitomycin C (MMC)를 하루 4회 점안 치료하였다. MMC 치료에 저항하는 것으로 판단되는 경우 1% 5-Fluorouracil (5-FU)을 하루 4회로 점안 치료하였다. 대상환자는 치료 전과 후에 전안부 빛간섭단층촬영기로 병변부위를 촬영하였다. 임상과 전안부 빛간섭단층촬영기를 이용하여 국소점안 화학요법의 치료효과와 부작용을 조사하였다. 결과: 대상 환자는 10명(남:여=8:2)으로 평균연령은 76.7세였다. MMC만으로 관해된 경우가 80% (8안)였고, 5-FU를 추가해 관해된 경우가 20% (2안)였다. 완전 관해는 평균 4.3주에 이루어졌고, 평균 17.5개월 동안 재발이 없었다. 전안부 빛간섭단층촬영기로 촬영한 병변부위의 두께는 치료 전 315.0 μm에서 관해 후 105.3 μm로 의미있게 감소하였고 병변의 상피는 정상화되었다. 합병증으로는 결막충혈 60.0% (6안), 알레르기반응 30.0% (3안), 표층각막염 20.0% (2안), 각막미란 20.0% (2안) 순으로 발생하였으나 심각한 합병증은 발생하지 않았다. 결론: 안구표면 편평상피세포 암종의 일차 치료로 국소점안 화학요법은 치료효과가 우수하고 부작용이 적었다. 또한 전안부 빛간섭단층촬영기는 안구표면 편평상피세포 암종의 비침습적 진단과 치료효과 판정에 유용하게 사용될 수 있을 것으로 생각된다.
Abstract
Purpose: In the present study, the effectiveness of topical chemotherapy for the primary treatment of ocular surface squamous neoplasia (OSSN) was evaluated. Methods: We enrolled 10 patients (10 eyes) diagnosed with OSSN who received both clinical examination and anterior segment optical coherence tomography (AS-OCT) imaging. The patients were administered topical 0.02% mitomycin-C (MMC) 4 times/day in the affected eye. The patients with MMC-resistant OSSN received topical 1% 5-fluorouracil (5-FU) 4 times/day. AS-OCT imaging was performed before and after the treatment. Clinical examination and AS-OCT were used to monitor the efficacy of topical chemotherapy, recurrence and side effects. Results: The mean age of the 10 patients (8 males, 2 females) was 76.7 years. The proportion of complete remission resulting from topical treatment with MMC was 80.0% (8 eyes) and 20.0% (2 eyes) when 5-FU was changed to MMC. The average duration of complete remission was 4.3 weeks and the average duration of no recurrence was 17.5 months. The epithelial thickness of the lesions, measured using AS-OCT, significantly decreased from 315.0 μm (pretreatment) to 105.3 μm (after complete remission). Additionally, the epithelial lesion appeared normal after treatment. The most common side effect was conjunctival hyperemia (60.0%, 6 eyes), followed by ocular allergy (30.0%, 3 eyes), superficial punctate keratitis (30.0%, 3 eyes) and corneal erosion (20%, 2 eyes). No serious complications were reported. Conclusions: Topical chemotherapy is as effective and well tolerated as a primary treatment for OSSN. Additionally, AS-OCT is a useful noninvasive adjunctive tool in the diagnosis and management of OSSN.
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