광역학치료와 베바시주맙을 이용한 특발 중심와부근 모세혈관확장증 I형의 치료
Combination Therapy with Photodynamic Therapy and Intravitreal Bevacizumab in Idiopathic Macular Telangiectasia Type I
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목적: 중심와부근모세혈관확장증 type I으로 진단된 환자에서 베바시주맙 유리체강내 주입술과 광역학치료 병합요법의 효과에 대해 알아보았다. 대상과 방법: 2008년 5월부터 2012년 2월까지 시력저하를 주소로 내원한 환자 중 안저소견상 황반부 이측에 이상소견이 관찰되고 형광안저혈관조영술에서 모세혈관 확장으로 인한 누출이 관찰되어, 중심와부근모세혈관확장증 type I으로 진단된 7명을 대상으로 유리체강내 베바시주맙주사와 광역학 치료를 병행한 복합치료를 시행하였다. 결과: 시술 전 시력(logMAR)은 0.48 ± 0.14였고 시술 후 0.18 ± 0.17로 호전되었다. 안압은 시술 전 17.9 ± 3.1에서 16.8 ± 2.3으로 의미있는 차이를 보이지는 않았으며 시술 후 형광안저혈관조영술상에서 시술 전에 있었던 모세혈관 확장 부위 형광 누출이 감소되는 것을 관찰할 수 있었다. 빛간섭단층촬영에서 황반내 부종이 호전되어 central subfield macular thickness가 시술 전 301.9 ± 50.7 μm에서 시술 후 193.6 ± 58.8 μm로 감소하였다. 결론: 중심와부근모세혈관확장증 type I에서 망막하모세혈관확장과 황반부종으로 인해 시력저하가 생길 때 광역학치료와 베바시주맙유리체강내 주입술 병합 치료를 통해 단기간에 효과적인 병변 호전 및 시력 개선을 가져올 수 있었다.
Abstract
Purpose: We investigated the clinical manifestations of combination therapy with photodynamic therapy (PDT) and intravitreal bevacizumab in idiopathic macular telangiectasia type I patients. Methods: The present study included 7 patients who visited our clinic from May 2008 to February 2011 complaining of decreasing visual acuity and diagnosed as idiopathic macular telangiectasia type I including visible aneurysms at juxtafoveal area and telangiectatic vessels leakage based on fluorescein angiography. Additionally, all patients were treated with combination therapy with PDT and intravitreal bevacizumab. Results: Visual acuity improved from 0.48 ± 0.14 (log MAR) to 0.18 ± 0.17 (log MAR) after the combination therapy, however, there was no change in intraocular pressure between before (17.9 ± 3.1) and after (16.8 ± 2.3) therapy. After combination therapy, fluorescein angiography showed decreased leakage of telangiectatic vessels and optical coherence tomography showed only minimal intraretinal edema. Central subfield macular thickness decreased from 301.9 ± 50.7 μm to 193.6 ± 58.8 μm after the combination therapy. Conclusions: Combination therapy with intravitreal bevacizumab injection and PDT in patients with idiopathic macular telangiectasia type Ⅰ can result in a rapid decrease of macular edema, which can lead to rapid visual recovery.
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