분지망막정맥폐쇄에 동반된 불응성 황반부종에서 유리체내 트리암시놀론 주사의 단기 치료 효과
Short-term Effectiveness of Intravitreal Triamcinolone Injection for Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion
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목적: 분지망막정맥폐쇄에서 유리체내 베바시주맙 주입술에 반응하지 않는 불응성 황반부종에 대한 치료로 유리체내 트리암시놀론주입술의 효과를 알아보고자 하였다. 대상과 방법: 분지망막정맥폐쇄로 인한 황반부종으로 진단 받고 2회 이상 매달 연속된 유리체내 베바시주맙 주입술을 시행 받은 환자중 치료 효과가 나타나지 않아 유리체내 트리암시놀론 주입술을 시행 받은 23명 23안의 의무기록을 후향적으로 조사하였다. 트리암시놀론 주입술 전과 주입술 후 1개월, 3개월째 최대교정시력 및 빛간섭단층촬영(optical coherence tomography, OCT) 상 소견을 분석하였다. 결과: 대상 환자들은 평균 3.4 ± 1.2회의 유리체내 베바시주맙 주입술을 시행 받았다. 유리체내 트리암시놀론 주입술은 마지막 유리체내 베바시주맙 주입술 시행 후 평균 4.3 ± 1.7주 뒤 시행되었다. 최대교정시력(logarithm of the minimal angle of resolution, logMAR)은 치료 전 0.61 ± 0.45에서 치료 1개월 후 logMAR 0.52 ± 0.35, 3개월 후 logMAR 0.58 ± 0.37로 좋아지는 경향을 보였으나, 통계학적으로는 유의하지 않았다(p=0.114, 0.412). 그러나 8안(34.8%)에서 3줄 이상의 시력호전을 보였으며, 4안(17.4%)에서는 2 줄 이하의 안정적인 시력 호전을 보였다. OCT 상 중심와두께(central foveal thichness, CFT)는 치료 전 512 ± 166 μm에서 치료후 한 달째 310 ± 139 μm, 3개월째 324 ± 159 μm로 통계적으로 유의한 호전을 보였다(p=0.014, 0.031). 결론: 분지망막정맥폐쇄에 동반된 황반부종에서 유리체내 트리암시놀론 주입술은 유리체내 베바시주맙 주입술에 반응하지 않는 일부환자에 있어 최대교정시력과 중심와두께에 호전 소견을 보였으며 하나의 치료적 방법으로 제안될 수 있다.
Abstract
Purpose: To evaluate the short-term efficacy of intravitreal triamcinolone (IVTA) injection for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO) refractory to intravitreal bevacizumab injections. Methods: This retrospective, observational study included 23 eyes of 23 patients with macular edema secondary to BRVO. The patients with macular edema unresponsive to 2 or more consecutive monthly intravitreal bevacizumab injections were treated with IVTA. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before IVTA and 1 month and 3 months after IVTA injections. Results: All patients were previously treated with 3.4 ± 1.2 intravitreal bevacizumab injections. The IVTA injection was performed at 4.3 ± 1.7 weeks after the last bevacizumab injection. The logarithm of the minimal angle of resolution (log MAR) BCVA was also decreased from 0.61 ± 0.45 to 0.52 ± 0.35 after 1 month and to 0.58 ± 0.37 after 3 months of IVTA, although without statistical significance (p = 0.114 and 0.412, respectively). Eight eyes (34.8%) showed more than 3 lines improvement of BCVA and 4 eyes (17.4%) showed stable BCVA increasing 2 lines or less. CFT was significantly improved from 512 ± 166 μm to 310 ± 139 μm after 1 month and to 324 ± 159 μm after 3 months of IVTA injections (p = 0.014 and 0.031, respectively). Conclusions: IVTA was beneficial in some patients with macular edema secondary to BRVO refractory to intravitreal bevacizumab therapy. This study indicates that IVTA could be considered as a treatment option for refractory macular edema associated with BRVO.
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