결절맥락막혈관병증에서 중심맥락막두께에 따른 애플리버셉트 유리체강내주입술의 효과 분석
Analysis of Efficacy of Intravitreal Aflibercept According to Subfoveal Choroidal Thickness in Polypoidal Choroidal Vasculopathy
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목적: 결절맥락막혈관병증 환자에서 중심맥락막두께에 따른 애플리버셉트 유리체강내주입술의 효과 차이를 분석하고자 하였다. 대상과 방법: 본원에서 결절맥락막혈관병증으로 진단 받고 애플리버셉트 유리체강내주입술을 받은 환자 중 6개월 이상 경과 관찰이 가능했던 60명 60안의 의무기록을 후향적으로 분석하였다. 주사 전 측정한 중심맥락막두께에 따라 얇은 군, 중간 군, 두꺼운 군으로 나누고 주사 후 6개월 동안의 최대교정시력, 중심맥락막두께, 중심황반두께 및 최대 망막색소상피박리 높이의 변화와 3개월째 결절폐쇄율, 6개월째 황반부종 소실률을 비교 분석하였다. 결과: 총 60안 중 얇은 군은 14안(23.3%), 중간 군은 33안(55.0%), 두꺼운 군은 13안(21.7%)이었으며, 주사 전 평균 중심맥락막두께는 각각 178.50 ± 28.42 μm, 287.03 ± 43.58 μm, 379.77 ± 17.09 μm였다. 세 군 간 초진 시 연령, 성비, 최대교정시력, 중심황반두께 및 최대 망막색소상피박리 높이는 유의한 차이가 없었다. 치료 6개월 후 최대교정시력은 얇은 군에서만 유의한 호전을 보였고(p=0.005) 중간 군과 두꺼운 군에서는 호전은 되었지만 통계적 유의성은 없었다(p=0.063, p=0.692). 중심맥락막두께, 중심황반두께 및 최대 망막색소상피박리 높이는 세 군 모두에서 유의한 감소를 보였다. 중심맥락막두께가 얇을수록 첫 주사 후 3개월째 완전 결절폐쇄율과 6개월째 황반부종 소실률이 높았다(p=0.013, p=0.004). 결론: 애플리버셉트 유리체강내주입술은 결절맥락막혈관병증의 치료에 있어서 효과적이었고, 중심맥락막두께가 얇을수록 더 좋은 치료 결과를 보였다.
Abstract
Purpose: To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV). Methods: We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thickness was manually measured as the distance from the hyper-reflective line of Bruch’s membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes. Results: Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 μm in the thin group (14 eyes, 23.3%), 287.03 ± 43.58 μm in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 μm in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively). Conclusions: Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes.
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