나이관련황반변성 환자에서 빛간섭단층촬영의 고반사점 및 치료 전 인자들과 시력과의 연관성
Correlation between Visual Outcomes and Pre-Treatment Factors Including Hyperreflective Foci in Neovascular Age-Related Macular Degeneration
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목적: 삼출성 나이관련황반변성 환자의 빛간섭단층촬영에서 나타난 고반사점(hyperreflective foci)과 유리체강내 라니비주맙 주입술후 시력 예후와의 연관성에 대해 알아보고자 하였다. 대상과 방법: 삼출성 나이관련황반변성 환자 44명 44안을 대상으로 후향적 연구를 시행하였다. 유리체강내 라니비주맙 치료 전 빛간섭단층촬영에서 나타난 내망막, 외망막, 망막하에 위치한 고반사점의 개수, 중심와 두께, 신생혈관 두께, 외경계막 및 광수용체 내외층경계부의 상태와 치료 6개월 후 시력과의 연관성을 조사하였다. 결과: 치료 후 고반사점은 망막 전층에서 감소하였다. 치료 후 최대교정시력과 관련 있는 인자는 치료 전 시력, 망막하 고반사점의개수, 광수용체 내외층경계부의 상태였다(각각 p=0.028, p=0.046, p=0.009). 치료 전 망막하 고반사점은 치료 후 중심와 두께, 맥락막신생혈관 두께와 유의한 상관관계가 있었다(각각 p=0.002, p=0.009). 결론: 치료 전 망막하 고반사점의 위치 및 개수로 유리체강내 항혈관내피성장인자 주입술 후 시력 예후를 예측할 수 있다.
Abstract
Purpose: To investigate the correlation between hyperreflective foci (HF) on spectral domain optical coherence tomography (SD-OCT) at baseline and visual outcomes after intravitreal ranibizumab injection in neovascular age-related macular degeneration (nAMD). Methods: We retrospectively reviewed the medical records of 44 eyes of 44 nAMD patients. The number of HF was counted according to the location of HF on SD-OCT: neurosensory retinal layer, outer retinal layer, and subretinal layer. Statistical correlations among final visual acuity (VA) and pretreatment OCT parameters including number of HF, foveal thickness (FT), thickness of choroidal neovascularization (CNV), the status of external limiting membrane, and photoreceptor inner and outer segments (IS/OS) were evaluated. Results: The number of HF was reduced in all retinal layers in nAMD patients after treatment. In multivariate regression analysis, final VA was associated with baseline VA, number of subretinal HF, and IS/OS disruption length (p = 0.028, p = 0.046 and p = 0.009, respectively) in nAMD patients. The baseline number of subretinal HF was correlated with final FT and CNV thickness (p = 0.002 and p = 0.009, respectively). Conclusions: The baseline number of subretinal HF on SD-OCT might predict the final VA after intravitreal ranibizumab treatment in nAMD patients.
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