난치성 당뇨황반부종에서 유리체강 내 덱사메타존 임플란트의 단기 치료 효과
Short-Term Results of Dexamethasone Intravitreal Implant in Patients with Refractory Diabetic Macular Edema
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목적: 베바시주맙과 트리암시놀론 병합 요법에 반응하지 않는 난치성 당뇨황반부종에서 유리체강 내 덱사메타존 임플란트(Ozurdex®) 주입 시 황반부종에 대한 치료 효과를 알아보고자 하였다. 대상과 방법: 난치성 당뇨황반부종으로 덱사메타존 임플란트를 주입한 9명 9안을 대상으로 의무기록을 후향적으로 분석하였다. 유리체강 내 베바시주맙 주입술과 후테논낭하 혹은 유리체강 내 트리암시놀론 주입술의 병합요법에도 반응하지 않고 3개월 이상 지속되는 당뇨황반부종 환자들을 대상으로, 시술 전과 1, 3, 4개월째의 최대 교정시력, 중심 황반 두께를 평가하였다. 결과: 평균 경과관찰 기간은 6.7 ± 2.2개월이었고, 시술 전 최대교정시력은 0.8 ± 0.48 logMAR에서 시술 후 1, 3, 4개월째 각각0.61 ± 0.37 logMAR (p=0.017), 0.57 ± 0.38 logMAR (p=0.011), 0.62 ± 0.36 logMAR (p=0.027)로 호전되었다. 중심 황반 두께는시술 전 558.0 ± 110.32 μm에서 1개월째 325 ± 64.21 μm (p=0.008), 3개월째 300.22 ± 59.46 μm (p=0.008)로 호전되었다가4개월째 468.44 ± 150.85 μm (p=0.058)로 증가되었다. 결론: 덱사메타존 임플란트는 베바시주맙과 트리암시놀론 병합 요법에 반응하지 않는 난치성 당뇨황반부종의 단기간 치료에 효과적이었다. 시력 호전 및 중심 황반 두께의 감소는 3개월간 유지되었으며 4개월째 중심 망막 두께는 다시 증가하였지만 시력 개선 효과는조금 더 오래 유지되었다.
Abstract
Purpose: To evaluate the effectiveness of a dexamethasone intravitreal implant (Ozurdex®) in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone. Methods: We reviewed 9 eyes of 9 patients with diabetic macular edema treated with dexamethasone intravitreal implant. The patients were included in the study if presenting with refractory diabetic macular edema of more than 3 months despite combined treatment of intravitreal bevacizumab injection with posterior subtenon triamcinolone injection or intravitreal triamcinolone injection. We assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography at initial visit and 1, 3 and 4 months. Results: The mean follow-up was 6.7 ± 2.2 months. The baseline mean BCVA was 0.81 ± 0.47 logarithm of the minimum angle of resolution (log MAR), which improved to 0.61 ± 0.37 log MAR (p = 0.017), 0.57 ± 0.38 log MAR (p = 0.011) and 0.62 ± 0.36 log MAR (p = 0.027) at 1 month, 3 months and 4 months, respectively. The baseline mean CMT was 558.0 ± 110.32 μm and decreased to 325 ± 64.21 μm (p = 0.008) and 300.22 ± 59.46 μm (p = 0.008) at 1 month and 3 months, respectively, then increased to 468.44 ± 150.85 μm (p = 0.058) at 4 months after injection. Conclusions: Dexamethasone intravitreal implant showed short-term efficacy in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone and produced significant improvements in BCVA and CMT until 3 months after injection. The CMT then increased, but BCVA was sustained until the fourth month.
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