망막분지정맥폐쇄에 의한 황반부종에서 덱사메타손 주입술 후 유병기간에 따른 임상경과 비교
Efficacy of Intravitreal Dexamethasone Implant for Macular Edema Due to Branch Retinal Vein Occlusion According to Symptom Duration
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 망막분지정맥폐쇄로 인한 황반부종 환자에서 덱사메타손 유리체강 내 삽입물 주입술 후 유병기간에 따른 결과를 비교하고자한다. 대상과 방법: 망막분지정맥폐쇄로 인한 황반부종 환자 31명(31안)을 대상으로 24주간 중심황반두께 및 시력 변화를 매달 후향적으로분석하였다. 유병기간에 따라 12주 미만(Group A: 16안)과 12주 이상(Group B: 15안)으로 분류하였다. 중심황반두께가 150 μm 이상증가하거나 최대교정시력(logMAR)이 0.2보다 증가한 경우 후테논낭하 스테로이드 주사를 시행하였다. 결과: 24주째까지 중심황반두께와 최대교정시력은 초진 시보다 호전된 상태를 유지했다(p＜0.001, p＜0.05, respectively). 주사 후4주, 8주째 중심황반두께는 Group A (285.3 ± 19.9, 276.1 ± 23.1 μm)가 Group B (310.3 ± 37.5, 318.1 ± 39.6 μm)보다 더 적었다(p=0.033, p=0.001, respectively). 최대교정시력은 4주째 Group A가 Group B보다 더 좋았다(p=0.009). 재발률 및 재발 시기는 두군 간에 유의한 차이가 없었다(p＞0.05). 24주째, Group A가 Group B보다 중심황반두께가 더 적었고 최대교정시력이 좋았다(p=0.043, p=0.041, respectively). 결론: 망막분지정맥폐쇄 환자에서 유리체강 내 덱사메타손 주입술 시 황반부종 및 시력이 호전되었다. 유병기간이 짧을수록 초기 경과 및 재치료 시 임상결과가 좋은 것으로 나타나 증상 발생 후 조기 치료가 중요할 것으로 생각된다.
Abstract
Purpose: To evaluate the efficacy of intravitreal dexamethasone implants for the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) according to the duration of symptoms. Methods: Thirty-one patients who received an intravitreal dexamethasone implant for ME due to BRVO were included in this retrospective study. The patients were divided into 2 groups. Group A included eyes with symptom duration less than 12 weeks and Group B included eyes with symptom duration of 12 weeks or longer. The main efficacy outcomes such as best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and every 4 weeks over 24 weeks. Retreatment criteria included an increased CMT of 150 μm or reduction of logarithm of the minimal angle of resolution (log MAR) scores of at least 0.2. Results: The CMT and BCVA improved significantly at each follow-up compared with the baseline (p < 0.001, p < 0.05, respectively). At 4 and 8 weeks after the first injection, CMT in Group A (285.3 ± 19.9, 276.1 ± 23.1 μm, respectively) was less than in Group B (310.3 ± 37.5, 318.1 ± 39.6 μm; p = 0.033, p = 0.001, respectively). At 4 weeks, the BCVA in Group A was better than in Group B (p = 0.009). Rate and timing of recurrence were not different between the 2 groups (p > 0.05). At 24 weeks, Group A showed less CMT and better BCVA compared with Group B (p = 0.043, p = 0.041, respectively). Conclusions: The intravitreal dexamethasone implant significantly reduced the CMT and improved BCVA in patients with ME due to BRVO. Patients with shorter symptom duration showed better anatomical and functional outcomes over 24 weeks. Early treatment with the intravitreal dexamethasone implant could produce better clinical results.
참고문헌 (23)
- Campochiaro PA., "Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study", Ophthalmology, 117, pp.1102~1112.e1 (2010)
- Scott IU., "A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular Edema secondary to branch retinal vein occlusion : the Standard Care vs Corticosteroid for Retinal Vein Occlusion(SCORE)study report 6", Arch Ophthalmol, 127, pp.1115~1128 (2009)
- "Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group", Am J Ophthalmol, 98, pp.271~282 (1984)
- CATT Research Group., "Ranibizumab and bevacizumab for neovascular age-related macular degeneration", N Engl J Med, 364, pp.1897~1908 (2011)
- Kuppermann BD., "Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema", Arch Ophthalmol, 125, pp.309~317 (2007)
- Haller JA., "Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results", Ophthalmology, 118, pp.2453~2460 (2011)
- Coscas G., "SD-OCT pattern of retinal venous occlusion with cystoid macular edema treated with Ozurdex(R)", Eur J Ophthalmol, 21, pp.631~636 (2011)
- Haller JA., "Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion", Ophthalmology, 117, pp.1134~1146.e3 (2010)
- Bezatis A., "Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up-the SOLO study", Acta Ophthalmol, 91, pp.e340~e347 (2013)
- Joshi L., "Dexamethasone implants in retinal vein occlusion : 12-month clinical effectiveness using repeat injections as-needed", Br J Ophthalmol, 97, pp.1040~1044 (2013)
- Matonti F., "Ozurdex in the management of the macular edema following retinal vein occlusion in clinical practice", Acta Ophthalmol, 91, pp.e584~e586 (2013)
- Patz A., "Argon laser photocoagulation for macular edema in branch vein occlusion", Am J Ophthalmol, 98, pp.374~375 (1984)
- 김영균, "망막분지정맥폐쇄와 관련된 황반부종에서 베바시주맙 안내주입술의 조기치료와 지연치료", 대한안과학회지, 50(10), pp.1527~1530 (2009), 대한안과학회
- 오주연, "Early versus Late Intravitreal Triamcinolone Acetonide for Macular Edema associated with Branch Retinal Vein Occlusion", Korean Journal of Ophthalmology, 21(1), pp.18~20 (2007), 대한안과학회
- Kondo M., "Intravitreal injection of bevacizumab for macular edema secondary to branch retinal vein occlusion : results after 12 months and multiple regression analysis", Retina, 29, pp.1242~1248 (2009)
- Hikichi T., "Two-year outcomes of intravitreal bevacizumab therapy for macular oedema secondary to branch retinal vein occlusion", Br J Ophthalmol, 98, pp.195~199 (2014)
- Demir M., "Intravitreal bevacizumab for macular edema due to branch retinal vein occlusion : 12-month results", Clin Ophthalmol, 5, pp.745~749 (2011)
- Karagiannis DA., "Recurrence of macular edema in retinal vein occlusions after treatment with intravitreal ranibizumab(Lucentis)", Can J Ophthalmol, 46, pp.486~490 (2011)
- Mayer WJ., "Twelve-month experience with Ozurdex for the treatment of macular edema associated with retinal vein occlusion", Eye(Lond), 27, pp.816~822 (2013)
- Stefansson E., "The therapeutic effects of retinal laser treatment and vitrectomy. A theory based on oxygen and vascular physiology", Acta Ophthalmol Scand, 79, pp.435~440 (2001)
- Larsson J., "The 30-Hz flicker cone ERG for monitoring the early course of central retinal vein occlusion", Acta Ophthalmol Scand, 78, pp.187~190 (2000)
- Kalogeropoulos C., "Morphology of early retinal lesions after experimental venous occlusion", Klin Monbl Augenheilkd, 208, pp.375~376 (1996)
- Veritti D., "Early effects of dexamethasone implant on macular morphology and visual function in patients with macular edema secondary to retinal vein occlusion", Ophthalmologica, 232, pp.144~148 (2014)