망막분지정맥폐쇄에 동반된 황반부종에서 황반 허혈과조기치료가 시력 예후에 미치는 영향
Effects of Macular Ischemia and Early Treatment on Visual Outcome in Branch Retinal Vein Occlusion
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목적: 망막분지정맥폐쇄에서 유리체강내 베바시주맙 주입술 시행 시 황반 허혈과 조기치료가 장기적으로 시력 예후에 미치는 영향을 알아보고자 하였다. 대상과 방법: 망막분지정맥폐쇄 환자 중 6주 간격으로 연속 3회 유리체강내 베바시주맙 주입술을 시행 받고 4년 이상 경과관찰이가능했던 42명 42안을 후향적으로 분석하였다. 시술 전, 첫 시술 후 6, 12, 24, 36, 48개월의 최대교정시력을 측정하고 빛간섭단층촬영을 시행하였으며, 시술 전 황반부 허혈 여부, 증상 발생부터 첫 치료까지의 기간을 조사하여 시력과의 연관성을 확인하였다. 결과: 42안의 망막분지정맥폐쇄에서 시술 전 최대교정시력(logMAR) 0.67 ± 0.43, 첫 시술 48개월 후 최대교정시력 0.30 ± 0.30로유리체강내 베바시주맙 주입술을 시행한 후 유의한 시력 호전을 보였다(p＜0.001). 황반부 비허혈군은 황반부 허혈군에 비해 시술48개월 후 최대교정시력이 유의하게 좋았지만 최종시력호전 정도는 유의한 차이를 보이지 않았다. 증상 발생부터 첫 주사치료까지의 기간이 짧은 군은 그렇지 않은 군에 비해 48개월 후 최대교정시력과 최종시력호전 모두 유의하게 좋았으며, 황반부 허혈이 있어도 조기치료를 할 경우 시력이 유의하게 호전되었다. 결론: 망막분지정맥폐쇄에서 유리체강내 베바시주맙 주입술 시행 시 황반부 허혈이 있어도 유의한 시력호전을 기대할 수 있다. 증상발생 후 6주 이내 치료받는 경우 장기적으로 시력 호전 정도가 유의하게 상승하며, 황반부 허혈군에서도 같은 결과를 보여 조기치료의 중요성을 확인할 수 있었다.
Abstract
Purpose: To evaluate the effects of macular ischemia and early treatment on the visual outcomes of patients with branchretinal vein occlusion (BRVO). Methods: This study retrospectively reviewed the records of 42 patients who were treated with an intravitreal bevacizumabinjection for BRVO, repeated 3 times at 6-week intervals and were whose data available for a follow-up period of at least4 years. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) results before treatment and at 6,12, 24, 36 and 48 months after the 3 serial injections, were measured. We assessed macular ischemia, time to the firsttreatment, and the relationship of these with BCVA. Results: Mean BCVA (log MAR) was significantly improved from 0.67 ± 0.43 at baseline to 0.30 ± 0.30 at 48 months (p <0.001). Four years after treatment, mean BCVA in the macular non-ischemic group was better than in the ischemic group,but this relationship did not hold for mean change in BCVA. There was a statistically significant (p < 0.05) difference betweenthe early (≤6 weeks) and late (>6 weeks) treatment groups in BCVA and mean change in BCVA after 48 months. There was statistically significant (p < 0.05) difference between the early (≤6 weeks) and late (>6 weeks) treatment groupswith macular ischemia in BCVA after 48 months. Conclusions: In patients with BRVO, a significant visual improvement was maintained after intravitreal bevacizumab injections,despite the presence of macular ischemia. Early treatment (within 6 weeks) is more effective for maintaining andimproving visual acuity. Similar results in the macular ischemia group confirmed the importance of early treatment.
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