망막혈관종성증식 환자에서 유리체강내항혈관내피세포성장인자 주입술의 12개월 임상결과
Twelve-Month Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Retinal Angiomatous Proliferation
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목적: 항혈관내피세포성장인자를 이용하여 망막혈관종성증식을 치료한 12개월 임상 결과를 보고하고자 한다. 대상과 방법: 망막혈관종성증식으로 진단 후 유리체강내 항혈관내피세포성장인자 주입술로 치료받은 33안(33명)을 대상으로 후향적의무기록 분석을 시행하였다. 진단 후 1개월 간격으로 3회의 주사를 시행하였고, 이후에는 재발하는 경우 추가 치료를 시행하였다. 치료 전 및 첫 번째 주사 후 3, 6, 12개월에 최대교정시력을 측정하였고, 이들 값을 서로 비교하였다. 결과: 12개월 동안 평균 4.2 ± 1.7회의 주입술이 시행되었다. 치료 전 및 첫 번째 주사 후 3, 6, 12개월에 측정한 평균 최대교정시력은각각 0.76 ± 0.49, 0.55 ± 0.35, 0.67 ± 0.41 및 0.70 ± 0.50으로, 첫 번째 주사 후 3개월 및 6개월에 측정된 시력은 치료 전보다유의하게 호전된 결과를 보였으나(p＜0.001, p=0.037), 12개월에 측정된 시력은 유의한 차이가 없었다(p=0.590). 12개월의 추적관찰기간 동안 시력이 0.2 logMAR (logarithm of minimal angle of resolution) 이상 호전된 환자는 13명(39.4%)이었으며, 16명(48.5%)의경우 비교적 안정적인 시력(＜0.2 logMAR 이내의 변화)을 유지하였다. 결론: 항혈관내피세포성장인자 치료는 대부분의 망막혈관종성증식 환자에서 황반 두께를 정상화시키고 시력을 호전시키거나 유지시키는 데 효과적인 방법으로 생각된다.
Abstract
Purpose: To evaluate the 12-month outcomes of anti-vascular endothelial growth factor (VEGF) treatment for patients with retinal angiomatous proliferation (RAP). Methods: Retrospective review of medical records was performed for 33 patients (33 eyes) who were diagnosed with RAP. All patients were initially treated with three consecutive intravitreal anti-VEGF injections after diagnosis. Additional treatment was performed when the recurrence of exudation was noted. The best-corrected visual acuity (BCVA) was measured before the first injection and at 3, 6, and 12 months after the first injection. The value measured before the treatment was compared with those measured after treatment. Results: The patients received an average of 4.2 ± 1.7 intravitreal anti-VEGF injections during the 12-month follow-up period. The logarithm of minimal angle of resolution (log MAR) values of BCVA before the first injection and at 3, 6, and 12months after the first injections were 0.76 ± 0.49, 0.55 ± 0.35, 0.67 ± 0.41, and 0.70 ± 0.50, respectively. BCVA was significantly improved at 3 and 6 months (p < 0.001 and p = 0.037) compared to that measured before the first injection. However, there was no significant difference between BCVA before the first injection and 12 months after the first injection (p = 0.590). At 12 months of follow-up, 29 eyes (87.9%) showed stable (<2 log MAR lines of change) or improved (≥2 log MAR lines of improvement) BCVA. Conclusions: Anti-VEGF therapy was found to be beneficial in both normalizing macular thickness and in improving or maintaining visual acuity in the majority of patients with RAP.
참고문헌 (31)
- Yannuzzi LA, "Retinal angiomatous proliferation in age-related macular degeneration", Retina, 21, pp.416~434 (2001)
- Massacesi AL, "The prevalence of retinal angiomatous proliferation in age-related macular degeneration with occult choroidal neovascularization", Graefes Arch Clin Exp Ophthalmol, 246, pp.89~92 (2008)
- Maruko I, "Clinical characteristics of exudative age-related macular degeneration in Japanese patients", Am J Ophthalmol, 144, pp.15~22 (2007)
- Liu Y, "Subtype lesions of neovascular age-related macular degeneration in Chinese patients", Graefe's Arch Clin Exp Ophthalmol, 245, pp.1441~1445 (2007)
- Gross NE, "Nature and risk of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation", Retina, 25, pp.713~718 (2005)
- Bottoni F, "Treatment of retinal angiomatous proliferation in age-related macular degeneration: a series of 104 cases of retinal angiomatous proliferation", Arch Ophthalmol, 123, pp.1644~1650 (2005)
- Rosenfeld PJ, "Ranibizumab for neovascular age-related macular degeneration", N Engl J Med, 355, pp.1419~1431 (2006)
- Brown DM, "Ranibizumab versus verteporfin for neovascular age-related macular degeneration", N Engl J Med, 355, pp.1432~1444 (2006)
- Spaide RF, "Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration", Retina, 26, pp.383~390 (2006)
- Cohen SY, "Results of one-year's treatment with ranibizumab for exudative age-related macular degeneration in a clinical setting", Am J Ophthalmol, 148, pp.409~413 (2009)
- 강승범, "연령관련황반변성에 동반된 맥락막신생혈관의 유리체강내 라니비주맙 주입술 임상결과", 대한안과학회지, 50(5), pp.725~730 (2009), 대한안과학회
- 김용환, "나이관련황반변성에 의한 맥락막혈관신생에서 유리체내 베바시주맙 주입술의 장기효과", 대한안과학회지, 49(12), pp.1935~1940 (2008), 대한안과학회
- Parodi MB, "Intravitreal bevacizumab versus ranibizumab for the treatment of retinal angiomatous proliferation", Acta Ophthalmol, 91, pp.267~273 (2013)
- Ghazi NG, "Intravitreal bevacizumab (Avastin) treatment of retinal angiomatous proliferation", Retina, 28, pp.689~695 (2008)
- Konstantinidis L, "Intravitreal ranibizumab (Lucentis®) in the treatment of retinal angiomatous proliferation (RAP)", Graefes Arch Clin Exp Ophthalmol, 247, pp.1165~1171 (2009)
- Costagliola C, "Intravitreal bevacizumab for the treatment of retinal angiomatous proliferation", Am J Ophthalmol, 144, pp.449~451 (2007)
- Hufendiek K, "Visual and morphological outcomes of bevacizumab (Avastin®) versus ranibizumab (Lucentis®) treatment for retinal angiomatous proliferation", Int Ophthalmol, 32, pp.259~268 (2012)
- Jae Hoon Kang, "Retinal Angiomatous Proliferation and Intravitreal Bevacizumab Injection", Korean Journal of Ophthalmology, 21(4), pp.213~215 (2007), 대한안과학회
- Lee MY, "Combination therapy of ranibizumab and photodynamic therapy for retinal angiomatous proliferation with serous pigment epithelial detachment in Korean patients:twelve-month results", Retina, 31, pp.65~73 (2011)
- 이필영, "1단계 망막혈관종성증식의 치료", 대한안과학회지, 49(3), pp.442~449 (2008), 대한안과학회
- 변석호, "연령연관황반변성에서 망막혈관종성증식과 동반된 망막색소상피 박리의 임상양상과 일차적인 광역학치료의 결과", 대한안과학회지, 47(9), pp.1410~1416 (2006), 대한안과학회
- 조윤정, "출혈우세병변이 동반된 연령관련 황반변성 환자에서의 유리체강 내 라니비주맙 주입술의 효과", 대한안과학회지, 52(7), pp.838~845 (2011), 대한안과학회
- Chang MA, "Prospective one-year study of ranibizumab for predominantly hemorrhagic choroidal neovascular lesions in age-related macular degeneration", Retina, 30, pp.1171~1176 (2010)
- Shienbaum G, "Management of submacular hemorrhage secondary to neovascular age-related macular degeneration with anti–vascular endothelial growth factor monotherapy", Am J Ophthalmol, 155, pp.1009~1013 (2013)
- Avery RL, "Natural history of subfoveal subretinal hemorrhage in agerelated macular degeneration", Retina, 16, pp.183~189 (1996)
- Bennett SR, "Factors prognostic of visual outcome in patients with subretinal hemorrhage", Am J Ophthalmol, 109, pp.33~37 (1990)
- Riusala AM, "Predictors of structural findings in old disciform lesions", Am J Ophthalmol, 138, pp.245~253 (2004)
- Holladay JT, "Visual acuity measurements", J Cataract Refract Surg, 30, pp.287~290 (2004)
- Arias L, "Delay in treating age-related macular degeneration in Spain is associated with progressive vision loss", Eye (Lond), 23, pp.326~333 (2009)
- Oliver-Fernandez A, "Progression of visual loss and time between initial assessment and treatment of wet age-related macular degeneration", Can J Ophthalmol, 40, pp.313~319 (2005)
- Rauch R, "Time to first treatment: the significance of early treatment of exudative age-related macular degeneration", Retina, 32, pp.1260~1264 (2012)