절반용량의 광역학치료를 받은 만성 중심장액맥락망막병증에서스펙트럼영역 빛간섭단층촬영 소견과 시력과의 상관관계
Correlation Between Optical Coherence Tomography and Visual-Acuity in Chronic Central Serous Chorioretinopathy Treated with Half Dose Photodynamic Therapy
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목적: 만성 중심장액맥락망막병증 환자에서 절반용량의 광역학치료의 효과 및 스펙트럼 영역 빛간섭단층촬영으로 측정한 소견들과시력과의 연관성에 대해서 알아보았다. 대상과 방법: 만성 중심장액맥락망막병증으로 절반용량의 광역학치료를 받고 3개월 이상 경과 관찰이 가능했던 환자 25명 25안을 대상으로 치료 전과 치료 후 3, 6개월째 시력, 외과립층의 두께 및 시세포층의 내외층 경계부를 측정하여 비교 분석하였다. 결과: 모든 대상안에서 6개월째 감각신경망막박리는 소실되었고 치료 후 최대교정시력은 0.31 ± 0.29 logMAR로 치료 전 0.50 ±0.32 logMAR보다 유의하게 시력이 호전되었다(p＜0.001). 6개월째 외과립층의 평균 두께는 88.76 ± 19.95 μm로 외과립층의 두께가감소할수록 시력이 떨어지는 상관관계를 보였다(γ=-0.64; p=0.001). 시세포층의 내외층 경계부에 따른 시력과의 연관성은 관찰되지않았다. 결론: 만성 중심장액맥락망망병증에서 시행되는 절반용량의 광역학치료는 감각신경망막박리를 소실시키고 시력을 향상시키는 효과적이고 안전한 치료법으로 생각되며, 외과립층의 두께가 많이 감소되어 있을수록 시력예후가 좋지 않음을 알 수 있었다.
Abstract
Purpose: To evaluate the results of half-dose photodynamic therapy (PDT) and determine the correlation between morphological changes measured by spectral-domain optical coherence tomography (SD-OCT) and visual acuity in patients with chronic central serous chorioretinopathy (CSC). Methods: Twenty-five eyes of 25 patients with chronic CSC who had received half-dose verteporfin PDT were enrolled in the present study. The best-corrected visual acuity (BCVA), outer nuclear layer (ONL) thickness, and the integrity of the photoreceptor inner and outer segment junction (IS/OS) using SD-OCT were evaluated at baseline and at 3 and 6 months after treatment. Results: The neurosensory retinal detachment disappeared in all eyes 6 months after treatment. The BCVA improved significantly from 0.50 ± 0.32 to 0.31 ± 0.29 log MAR at 6 months (p < 0.001). The average ONL thickness at the central fovea was 88.76 ± 19.95 μm at 6 months and the ONL thickness was well correlated with the BCVA (γ = -0.64; p = 0.001). There was no significant correlation between the status of IS/OS and the BCVA. Conclusions: Half-dose PDT is effective in treating chronic CSC resulting in visual improvement and complete resolution of neurosensory retinal detachment. The ONL thickness which was positively correlated with the BCVA could be an indicator for visual prognosis of chronic CSC.
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