삼출성 노인황반변성에 대한 치료 후 발생한망막색소상피파열의 임상결과
Clinical Manifestation of Retinal Pigment Epithelial Tear after Treatment of Age-Related Macular Degeneration
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목적: 삼출성 노인황반변성 환자에 대한 치료 후 발생하는 망막색소상피파열의 임상양상에 대하여 보고하고자 한다. 대상과 방법: 2009년 3월부터 2012년 2월까지 연속적으로 내원한 삼출성 노인황반변성 환자 219명의 의무기록을 후향적으로 조사하고이 중 망막색소상피파열이 발생한 환자를 조사하였다. 망막색소상피파열 전 및 1년 경과관찰 시까지의 시력을 조사하였고, 치료시작시점에서 망막색소상피파열이 발생하는 시점을 조사하였다. 망막색소상피파열 후 추가적인 항체주사치료를 시행한 경우 치료효과를1년간 경과관찰하였다. 망막색소상피파열 후의 “시력 유지”는 파열 직전의 시력보다 교정시력이 시력표 상 한 칸 미만으로 떨어진 경우까지로 정의하였다. 결과: 총 219명의 환자 중 10명(4.6%)의 환자에서 망막색소상피파열이 발생하였다. 10명의 환자 중 7명이 잠복 맥락막신생혈관이었고, 3명이 결절성 맥락막혈관병증이었다. 망막색소상피파열환자의 나이(75.4 ± 3.1세)가 그렇지 않은 환자(65.7 ± 11.7세)보다 평균나이가 더 높았다(p=0.001). 망막색소상피파열 직후, 방법에서 정의한 기준의 “시력유지” 환자는 10명 중 5명(50%)이었고 평균 4개월 정도시력이 유지되었다. 그러나 1년 경과관찰 시 추가적인 치료를 시행하더라도 모든 환자에서 불량한 시력을 보였다. 결론: 삼출성 노인황반변성 환자를 치료하는 도중 발생하는 망막색소상피파열은 상대적으로 더 많은 나이에서 발병하며, 발생 직후초기에는 시력을 유지할 수 있으나, 어떤 치료를 하더라도 1년 경과관찰 시 모두 불량한 시력예후를 보인다.
Abstract
Purpose: To determine the risk factors of retinal pigment epithelial (RPE) tears developed after treatment of exudative age-related macular degeneration (AMD) and to report its clinical manifestations. Methods: A retrospective, consecutive chart review was performed for all patients with exudative AMD treated with intravitreal anti-vascular endothelial growth factor (VEGF) antibody or photodynamic therapy (PDT) between March 2010 and January 2013. The main outcome measures were the time from first injection to development of the RPE tear and pre- and post-RPE tear visual acuity. The visual acuity conservational interval was defined between the time the RPE tear occurred and the time visual acuity decreased 5 letters or more from pre-RPE tear visual acuity. Results: A total of 219 eyes were treated with intravitreal bevacizumab, ranibizumab or PDT. Ten eyes from 10 patients developed a RPE tear (4.6%); 7 were occult choroidal neovasculization (CNV) and 3 were polypoidal choroidal vasculopathy (PCV). The average age of the RPE tear patients was 75.4 years which is statistically greater than the others (65.7)(p = 0.001). Ninety percent (9/10) of the RPE tears occurred within the first 12 weeks after treatment started. Five patients conserved their visual acuity for approximately 4 months after the RPE tear occurred. However, all 10 patients had poor visual acuity within 1 year of the follow-up period. Conclusions: RPE tears occur after intravitreal anti-VEGF antibody or PDT treatments for exudative AMD in elderly patients. Visual acuity could be conserved in the early period after a RPE tear occurred but decreased within the next year.
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