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만성 중심장액맥락망막병증에서 절반에너지 광역학치료와베바시주맙 주입술의 12개월간 치료효과 비교

Comparison of Therapeutic Effect Between Half-Energy Photodynamic Therapy and Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy for 12 Months

진선영|이영훈|김형석|이태곤|김영승
대한안과학회 (The Korean Ophthalmological Society)|2013.10|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제54권 제10호|pp. 1526-1533

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Photodynamic therapyChronic serous chorioretinopathy (CSC)Intravitreal Bevacizumab injection
주제분류안과학

초록

목적: 만성 중심장액맥락망막병증에서 절반에너지 광역학치료와 유리체강내 베바시주맙 주입술의 치료효과를 비교하고자 하였다. 대상과 방법: 2008년 3월부터 2011년 4월까지, 만성 중심장액맥락망막병증으로 진단받고 절반에너지 광역학치료 또는 유리체강내베바시주맙 주입술을 시행 받은 42명, 45안을 대상으로 후향적 연구를 진행하였으며, 최대교정시력, 망막하액 및 중심황반두께의 변화를 조사하였다. 결과: 광역학 치료군이 21안, 베바시주맙 주입군이 24안이었다. 두 군 모두에서 치료 후 경과관찰 기간 동안 시력이 유의하게 호전되었고, 두 군간에는 각 시기별 시력에 유의한 차이가 없었으나, 광역학레이저 치료군에서 치료 6개월 및 12개월째 시력호전의 정도가유의하게 높았다. 망막하액이 완전히 흡수된 경우는 광역학치료군에서 19안(90%), 베바시주맙 주입군에서 7안(29%)이었으며, 치료후 각각 평균 1.3 ± 0.8개월 및 3.2 ± 2.8개월에 흡수되었다. 재발은 광역학 치료군에서 1안(5%), 베바시주맙 주입군에서 4안(57%)이었다. 중심황반두께는 광역학 치료군이 베바시주맙 주입군에 비해 치료 1, 3, 6개월 후 유의하게 감소되었으나, 정상치의 2표준편차이하로 황반두께가 얇아진 경우가 광역학 치료군에서 더 많이 관찰되었다. 결론: 만성 중심장액맥락망막병증에서 절반에너지 광역학레이저치료와 베바시주맙 주입술 모두 효과적이었으나, 광역학레이저치료군에서 더 유의한 해부학적, 기능적 호전을 보였다. 그러나 정상치 이하의 황반두께 얇아짐이 광역학치료군에서 더 흔하게 발생하여이에 대한 연구와 환자에 따른 적절한 치료법의 선택이 필요할 것으로 생각한다.

Abstract

Purpose: In this study we compared the effectiveness between half energy photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injection for chronic central serous chorioretinopathy (CSC). Methods: Forty-five eyes of 42 patients diagnosed as chronic CSC from March 2008 to April 2011 were treated with half energy PDT or IVB injection. The subjects were chosen for a retrospective study and analysis was performed on changes in best corrected visual acuity and existence of subretinal fluid, recurrence rate and changes in central macular thickness. Results: Similar improvement of visual acuity was observed in both treatment groups 1 month after treatment and no meaningful difference was found in each stage for both groups (p = 0.001, p = 0.0012, respectively). However, 6 to 12months after the treatment, the half energy PDT group showed more improvement in visual acuity compared to the IVB injection group (p = 0.019, p = 0.043, respectively). Nineteen out of 21 cases showed full recovery of subretinal fluid in the half energy PDT group with an average treatment period of 1.3 ± 0.8 months and 7 out of 24 cases showed full recovery in the IVB injection group with an average treatment period of 3.2 ± 2.8 months. There was a single case of recurrence in the half energy PDT group and 4 in the IVB injection group. The half energy PDT group showed a meaningful decline in central macular thickness at 1, 3, and 6 months after treatment (p = 0.001, p = 0.005, p = 0.007, respectively)compared to the IVB injection group and showed numerous cases with decline in central macular thickness below the 2standard deviation from normal values (p = 0.002). Conclusions: Both half energy PDT and IVB injection were effective for the treatment of chronic central serous chorioretinopathy. However, the half energy PDT group comparatively showed better anatomical and functional outcomes. The thinning of central macular thickness below normal value was also observed, thus careful choice of treatment is necessary for patients with chronic central serous chorioretinopathy.

참고문헌 (36)

  1. Von Graefe A, "Ueber centrale recidivirende retinitis", Albrecht von Graefes Arch Clin Exp Ophthalmol, 12, pp.211~215 (1866)
  2. Gass JDM, "Pathogenesis of disciform detachment of the neuroepithelium II. Idiopathic central serous chorioretinopathy", Am J Ophthalmol, 63, pp.587~615 (1967)
  3. Gelber GS, "Loss of vision due to central serous chorioretinopathy following psychological stress", Am J Psychiatry, 144, pp.46~50 (1987)
  4. Yannuzzi LA, "Type-A behavior and central serous chorioretinopathy", Retina, 7, pp.111~131 (1987)
  5. Prünte C, "Choroidal capillary and venous congestion in central serous chorioretinopathy", Am J Ophthalmol, 121, pp.26~34 (1996)
  6. Spaide RF, "Indocyanine green videoangiography of older patients with central serous chorioretinopathy", Retina, 16, pp.203~213 (1996)
  7. Yap EY, "The long-term outcome of central serous chorioretinopathy", Arch Ophthalmol, 114, pp.689~692 (1996)
  8. Loo RH, "Factors associated with reduced visual acuity during long-term follow-up patients with idiopathic central serous chorioretinopathy", Retina, 22, pp.19~24 (2002)
  9. Leaver P, "Argon laser photocoagulation in the treatmentof central serous retinopathy", Br J Ophthalmol, 63, pp.674~677 (1979)
  10. Robertson DM, "Direct, indirect and sham laser photocoagulation in the management of central serous chorioretinopathy", Am J Ophthalmol, 95, pp.457~466 (1983)
  11. Piccolino FC, "Laser treatment of eccentric leaks in central serous chorioretinopathy resulting in disappearance of untreated juxtafoveal leaks", Retina, 12, pp.96~102 (1992)
  12. Schmidt-Erfurth U, "Histopathological changes following photodynamic therapy in human eyes", Arch Ophthalmol, 120, pp.835~844 (2002)
  13. Lai TY, "Transient reduction in retinal function revealed by multifocal electroretinogram after photodynamic therapy", Am J Ophthalmol, 137, pp.826~833 (2004)
  14. Schlotzer-Schrehardt U, "Doserelated structural effects of photodynamic therapy on choroidal and retinal structures of human eyes", Graefes Arch Clin Exp Ophthalmol, 240, pp.748~757 (2002)
  15. Artunay O, "Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy: a prospective, controlled clinical study", Curr Eye Res, 35, pp.91~98 (2010)
  16. Schaal KB, "Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy", Eur J Ophthalmol, 19, pp.613~617 (2009)
  17. Seong HK, "Intravitreal bevacizumab to treat acute central serous chorioretinopathy: short-term effect", Ophthalmologica, 223, pp.343~347 (2009)
  18. Bouzas EA, "Central serous chorioretinopathy and glucocorticoids", Surv Ophthalmol, 47, pp.431~448 (2002)
  19. Guyer DR, "Digital indocyaine green videoangiography of central serous chorioretinopathy", Arch Ophthalmol, 112, pp.1057~1062 (1994)
  20. Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group., "Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials-- TAP report", Arch Ophthalmol, 117, pp.1329~1345 (1999)
  21. Verteporfin in Photodynamic Therapy Study Group, "Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin: one-year results of a randomized clinical trial-VIP report 1", Ophthalmology, 108, pp.841~852 (2001)
  22. Verteporfin in Photodynamic Therapy Study Group, "Verteporfin therapy of subfoveal choroidal neovascularization in Age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization- VIP report 2", Am J Ophthalmol, 131, pp.541~560 (2001)
  23. Chan WM, "Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level", Br J Ophthalmol, 87, pp.1453~1458 (2003)
  24. Cardillo Piccolino F, "Photodynamic therapy for chronic central serous chorioretinopathy", Retina, 23, pp.752~763 (2003)
  25. Tzekov R, "Ocular changes after photodynamic therapy", Invest Ophthalmol Vis Sci, 47, pp.377~385 (2006)
  26. 장문희, "만성 중심장액맥락망막병증에서 절반 에너지를 적용한 광역학치료의 효과", 대한안과학회지, 50(9), pp.1326~1333 (2009), 대한안과학회
  27. 김정림, "만성 중심장액맥락망막병증 환자에서 짧은 시간의 광역학치료의 효과", 대한안과학회지, 49(7), pp.1078~1086 (2008), 대한안과학회
  28. Chan WM, "Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy. One-year results of a randomized controlled trial", Ophthalmology, 115, pp.1756~1765 (2008)
  29. Lim SJ, "Intravitreal bevacizumab injection for central serous chorioretinopathy", Retina, 30, pp.100~106 (2010)
  30. Lim JW, "The efficacy of intravitreal bevacizumab for idiopathic central serous chorioretinopathy", Graefes Arch Clin Ophthalmol, 249, pp.969~974 (2011)
  31. 신범호, "베바시주맙 안내주입술로 호전된 하층망막박리를 동반한 중심장액맥락망막병증 1예", 대한안과학회지, 51(10), pp.1419~1422 (2010), 대한안과학회
  32. Lee JY, "Intravitreal bevacizumab versus the conventional protocol of photodynamic therapy for treatment of chronic central serous chorioretinopathy", Acta Ophthalmol, 89, pp.293~294 (2011)
  33. Torres-Soriano ME, "A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (case reports)", Graefes Arch Clin Exp Ophthalmol, 246, pp.1235~1239 (2008)
  34. Semeraro F, "Intravitreal bevacizumab versus low-fluence photodynamic therapy for treatment of chronic central serous chorioretinopathy", Jpn J Ophthalmol, 56, pp.608~612 (2012)
  35. Huang WC, "Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy", Eye (Lond), 23, pp.488~489 (2009)
  36. Gregori-Gisbert I, "Recurrent and chronic central serous chorioretinopathy. Retina thickness evaluation one month after intravitreal bevacizumab injection", Arch Soc Esp Oftalmol, 86, pp.407~411 (2011)

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