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연령관련황반변성에서 유리체강내 혈관내피성장인자억제제주입술 후 망막색소상피파열의 위험인자

Risk Factors for Retinal Pigment Epithelium Tears after Anti-VEGF Agent Injection in Age-Related Macular Degeneration

박재홍|김상원|이우석|윤희성|최우석
대한안과학회 (The Korean Ophthalmological Society)|2013.10|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제54권 제10호|pp. 1546-1553

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참고문헌

키워드

BevacizumabRanibizumabIntravitreal injectionRPE tearPED
주제분류안과학

초록

목적: 연령관련황반변성에서 유리체강내 주입술 후 발생하는 망막색소상피파열의 사례를 대조군과 비교하여 위험인자를 알아보고자하였다. 대상과 방법: 라니비주맙이나 베바시주맙을 유리체강내 주사한 후 망막색소상피 파열이 발생한 파열군 11명 11안과, 파열이 발생하지않은 대조군 22명 22안을 선정하여 두 군을 후향적으로 비교 분석하였다. 각각의 경우에서 환자의 나이와, 성별, 편위성, 시력, 주사에서 파열 발생까지 걸린 시간, 빛간섭단층촬영에서 망막색소상피박리의 최대직경과 넓이, 중심황반두께, 망막하액 유무, 형광안저혈관조영술에서 맥락막신생혈관의 넓이와 최대직경을 조사하였다. 결과: 평균 연령은 파열군에서 81.36 ± 5.55세, 대조군은 74.82 ± 5.28세(p=0.003), 빛간섭단층촬영상 망막색소상피박리의 최대직경은 파열군에서 2978.45 ± 947.69 μm, 대조군에서 2250.23 ± 988.49 μm (p=0.027), 망막색소상피박리의 높이는 파열군에서 507.09± 153.97 μm 대조군에서 353.23 ± 199.42 μm (p=0.010), 중심황반두께는 파열군에서 431.64 ± 200.33 μm, 대조군에서 289.95± 61.27 μm (p = 0.005)였고 이상 모두 단변수 분석에서 의미있는 차이였으나 다변수 분석에서는 나이만 의미가 있었다. 그러나성별, 편위성, 시력, 빛간섭단층촬영상 망막하액 유무, 형광안저혈관조영술상의 각종 소견에서는 유의한 차이를 보이지 않았다. 결론: 망막색소상피파열이 발생한 환자군에서 나이가 많고 치료 전 망막색소상피박리가 크고 높은 경우가 많았다.

Abstract

Purpose: Intravitreal anti-vascular endothelial growth factor (VEGF) treatment has become an important part in the treatment of neovascular age-related macular degeneration (AMD). In the present study we describe the clinical feature of retinal pigment epithelium (RPE) tears after intravitreal injection of anti-VEGF agent and compared the tear group to the control group. Methods: In this retrospective case series, data of 11 patients with eyes that developed RPE tears after intravitreal anti-VEGF injection (8 ranibizumab and 3 bevacizumab) were collected and analyzed. The tear group included 11 patients with eyes that developed RPE tears and the control group included 22 patients with no RPE tears after treatment. We investigated age, gender, bilaterality, duration from injection to tear, pigment epithelial detachment (PED) height and diameter, along with central retinal thickness (CMT) using optical coherence tomography (OCT), fluorescein angiography (FAG), and visual acuities before and after treatment. Results: The mean age of the tear group was 81.36 ± 5.55 years which was significantly different from the control group’s mean age of 74.82 ± 5.28 years (p = 0.003). OCT findings showed PED greatest linear dimension (GLD) was 2978.45 ±947.69 μm in the tear group and 2250.23 ± 988.49 μm in the control group (p = 0.027). PED height was 507.09 ± 153.97 μm in the tear group and 353.23 ± 199.42 μm in the control group (p = 0.010). CMT was 431.64 ± 200.33 μm in the tear group and 289.95 ± 61.27 μm in the control group (p = 0.005). There was no significant difference between groups according to gender, bilaterality, visual acuities, and subretinal fluid based on OCT and FAG findings. In the tear group, visual acuities before and after the tear were not significantly different. Conclusions: Old age and eyes with high and wide PED appear to be more vulnerable to RPE tear. Further investigation with a larger number of patients is needed to further confirm these results.

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