만성중심장액맥락망막병증에서 절반 에너지보다 낮은 에너지를 이용한 광역학치료의 효과
Comparison of Very Low Fluence and Low Fluence Photodynamic Therapy in Chronic Central Serous Chorioretinopathy
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목적: 만성중심장액맥락망막병증에서 합병증 없이 안전하고 효과적인 광역학치료의 강도를 찾고자 하였다. 대상과 방법: 2009년 11월에서 2010년 7월까지 기존 TAP 프로토콜의 50% 에너지를 이용한 광역학치료군 27명 27안(1군)과 2011년 4월에서 2012년 2월까지 25% 에너지를 이용한 광역학치료군 10명 11안(2군)을 대상으로 시술 전후 최대교정시력과 중심황반두께, 재발률,맥락막과형광의 변화, 합병증을 후향적으로 비교 분석하였다. 결과: 1군에서 최대교정시력(logMAR)은 치료 전 0.33 ± 0.17에서 치료 6개월째 0.14 ± 0.15로 유의한 상승을 보였고(p˂0.001), 2군에서는 0.31 ± 0.38에서 0.18 ± 0.23로 상승하였으나 통계적으로 유의하지 않았다(p=0.050). 치료 후 6개월까지 1군은 3.7% (27안중 1안)에서만 재발을 보였으나, 2군은 45.5% (11안 중 5안)에서 치료에 반응하지 않거나 재발을 보였다(p=0.016). 치료 후 맥락막과형광이 감소하거나 사라진 경우도 1군에서 100%, 2군에서 54.5%로 유의한 차이를 보였다(p=0.016). 두 군 모두에서 심각한 합병증을보인 경우는 없었다. 결론: 만성중심장액맥락망막병증에서는 50% 에너지를 사용한 광역학치료가 25% 에너지를 사용한 광역학치료보다 재발률이 적으면서더 유용한 방법으로 생각한다.
Abstract
Purpose: To investigate the safe, effective light dose for photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC). Methods: Thirty-eight eyes of 37 patients with chronic CSC were recruited for this study. From November 2009 to July 2010 and from April 2011 to February 2012, PDT was performed using 50% and 25% of the full light dose in 27 eyes of 27patients (group I) and 11 eyes of 10 patients (group II), respectively. The minimum follow-up period was 6 months. Mean change in best corrected visual acuity (BCVA) and central retinal thickness, hyperpermeability change from abnormal choriocapillaris,success rate, recurrence rate, and complications were analyzed. Results: Group I showed that BCVA (log MAR) improved significantly from 0.33 ± 0.17 to 0.14 ± 0.15 at 6 months (p <0.001). However, there was no significant improvement of BCVA (p = 0.050) in group II. One eye out of 27 eyes (3.7%) in group I and 5 eyes out of 11 eyes (45.5%) in group II showed recurrence at the 6-month follow-up (p = 0.016). After initial PDT, hyperpermeability from abnormal choriocapillaris reduced or disappeared at 95.5% in group I and 54.5% in group II at month 3 (p = 0.016). No patient in either group experienced severe adverse events. Conclusions: PDT performed with 50% of the full light dose appears to be a more useful method in the treatment of chronic CSC, with less frequent recurrence, than PDT using 25% of the full light dose.
참고문헌 (41)
- Klais CM, "Central serous chorioretinopathy" (2006), Elsevier Mosby
- Prünte C, "Choroidal capillary and venous congestion in central serous chorioretinopathy", Am J Ophthalmol, 121, pp.26~34 (1996)
- Spaide RF, "Indocyanine green videoangiography of older patients with central serous chorioretinopathy", Retina, 16, pp.203~213 (1996)
- Jalkh AE, "Retinal pigment epithelium decompensation. I. Clinical features and natural course", Ophthalmology, 91, pp.1544~1548 (1984)
- Ie D, "Subretinal exudative deposits in central serous chorioretinopathy", Br J Ophthalmol, 77, pp.349~353 (1993)
- Iida T, "Cystoid macular degeneration in chronic central serous chorioretinopathy", Retina, 23(1-7), pp.137~138 (2003)
- Ficker L, "Long-term follow-up of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy", Br J Ophthalmol, 72, pp.829~834 (1988)
- Pikkel J, "Acetazolamide for central serous retinopathy", Ophthalmology, 109, pp.1723~1725 (2002)
- Forooghian F, "Finasteride for chronic central serous chorioretinopathy", Retina, 31, pp.766~771 (2011)
- Battaglia Parodi M, "Photodynamic therapy in chronic central serous chorioretinopathy", Retina, 23, pp.235~237 (2003)
- Cardillo Piccolino F, "Photodynamic therapy for chronic central serous chorioretinopathy", Retina, 23, pp.752~763 (2003)
- Yannuzzi LA, "Indocyanine green angiography- guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study", Retina, 23, pp.288~298 (2003)
- 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)
- Colucciello M, "Choroidal neovascularization complicating photodynamic therapy for central serous retinopathy", Retina, 26, pp.239~242 (2006)
- Schlötzer-Schrehardt U, "Dose-related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes", Graefes Arch Clin Exp Ophthalmol, 240, pp.748~757 (2002)
- Chan WM, "Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy: one-year results of a prospective study", Retina, 28, pp.85~93 (2008)
- Senturk F, "Microperimetric changes after photodynamic therapy for central serous chorioretinopathy", Am J Ophthalmol, 151(303-9), pp.e1~ (2011)
- Michels S, "Influence of treatment parameters on selectivity of verteporfin therapy", Invest Ophthalmol Vis Sci, 47, pp.371~376 (2006)
- Zhao MW, "Photodynamic therapy for acute central serous chorioretinopathy: the safe effective lowest dose of verteporfin", Retina, 29, pp.1155~1161 (2009)
- Kaiser PK, "Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: 5-year results of two randomized clinical trials with an open-label extension: TAP report no. 8", Graefes Arch Clin Exp Ophthalmol, 244, pp.1132~1142 (2006)
- Arnold JJ, "Acute severe visual acuity decrease after photodynamic therapy with verteporfin: case reports from randomized clinical trials-TAP and VIP report no. 3", Am J Ophthalmol, 137, pp.683~696 (2004)
- Schmidt MH, "Preclinical evaluation of benzoporphyrin derivative combined with a light-emitting diode array for photodynamic therapy of brain tumors", Pediatr Neurosurg, 30, pp.225~231 (1999)
- Miller JW, "Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of a single treatment in a phase 1 and 2 study", Arch Ophthalmol, 117, pp.1161~1173 (1999)
- Bandello F, "ICG angiography and retinal pigment epithelial decompensation (CRSC and epitheliopathy)", J Fr Ophtalmol, 24, pp.448~451 (2001)
- Lai TY, "Transient reduction in retinal function revealed by multifocal electroretinogram after photodynamic therapy", Am J Ophthalmol, 137, pp.826~833 (2004)
- Lai TY, "Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy : a short term pilot study", Br J Ophthalmol, 90, pp.869~874 (2006)
- Tzekov R, "Ocular changes after photodynamic therapy", Invest Ophthalmol Vis Sci, 47, pp.377~385 (2006)
- 김마르다, "만성중심장액맥락망막병증에 대한 광역학치료 결과", 대한안과학회지, 50(7), pp.1035~1043 (2009), 대한안과학회
- 송민혜, "만성 중심장액맥락망막병증에서 광역학치료 효과", 대한안과학회지, 48(8), pp.1048~1056 (2007), 대한안과학회
- Spaide RF, "Central serous chorioretinopathy in younger and older adults", Ophthalmology, 103, pp.2070~2079 (1996)
- Yannuzzi LA, "Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy", Ophthalmology, 91, pp.1554~1572 (1984)
- Yannuzzi LA, "Type A behavior and central serous chorioretinopathy", Trans Am Ophthalmol Soc, 84, pp.799~845 (1986)
- Fujita K, "Retinal sensitivity after photodynamic therapy with half-dose verteporfin for chronic central serous chorioretinopathy: short-term results", Retina, 31, pp.772~778 (2011)
- Lim JW, "Comparative study of patients with central serous chorioretinopathy undergoing focal laser photocoagulation or photodynamic therapy", Br J Ophthalmol, 95, pp.514~517 (2011)
- Butler AL, "Very minimal fluence photodynamic therapy for chronic central serous chorioretinopathy", Can J Ophthalmol, 47, pp.42~44 (2012)
- Uetani R, "Half-dose vs one-third-dose photodynamic therapy for chronic central serous chorioretinopathy", Eye (Lond), 26, pp.640~649 (2012)
- 장문희, "만성 중심장액맥락망막병증에서 절반 에너지를 적용한 광역학치료의 효과", 대한안과학회지, 50(9), pp.1326~1333 (2009), 대한안과학회
- 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)
- Feigl B, "Dynamics of retinal function after multiple photodynamic therapies in age-related macular degeneration: a report of cases", Doc Ophthalmol, 111, pp.135~148 (2005)
- 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)
- 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-- verteporfin in photodynamic therapy report 2", Am J Ophthalmol, 131, pp.541~560 (2001)