만성중심장액맥락망막병증에서 맥락막과형광에 따른 광역학치료 효과 비교
Photodynamic Therapy for Chronic Central Serous Chorioretinopathy According to Degree of Choroidal Hyperfluorescence
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목적: 만성중심장액맥락망막병증 환자에서 광역학치료를 시행할 때 인도사이아닌그린혈관조영술에서 나타나는 맥락막과형광 정도에따라 치료 효과의 차이를 보이는지 알아보고자 하였다. 대상과 방법: 절반에너지를 이용한 광역학치료(25 J/cm2)를 시행 받고 6개월 이상 경과관찰이 가능하였던 만성중심장액맥락망막병증환자 23명 23안을 대상으로 하였다. 시술 전 중기 인도사이아닌그린혈관조영술에서 나타나는 누출점 주변의 맥락막혈관과형광 정도에따라 강한 과형광 또는 약한 과형광을 보이는 경우로 분류하고, 시술 후 최대교정시력변화와 빛간섭단층촬영검사상 중심황반두께 변화, 재발률, 합병증을 비교하였다. 결과: 강한 과형광을 보이는 환자는 11안, 약한 과형광을 보이는 환자는 12안이었고 모든 환자에서 치료 후 1개월째 망막하액 소실을보였다. 약한 과형광을 보인 환자 1안에서 광역학치료 후 5개월째 재발이 관찰되었지만, 재발은 두 군 사이에서 통계적으로 유의한차이를 보이지 않았다(p=1.000). 결론: 만성중심장액맥락망막병증에서 절반에너지를 이용한 광역학치료는 치료 전 시행한 인도사이아닌그린혈관조영술에서 나타나는맥락막과형광 정도와 상관없이 효과적이고 안전한 방법으로 생각된다.
Abstract
Purpose: To compare the efficacy of photodynamic therapy (PDT) depending on the degree of hyperfluorescence based on indocyanine green angiography (ICGA) for treating chronic central serous chorioretinopathy (CSC). Methods: Twenty-three eyes of 23 patients with chronic CSC were recruited for the present study. The minimum follow-up period was six months. The total energy of PDT was reduced to 25 J/cm2 for 83 seconds. The baseline middle-phase ICGA findings were classified as intense or low hyperfluorescence depending on the degree of hyperpermeability from choriocapillaris. The change in mean best-corrected visual acuity, the resolution of subretinal fluid, recurrence rate, and complication were analyzed in relation to each ICGA finding at baseline. Results: The baseline ICGA findings showed intense hyperfluorescence in 11 eyes (47.8%) and low hyperfluorescence in 12 eyes (52.2%). The subretinal fluid resolved completely one month after a single application of low-fluence PDT in both groups. The subretinal fluid recurred in one of 12 eyes (8.3%) with low hyperfluorescence and in no eyes (0%) with intense hyperfluorescence. There was no statistically significant difference in the rate of recurrence between the two groups. Conclusions: Low-fluence PDT appears to be an effective and safe treatment option for long-standing chronic CSC regardless of the degree of hyperfluorescence based on the ICGA.
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