유리체절제술을 시행한 눈에서 난치성 당뇨황반부종에 대한 후테논낭하 트리암시놀론 주사
Posterior Subtenon Triamcinolone Acetonide Injection for Refractory Diabetic Macular Edema in Vitrectomized Eye
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목적: 유리체절제술을 시행한 눈에서 재발하는 난치성 당뇨황반부종에 대한 후테논낭하 트리암시놀론 주사의 효과를 알아보고자 하였다. 대상과 방법: 유리체절제술을 시행 받은 눈 중 재발하는 황반부종으로 후테논낭하 트리암시놀론을 주입받고 6개월 이상 경과 관찰이가능하였던 16명 17안을 대상으로 주사 전, 주사 후 1, 3, 6개월의 교정 시력 및 빛간섭단층촬영에 의한 황반부 중심 1 mm 영역의두께를 측정하였다. 결과: 대상 안은 남자 4명, 여자 12명이었고 평균 나이는 56.9세였으며, 주사 후 logMAR시력은 주사 전 평균 0.70 ± 0.33에서 주사후 1개월 0.56 ± 0.24과 3개월 0.54 ± 0.21로 유의하게 호전되었으나(p＜0.05), 6개월은 0.61 ± 0.24로 유의성이 없었다(p=0.17). 황반중심영역 두께도 주사 전 평균 493 ± 145 μm에서 주사 후 1개월 323 ± 58 μm, 3개월 343 ± 100 μm, 그리고 6개월 389 ± 156 μm로 모든 기간에 유의하게 감소하였다(p＜0.05). 결론: 유리체절제술 후에도 지속되는 황반부종에서 후테논낭하 트리암시놀론 주입은 단기적으로 시력호전과 황반부종의 감소를 얻을수 있는 방법이다.
Abstract
Purpose: To evaluate the effect of posterior subtenon injection of triamcinolone acetonide (TA) in patients with refractory diabetic macular edema (DME) after vitrectomy. Methods: Seventeen vitrectomized eyes in 16 patients with DME underwent a posterior subtenon injection of TA (40mg/1.0 ml) and were followed-up for more than six months. Visual acuity (VA, logMAR) and central subfield macular thickness (CSMT, μm) according to optical coherent tomography were assessed at baseline and 1, 3, and 6 months after an injection of TA. Results: The patients included four men and 12 women with an average age of 56.9 years. VA improved significantly from 0.70 ± 0.33 (mean ± SD) before injection to 0.56 ± 0.24 one month and 0.54 ± 0.21 three months after an injection of TA. Visual acuity at six months was 0.61 ± 0.24 and had no significance (p = 0.17). CSMT decreased significantly from 469 ±145 before injection to 323 ± 58, 343 ± 100, and 389 ± 156 one, three, and six months after an injection of TA, respectively. Conclusions: Posterior subtenon injection of TA is effective in the short-term for improving VA and CMT in patients with refractory diabetic macular edema after vitrectomy.
참고문헌 (29)
- "Photocoagulation for diabetic macular edema", Arch Ophthalmol, 103, pp.1796~1806 (1985), Early Treatment Diabetic Retinopathy Study research group
- "Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema", Ophthalmology, 94, pp.761~774 (1987), Early Treatment Diabetic Retinopathy Study Research Group
- "Focal photocoagulation treatment of diabetic macular edema", Arch Ophthalmol, 113, pp.1144~1155 (1995), Treatment Diabetic Retinopathy Study Research Group
- Jampol LM, "Pharmacologic therapy of aphakic cystoid macular edema", Ophthalmology, 89, pp.891~897 (1982)
- Pendergast SD, "Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid", Am J Ophthalmol, 130, pp.178~186 (2000)
- Martidis A, "Intravitreal triamcinolone for refractory diabetic macular edema", Ophthalmology, 109, pp.920~927 (2002)
- Haritoglou C, "Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema", Retina, 26, pp.999~1005 (2006)
- Shimura M, "Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema", Am J Ophthalmol, 145, pp.854~861 (2008)
- Moshfeghi DM, "Acute endophthalmitis following intravitreal triamcinolone acetonide injection", Am J Ophthalmol, 136, pp.791~796 (2003)
- Jonas JB, "Intravitreal triamcinolone acetonide as an additional tool in pars plana vitrectomy for proliferative diabetic retinopathy", Eur J Ophthalmol, 13, pp.468~473 (2003)
- Jonas JB, "Intraocular pressure after intravitreal injection of triamcinolone acetonide", Br J Ophthalmol, 87, pp.24~27 (2003)
- Rosenblatt BJ, "Pars plana vitrectomy with internal limiting membranectomy for refractory diabetic macular edema without a taut posterior hyaloid", Graefes Arch Clin Exp Ophthalmol, 243, pp.20~25 (2005)
- Chin HS, "Difference in clearance of intravitreal triamcinolone acetonide between vitrectomized and nonvitrectomized eyes", Retina, 25, pp.556~560 (2005)
- Sato H, "Efficacy of sub-Tenon's capsule injection of triamcinolone acetonide for refractory diabetic macular edema after vitrectomy", J Med Invest, 55, pp.279~282 (2008)
- Bakri SJ, "Posterior subtenon triamcinolone acetonide for refractory diabetic macular edema", Am J Ophthalmol, 139, pp.290~294 (2005)
- Floman N, "Mechanism of steroid action in ocular inflammation Inhibition of prostaglandin production", Invest Ophthalmol Vis Sci, 16, pp.69~73 (1977)
- Wilson CA, "Treatment with intravitreal steroid reduces blood retinal barrier breakdown due to retinal photocoagulation", Arch Ophthalmol, 110, pp.1155~1159 (1992)
- Shimura M, "Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema", Am J Ophthalmol, 145, pp.854~861 (2008)
- Lewis H, "The role of vitrectomy in the treatment of diabetic macular edema", Am J Ophthalmol, 131, pp.123~125 (2001)
- Cardillo JA, "Comparison of intravitreal versus posterior sub-Tenon's capsule injection of triamcinolone acetonide for diffuse diabetic macular edema", Ophthalmology, 112, pp.1557~1563 (2005)
- 권순재, "당뇨황반부종에 대한 트리암시놀론의 유리체강내 주입술과 테논낭하 주입술의 비교", 대한안과학회지, 49(1), pp.81~90 (2008), 대한안과학회
- Lee SJ, "Pharmacokinetics of intraocular drug delivery of Oregon Green 488-labeled triamcinolone by subtenon injection using ocular fluorophotometry in rabbit eyes", INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, 49, pp.4506~4514 (2008), ASSOC RESEARCH VISION OPHTHALMOLOGY INC
- McGhee CN, "Locally administered ocular corticosteroids benefits and risks", Drug Saf, 25, pp.33~55 (2002)
- Kalina PH, "Biochemical quantification of triamcinolone in subconjunctival depots", Arch Ophthalmol, 113, pp.867~869 (1995)
- Nozik RA, "Periocular injection of steroids", Trans Am Acad Ophthalmol Otolaryngol, 76, pp.695~705 (1972)
- Moshfeghi DM, "Retinal and choroidal vascular occlusion after posterior sub-tenon triamcinolone injection", Am J Ophthalmol, 134, pp.132~134 (2002)
- D'Amico DJ, "Anecortave acetate as monotherapy for treatment of subfoveal neovascularization in age related macular degeneration twelve month clinical outcomes", Ophthalmology, 110, pp.2372~2383 (2003)
- Ambati J, "Transscleral delivery of bioactive protein to the choroid and retina", Invest Ophthalmol Vis Sci, 41, pp.1186~1191 (2000)
- 김훈동, "당뇨황반부종에서 유리체내 베바시주맙 및 후테논낭하 스테로이드 주입술 병합요법의 효과", 대한안과학회지, 50(11), pp.1652~1656 (2009), 대한안과학회