맥락막신생혈관을 동반한 광범위한 망막하출혈환자에 대한 삼중치료 효과
The Effect of Triple Therapy on Patients with Subretinal Hemorrhage Accompanied by Choroidal Neovascularization
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목적: 맥락막신생혈관을 동반한 광범위한 망막하출혈환자에 대한 C_3F_8 가스주입술, 항혈관내피증식인자 유리체강내 주입술 및 광역학 치료의 삼중치료 효과를 알아보았다. 대상과 방법: 증상발현이 1주일 이내인 망막하출혈환자 중 맥락막신생혈관으로 진단받은 12명 12안에 대하여 C_3F_8가스주입술을 시행하 고 3일간 엎드리게 하였다. 항혈관내피증식인자 유리체강내 주입술을 시행하고 1주후까지 엎드린 자세를 유지시킨 후 광역학치료를 시행하였으며 1달, 2달 후에 다시 항혈관내피증식인자 유리체강내 주입술을 시행하였다. 결과: 시력은 10안에서 술 전보다 향상되었으며 1안에서는 변화가 없었고, 1안에서는 저하되었으나 병변은 안정되었다. logMAR시력은 술 전 1.05 ± 0.43에서 술 후 3개월, 6개월 0.74 ± 0.58, 0.53 ± 0.51로 향상되었고, 6개월째 시력은 통계학적으로 유의하게 향상되었다 결론: 맥락막신생혈관을 동반한 광범위한 망막하출혈에 여러가지 치료가 시도되고 있다. 저자들은 새롭게 가스주입술, 항혈관내피증식 인자 유리체강내 주입술 및 광역학치료를 시행하여 만족할 만한 결과를 얻을 수 있었다. 향후 많은 환자를 대상으로 대조군을 통한 연구가 필요할 것으로 생각한다.
Abstract
Purpose: To presents the effect of triple therapy including C_3F_8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy on patients with subretinal hemorrhage accompanied by choroidal neovascularization. Methods: Twelve eyes of 12 patients suffering from subretinal hemorrhage accompanied by choroidal neovascularization with onset of the symptom within a week prior to three-day prone positioning after C_3F_8 gas injection were included in the present study. Next, intravitreal anti-VEGF injection and photodynamic therapy was performed. Then, within two months, intravitreal bevacizumab or ranibizumab injection was performed. Results: After stabilization of the submacular hemorrhagic lesion, ten eyes of ten patients showed improved visual acuity, one eye showed no improvement, and decreased visual acuity developed in one patient. LogMAR visual acuity improved after the initial treatment from 1.05 ± 0.43 to 0.74 ± 0.58 and 0.53 ± 0.51 at three and six months, respectively. The improvement was considered to be clinically significant. Conclusions: An appropriate regimen for treating broad submacular hemorrhage accompanied by choroidal neovascularization has not been established. The authors of the patients had obtained positive results from C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy. In the future, additional studies should be conducted.
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