당뇨망막병증에서 패턴 범망막광응고술과 기존 범망막광응고술과의 치료 효과 비교
Comparison of the Effects of Patterned and Conventional Panretinal Photocoagulation on Diabetic Retinopathy
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
목적: 당뇨망막병증에서 패턴 범망막광응고술 시행 시 치료 효과, 합병증 여부 및 통증 등을 기존의 방법과 비교하고자 하였다. 대상과 방법: 심한 비증식 당뇨망막병증 이상의 범망막광응고술이 필요한 환자 80명을 무작위로 두 군으로 나누어 패턴 광응고술 군에 서는 짧은 레이저 노출 시간(0.02초), 기존 광응고술 군에서는 긴 노출 시간(0.2초)을 이용하였다. 1년 이상 경과 관찰 중 당뇨망막병증 의 진행 여부, 최대교정시력 및 중심황반두께를 비교하였고, 시술 도중 환자가 느끼는 통증 및 합병증 여부를 조사하였다. 결과: 시술 전 두 군 간 임상 양상의 차이는 없었다. 1년 이상 관찰 중 당뇨망막병증의 진행 정도는 두 군 간 차이가 없었다. 시술 후 1, 2, 4, 8주에 측정한 최대교정시력은 두 군 모두 시력 감소를 보였고, 기존 광응고술 군에서 시력 감소의 정도가 컸으며, 시술 후 중심황반두께는 기존 광응고술 군에서 두께 증가의 폭이 컸다. 결론: 짧은 레이저 노출 시간을 이용한 패턴 범망막광응고술은 당뇨망막병증 치료 효과에 차이가 없으면서, 초기 시력 감소, 황반부종 등의 합병증이 적고, 시술 시 통증이 적은 방법으로 생각된다.
Abstract
Purpose: To compare the therapeutic effects and complications after panretinal photocoagulation (PRP) and discomforts of patients using patterned PRP versus conventional PRP for diabetic retinopathy. Methods: Eighty patients who required PRP due to diabetic retinopathy were enrolled in a prospective randomized controlled study. The patients were randomly divided into two groups: a patterned PRP group in which PRP was performed with a short laser exposure time (0.02 seconds) and a conventional PRP group with a long exposure time (0.2 seconds). At the 1-year follow-up visit, the progressions of diabetic retinopathy, best-corrected visual acuity, and central macular thickness were evaluated. All patients were questioned about the grade of pain during PRP. In addition, the complications after PRP were investigated. Results: There were no statistical differences in clinical characteristics between both groups. The progression of diabetic retinopathy was not different in both groups at the 1-year follow-up visit. The best-corrected visual acuities at 1, 2, 4, and 8 weeks after PRP were decreased in both groups and, in the conventional PRP group, the decrements of visual acuity were greater than in the patterned PRP group. The increments of central macular thickness were also greater in the conventional PRP group than the patterned PRP group. Conclusions: When patterned PRP is performed using a short laser exposure time, the efficacy in the treatment of diabetic retinopathy is similar to that of the conventional PRP using a longer laser exposure time. Moreover, patterned PRP is less painful, and fewer complications.
참고문헌 (26)
- Wessing A, "Treatment of diabetic retinopathy by light-coagulation", Diabetologia, 5, pp.312~317 (1969)
- Beetham WP, "Ruby laser photocoagulation of early diabetic neovascular retinopathy: preliminary report of long-term controlled study", Arch Ophthalmol, 83, pp.261~272 (1970)
- Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study (DRS) findings, , Ophthalmology, 583~600, pp.DRS report no.8 (1981)
- Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study, "Early Treatment Diabetic Retinopathy Study Research Group", Int Ophthalmol Clic, 254~264, pp.Report No. 3 (1987)
- McDonald HR, "Macular edema following panretinal photocoagulation", Retina, 5, pp.5~10 (1985)
- Khosla PK, "Contrast sensitivity in diabetic retinopathy after panretinal photocoagulation", Ophthalmic Surg, 25, pp.516~520 (1994)
- Pahor D, "Visual field loss after argon laser panretinal photocoagulation in diabetic retinopathy: full- versus mild-scatter coagulation", Int Ophthalmol, 22, pp.313~319 (1998)
- Yuki T, "Ciliary body and choroidal detachment after laser photocoagulation for diabetic retinopathy. A high-frequency ultrasound study", Ophthalmology, 104, pp.1259~1264 (1997)
- Scott J, "Graphic representation of pain", Pain, 2, pp.175~184 (1976)
- Patz A, "Studies on retinal neovascularization", Invest Ophthalmol Vis Sci, 19, pp.1133~1138 (1980)
- Molnar J, "Effect of laser photocoagulation on oxygenation of the retina in miniature pigs", Invest Ophthalmol Vis Sci, 26, pp.1410~1414 (1985)
- Yoshimura N, "Photocoagulated human retinal pigment epithelial cells produce an inhibitor of vascular endothelial cell proliferation", Invest Ophthalmol Vis Sci, 36, pp.1686~1691 (1995)
- Martidis A, "Intravitreal triamcinolone for refractory diabetic macular edema", Ophthalmology, 109, pp.920~927 (2002)
- Wu L, "Twelve-month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PACORES)", Graefes Arch Clin Exp Ophthalmol, 246, pp.81~87 (2008)
- Chun DW, "A pilot study of multiple intravitreal injections of ranibizumab in patients with center-involving clinically significant diabetic macular edema", Ophthalmology, 113, pp.1706~1712 (2006)
- Moorman CM, "Clinical applications of the micropulse diode laser", Eye, 13, pp.145~150 (1999)
- Bandello F, "Light panretinal photocoagulation (LPRP) versus classic panretinal photocoagulation (CPRP) in proliferative diabetic retinopathy", Semin Ophthalmol, 16, pp.12~18 (2001)
- Wade EC, "The effect of short versus long exposure times of argon laser panretinal photocoagulation on proliferative diabetic retinopathy", Graefes Arch Clin Exp Ophthalmol, 228, pp.226~231 (1990)
- Mainster MA, "Decreasing retinal photocoagulation damage: principles and techniques", Semin Ophthalmol, 14, pp.200~209 (1999)
- Paulus YM, "Healing of retinal photocoagulation lesions", Invest Ophthalmol Vis Sci, 49, pp.5540~5545 (2008)
- Cuthbertson FM, "Kinetic anesthesia for laser surgery", Eye, 19, pp.1205~1207 (2005)
- Vaideanu D, "Double masked randomized controlled trial to assess the effectiveness of paracetamol in reducing pain in panretinal photocoagulation", Br J Ophthalmol, 90, pp.713~717 (2006)
- Weinberger D, "Analgesic effect of topical sodium diclofenac 0.1% drops during retinal laser photocoagulation", Br J Ophthalmol, 84, pp.135~137 (2000)
- Al-Hussainy S, "Pain response and follow-up of patients undergoing panretinal laser photocoagulation with reduced exposure times", Eye, 22, pp.96~99 (2008)
- Sanghvi C, "Initial experience with the Pascal photocoagulator: a pilot study of 75 procedures", Br J Ophthalmol, 92, pp.1061~1064 (2008)
- 조범주, "당뇨망막병증에서 짧은 노출시간을 이용한 패턴 범망막광응고술의 단기 임상결과", 대한안과학회지, 50(3), pp.376~382 (2009), 대한안과학회