삼출성 연령관련황반변성에서 유리체강내 베바시주맙 주입술의 해부학적 비반응군 조사
Anatomical Non-Responder to Intravitreal Bevacizumab for Neovascular Age-Related Macular Degeneration
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목적: 삼출성 연령관련황반변성에서 유리체강내 베바시주맙주입술에 대한 해부학적 비반응군의 특징을 알아보고자 하였다. 대상과 방법: 삼출성 연령관련황반변성으로 유리체강내 베바시주맙주입술을 시행받은 환자를 대상으로 하였으며, 비반응군은 맥락막신 생혈관의 크기나 형광 누출에 변화를 보이지 않거나 중심황반두께의 변화가 없는 환자로 정의하였다. 반응군과 비반응군으로 나누어 임상 양상을 비교하였다. 결과: 42명 44안 중에서 5명 6안(13.6%)이 비반응군으로 분류되었다. 평균 연령은 비반응군(75.17 ± 3.66세)이 반응군(71.89 ± 8.06세) 에 비해 많았고(P=0.237), 잠복맥락막신생혈관인 경우도 비반응군에 더 많이 분포하였으나(83.3% vs. 55.3%, P=0.375) 반응군에 비 해 유의한 차이를 보이지는 않았다. 망막색소상피박리의 크기는 비반응군이 4.42±1.56 mm2으로 반응군의 1.51 ± 2.33 mm2보다 유의 하게 더 컸다(P=0.001). 결론: 본 연구를 통해 삼출성 연령관련황반변성에서 유리체강내 베바시주맙주입술에 대한 비반응군이 존재하며, 이들은 반응군보다 망막색소상피박리의 크기가 유의하게 더 큼을 확인할 수 있었다.
Abstract
Purpose: To analyze the characteristics of anatomical non-response to intravitreal bevacizumab (IVB) in patients with neovascular age-related macular degeneration (AMD). Methods: Neovascular AMD patients who were treated with IVB were studied. A non-responder was defined as a patient whose eyes had no change in choroidal neovascularization (CNV) lesion size or fluorescein leakage and no change in foveal thickness (FT) after at least two administrations of IVB. Demographic findings and efficacy outcomes were compared between responders and non-responders based on patient gender, age, visual acuity (VA), FT, CNV lesion type, CNV lesion size, presence of serous retinal detachment (SRD), presence of pigment epithelial detachment (PED), PED size, and presence of sub-macular hemorrhage (SMH). Results: Five patients (six eyes; 13.6%) were identified as non-responders to treatment with IVB. The mean age of the non-responder group (75.17 ± 3.66 yers) was greater (p = 0.237) than that of the responder group (71.89 ± 8.06 years), and the proportion of occult CNV (85.7% versus 55.3%, p = 0.375) was higher in the non-responder group, although there was no significant difference compared with that of the responder group. The PED size of the non-responder group (4.42 ± 1.56 mm2) was significantly larger than that of the responder group (1.51 ± 2.33 mm2, p = 0.001). Conclusions: The authors report a group of patients in AMD with poor treatment response to IVB. The PED size of the non-responder group was confirmed to be significantly larger than that of the responder group.
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