분지망막정맥폐쇄 황반부종에서 빛간섭단층촬영을 이용한 치료 반응인자에 대한 연구
OCT Biomarkers Predicting Recurrence of Macular Edema Secondary to Branch Retinal Vein Occlusion
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목적: 빛간섭단층촬영을 이용하여 분지망막정맥폐쇄 환자에서 황반부종의 재발인자를 알아보고자 한다. 대상과 방법: 2022년 3월부터 2023년 3월까지 분지망막정맥폐쇄로 진단되어 황반부종으로 유리체 내 항혈관내피성장인자 또는 덱사메타손삽입물 주입술을 시행받은 환자 55명 55안을 대상으로 하였다. 유리체강 내 주입술을 첫 6개월 동안 3회 이하로 시행받고12개월 이상 부종의 재발이 없는 환자군(비재발군)과 병의 발생 후 치료를 진행하였음에도 호전이 없거나 12개월 이내에 부종이 재발하였던 환자군(재발군)으로 나누어 후향적으로 분석하였다. 의무기록에서 시력, 구면렌즈대응치, 안압, 주사 횟수, 경과 관찰 기간을수집하고, 유리체강 내 주입술 전과 주입술 후 6개월째 빛간섭단층촬영의 황반부를 추출하여 중심망막두께, 중심와아래 맥락막두께, 망막내층손상을 측정하였다. 결과: 두 군의 치료 전후의 중심망막두께의 변화량은 동일하였다. 치료 전의 시력은 두 군 사이의 차이가 없었으나, 치료 6개월 후시력은 비재발군에서 유의하게 높았다. 비재발군은 재발군에 비하여 나이가 젊고, 치료 전과 치료 시작 6개월 후 안압이 유의하게감소하였다. 또한 치료 전후의 맥락막두께가 감소할수록, 치료 전 반대안과 맥락막두께의 차이가 있을수록, 치료 전후의 망막내층손상이 적을수록 황반부종의 재발이 적은 결과를 보였다. 결론: 치료 전후의 맥락막두께의 변화, 치료 전 반대안과 맥락막두께의 차이, 망막내층손상의 정도는 황반부종의 재발과 연관성이있었다. 분지망막정맥폐쇄 환자의 6개월 내의 초기 빛간섭단층촬영을 통해 재발 예측인자를 찾아볼 수 있었다.
Abstract
Purpose: We evaluated factors predicting the recurrence of macular edema in patients with branch retinal vein occlusion using optical coherence tomography (OCT). Methods: This study enrolled 55 patients diagnosed with branch retinal vein occlusion who presented to the outpatient clinic between March 2022 and March 2023. A retrospective analysis categorized patients into non-recurrence and recurrence groups. Data on visual acuity, spherical equivalent, intraocular pressure, number of injections, and follow-up duration were collected from medical records. OCT images were obtained before and 6 months after intravitreal injection to measure and analyze central retinal thickness, subfoveal choroidal thickness, and disorganization of retinal inner layers. Results: No statistically significant difference was observed in the central retinal thickness change before and after treatment between the groups. Although no significant differences were observed in visual acuity between the two groups before treatment, significant improvement in visual acuity was observed in the non-recurrence group after 6 months of treatment. The non-recurrence group was younger compared to the recurrence group; moreover, the intraocular pressure in non-recurrence patients decreased significantly during the 6-month treatment period. In addition, a decrease in subfoveal choroidal thickness before and after treatment, the difference in subfoveal choroidal thickness between the affected eye and the fellow eye before treatment, and the reduction in disorganization of retinal inner layers before and after treatment were associated with a favorable prognosis without recurrence. Conclusions: Changes in subfoveal choroidal thickness before and after treatment, variations in subfoveal choroidal thickness between the affected and fellow eyes before treatment, and the degree of disorganization of retinal inner layers exhibited significant associations with the recurrence of macular edema. This is significant because it allows for predictions based on baseline OCT images.
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