결절맥락막혈관병증에서 유리체강 내 애플리버셉트 단독치료의 장기 결과
Long-term Treatment Outcome of Intravitreal Aflibercept Monotherapy for Polypoidal Choroidal Vasculopathy
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목적: 결절맥락막혈관병증에 대한 유리체강 내 애플리버셉트 단독치료의 장기 결과를 알아보고자 한다. 대상과 방법: 결절맥락막혈관병증으로 진단 후 애플리버셉트를 이용하여 24개월간 지속적으로 치료하였던 46안을 대상으로 후향적 의무기록 분석을 시행하였다. 진단 당시, 3개월, 12개월 및 24개월 시점의 최대교정시력을 서로 비교하였으며, 24개월 시력과 유의한 연관관계를 보인 진단 당시의 형태학적 인자를 확인하였다. 결과: 환자의 평균 연령은 65.8 ± 7.9세였으며, 경과관찰 기간 동안 평균 7.0 ± 2.3회의 애플리버셉트 주사가 시행되었다. 최초 진단 시, 3개월, 12개월 및 24개월 시점에 측정한 평균 logarithm of minimal angle of resolution (logMAR) 최대교정시력은 0.56 ± 0.40, 0.36 ± 0.36, 0.45 ± 0.42 및 0.52 ± 0.47이었다. 진단 당시와 비교하였을 때, 3회 주사 후 측정한 시력(p＜0.001) 및 12개월의 시력(p=0.022)은 유의하게 호전되었으나 24개월(p=1.000)에 측정한 시력은 차이가 없었다. 35안(76.1%)에서 시력이 유지 혹은 호전되었다. 결절모양병변의 위치가 중심와 바깥인 경우 중심와하/중심와곁인 경우에 비해 더 나은 시력 결과를 보였다(p=0.016). 결론: 애플리버셉트 단독치료는 결절맥락막혈관병증에서 장기간 시력을 유지 혹은 호전시키는 데에 효과적인 방법으로 생각된다. 장기 시력 예후의 예측에 있어서 진단 당시 결절모양병변 위치를 중요한 인자로 고려할 수 있을 것이다.
Abstract
Purpose: To evaluate long-term treatment outcomes of intravitreal aflibercept monotherapy for polypoidal choroidal vasculopathy (PCV). Methods: A retrospective review of medical records was performed with 46 patients who were diagnosed with PCV and treated with aflibercept monotherapy for 24 months. Best-corrected visual acuity (BCVA) values measured at diagnosis, 3 months, 12 months, and 24 months were compared. Baseline morphological factors associated with the 24 month BCVA were additionally investigated. Results: The mean age of the patients was 65.8 ± 7.9 years. The patients were treated with a mean of 7.0 ± 2.3 aflibercept injections. The mean logarithm of the minimal angle of resolution (logMAR) BCVA at diagnosis, 3 months, 12 months, and 24 months was 0.56 ± 0.40, 0.36 ± 0.36, 0.45 ± 0.42, and 0.52 ± 0.47, respectively. When compared with baseline values, the BCVA was significantly improved at 3 months (p < 0.001) and 12 months (p = 0.022). However, the value at 24 months was not significantly different (p = 1.000). The BCVA was improved or maintained in 35 eyes (76.1%). Extrafoveal polypoidal lesions were associated with a better 24 month visual outcome than subfoveal/juxtafoveal lesions. Conclusions: Aflibercept monotherapy was found to be an effective method to maintain or improve long-term visual acuity in PCV patients. The location of polypoidal lesions was a predictive factor for long-term visual outcomes.
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