망막중심정맥폐쇄에 동반된 황반부종에서 유리체강내 덱사메타손삽입물 치료의 1년 효과
One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion
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목적: 망막중심정맥폐쇄에 동반된 황반부종에서 유리체강내 덱사메타손삽입물의 1년 효과를 알아보고자 하였다. 대상과 방법: 망막중심정맥폐쇄에 동반된 황반부종으로 유리체강내 덱사메타손삽입물 주입술을 1년 동안 2회 이상 시행 받은 22명(22 안)의 의무기록을 조사하여, 최대교정시력, 중심황반두께 및 안압의 1년간 변화를 분석하였다. 백내장 발생, 안압 상승 등의 이상반응 여부도 확인하였다. 결과: 전체 환자의 평균연령은 64.3 ± 9.5세이며, 남성이 10명이었다. 주입술 시행 횟수는 평균 2.4 ± 0.6회였으며, 첫 주입술과 두 번째 주입술 사이의 간격은 22.0 ± 6.4주였다. 평균시력(logMAR)은 시술 후 8개월까지는 유의하게 좋아졌으나 1년째에는 0.72 ± 0.62로 시술 전 0.82 ± 0.50과 비교하여 유의하게 호전되지는 않았다(p=0.638). 중심황반두께의 경우 1년에 걸쳐 전 구간에서 유의하게 감소하였다(p<0.05). 위험군별 다변량 분석을 시행하였을 때, 유리체강내 덱사메타손의 농도가 유지되는 구간에서 시력이 유의하게 더 호전되었고, 중심황반두께 역시 유의하게 더 감소하였다. 또한 고혈압군과 허혈성 망막중심정맥폐쇄군에서 중심황반두께가 유의하게 더 감소하였다(p=0.006, p=0.032). 경과관찰기간 동안 6명(27.3%)의 환자가 22 mmHg 이상으로 안압이 증가하였고 3명(13.6%)에서는 백내장 진행이 있었다. 결론: 유리체강내 덱사메타손삽입물 주입술은 망막중심정맥폐쇄에서 심각한 부작용 없이 시력의 안정과 황반부종을 감소시키는 효과를 보였다.
Abstract
Purpose: In the present study, 1-year outcome of intravitreal dexamethasone implant in macular edema secondary to central retinal vein occlusion (CRVO) was evaluated. Methods: The medical records of 22 patients (22 eyes) with macular edema secondary to CRVO were reviewed retrospectively. All patients were treated with intravitreal dexamethasone implant more than twice a year and followed up at least for 1 year from the first dexamethasone implant injection. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured every 2 months after the first injection. Adverse effects, including cataract formation and elevation of IOP, were analyzed. Results: The mean patient age was 64.3 ± 9.5 years and 10 patients (45.5%) were male. The average number of injections was 2.4 ± 0.6 and the interval between the first and second injection was 22.0 ± 6.4 weeks. The mean BCVA (log MAR) was 0.82 ± 0.50 and 0.72 ± 0.62 at baseline and after 1 year, respectively. Vision was significantly improved for 8 months after the first injection (p < 0.05). However, vision was not different from baseline after 1 year. The CMT was significantly decreased compared to baseline (p < 0.001). Subgroup analysis revealed that BCVA was improved and CMT decreased significantly when intravitreal dexamethasone concentration was presumed sufficient. Moreover, CMT decreased significantly in hypertensive and ischemic groups compared with normotensive and non-ischemic groups, respectively (p < 0.001). Elevated IOP was observed in 6 eyes (27.3%), but all 6 eyes became normal after topical agent was applied. Cataract formation was observed in 3 eyes (13.6%). Conclusions: Intravitreal dexamethasone implant resulted in visual acuity stabilization and macular edema reduction in patients having macular edema secondary to CRVO without significant adverse events.
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