베바시주맙과 라니비주맙에 반응 없는 삼출성 나이관련황반변성에서 애플리버셉트 주입술의 효과
Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration Resistant to Bevacizumab and Ranibizumab
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목적: 유리체강내 베바시주맙과 라니비주맙 주입술에 반응하지 않는 삼출성 나이관련황반변성에서 유리체강내 애플리버셉트 주입술의 효과를 알고자 하였다. 대상과 방법: 나이관련황반변성으로 진단 받고 유리체강내 베바시주맙과 라니비주맙 주입술을 시행 받고 반응이 없는 환자에서 애플리버셉트로 교체하여 유리체강내 주입술을 시행 받은 20명의 환자를 대상으로 주입술 후 1개월째 시력과 중심 망막두께의 변화를조사하였다. 또한 망막하액, 망막내액, 망막색소상피박리의 변화를 조사하였다. 결과: 유리체강내 애플리버셉트 주입술 전 대상안의 평균 최대 교정시력은 0.83 ± 0.56 logMAR였으며 평균 중심 망막 두께는 294.20 ± 12.99 μm였다. 애플리버셉트로 전환하여 유리체강내 주입술을 시행하고 1개월째 대상안의 평균 최대 교정시력은 0.86 ± 0.61 logMAR로 기존 시력과 통계적으로 유의하게 변화하지 않았고(p=0.406), 평균 중심 망막 두께는 232.45 ± 12.05 μm로 전환 이전에비해 통계적으로 유의한 감소가 관찰되었다(p=0.011). 유리체강내 애플리버셉트 주입술을 시행하고 1개월째 망막내액의 감소를 보인경우 4안(80%), 망막하액의 감소를 보인 경우 11안(78.6%), 망막색소상피박리의 감소를 보인 경우 5안(50%)이 관찰되었으며 망막내액, 망막하액 및 망막색소상피박리가 증가하거나 새로 발생한 경우는 없었다. 결론: 유리체강내 베바시주맙과 라니비주맙 주입술에 반응하지 않는 삼출성 나이관련황반변성 환자에서 애플리버셉트는 유용한 치료제임을 확인할 수 있었다.
Abstract
Purpose: To evaluate outcomes of intravitreal aflibercept in cases resistant to bevacizumab and ranibizumab in neovascular age-related macular degeneration. Methods: Twenty patients with neovascular age-related macular generation who were resistant to treatment with bevacizumab and ranibizumab were evaluated. After switching to aflibercept the best corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared at baseline and at 1 month after injection. Additionally, changes in the intraretinal fluid, subretinal fluid and pigment epithelial detachment were evaluated. Results: The mean BCVA was 0.83 ± 0.56 log MAR and the mean CRT was 294.20 ± 12.99 μm before aflibercept treatment. After switching to aflibercept the mean BCVA was 0.86 ± 0.61 log MAR with no statistical difference (p = 0.406) and the mean CRT was decreased to 232.45 ± 12.05 μm (p = 0.011). After 1 month of aflibercept injections, a reduction of intraretinal fluid in 4 eyes (80%), reduction of subretinal fluid in 11 eyes (78.6%) and reduction of pigment epithelial detachment in 5 eyes (50%) were observed. Increases in fluid or new lesions were not observed. Conclusions: Aflibercept injection appears beneficial in patients with neovascular age-related macular generation who are resistant to bavacizumab and ranibizumab treatment.
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