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만성중심장액맥락망막병증에서 광역학치료와 유리체강내 라니비주맙주입술 전후의 맥락막 과투과성 변화에 대한 정량적 비교

Comparison of Choroidal Hyperpermeability Change after Photodynamic Therapy and Ranibizumab for Chronic Central Serous Chorioretinopathy

신주영|안지윤|허장원|배소현|정흠|김정아
대한안과학회 (The Korean Ophthalmological Society)|2015.02|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제56권 제2호|pp. 205-212

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참고문헌

키워드

Intravitreal ranibizumab injectionChronic central serous chorioretinopathyChoroidal hyperpermeabilityHalf-energy photodynamic therapy
주제분류안과학

초록

목적: 만성중심장액맥락망막병증에서 절반에너지 광역학치료와 유리체강내 라니비주맙 주입술 치료 후의 맥락막 과투과성의 변화를정량적으로 비교하고자 하였다. 대상과 방법: 만성중심장액맥락망막병증에서 절반에너지 광역학치료와 유리체강내 라니비주맙 주입술의 무작위대조시험을 시행하였다. 치료 3개월 후에 효과를 평가하여, 호전이 없으면 구제치료를 시행하였다. 사후 분석으로, 상용 이미지 분석 소프트웨어를 이용하여 인도사이아닌그린 혈관조영에서 치료 전후 병변의 맥락막 과투과성 변화를 정량화하여 비교하였다. 결과: 절반에너지 광역학치료를 받은 군은 모두가 망막하액이 소실되었으나, 라니비주맙 주입술을 받은 군은 일부만이 호전을 보였다. 상용 이미지 분석 소프트웨어를 이용하여 분석한 결과 광역학치료 군이 라니비주맙 군에 비하여, 치료 후에 맥락막 과투과성의 감소가 통계적으로 유의하게 컸다(p＜0.001). 광역학치료를 받은 군에서 일차치료와 구제치료 간의 맥락막 과투과성 변화의 차이는 없었다(p=0.427). 라니비주맙 주입술을 받은 군 내에서는 호전된 5안이 치료 효과가 없었던 8안에 비해 통계적으로 유의하게 맥락막 과투과성이 감소하였다(p=0.005). 결론: 인도사이아닌그린 혈관조영에서 맥락막 과투과성의 변화를 정량화하는 새로운 방법을 이용하여, 만성중심장액맥락망막병증에서 치료 효과와 맥락막 과투과성의 감소의 상관관계를 확인하였다. 결론적으로 절반에너지를 이용한 광역학치료가 유리체강내 라니비주맙 주입술과 비교하여 맥락막 과투과성을 줄이는 효과가 더 크기 때문에 만성중심장액맥락망막병증에서 치료 결과가 더 우수한것으로 생각한다.

Abstract

Purpose: To compare changes in choroidal hyperpermeability after half-energy photodynamic therapy (PDT) and intravitreal ranibizumabin the treatment of chronic central serous chorioretinopathy (CSC). Methods: Post-hoc analysis was performed in a randomized, controlled trial comparing half-energy PDT versus intravitreal ranibizumabfor chronic CSC; during the experiments, the other treatment was available for salvage treatment if the original was unsuccessfulat 3 months. A commercially available image analysis program (Adobe® Photoshop® CS6 [Adobe Systems, Inc., SanJose, CA]) was used for quantification of change in choriodal hyperpermeability on indocyanine green angiography after half-energyPDT or three consecutive intravitreal injections of ranibizumab. Post-treatment images were subtracted from pre-treatmentimages after adjustments were made to create images depicting the change in choroidal hyperpermeability with treatment. Integrated gray scale values per area in this image were used for analysis of change in choroidal hyperpermeability. Results: The calculated change in choroidal hyperpermeability was significantly greater in the half-energy PDT group (17.36 ±8.74) than in the ranibizumab group (6.78 ± 5.03) (p < 0.001). All eyes in the half-energy PDT group showed complete resolutionof subretinal fluid, and no significant difference in change of choroidal hyperpermeability was found in eyes that received half-energyPDT as primary or salvage treatment. In the ranibizumab-treated group, subretinal fluid resolution was accomplished in 5eyes, and these eyes showed a significantly larger decrease in choroidal hyperpermeability when compared with eyes showingpoor response (10.31 ± 4.00 vs. 2.74 ± 2.16, p = 0.005). In the successfully treated eyes with ranibizumab, there was no significantdifference in choroidal hypopermeability change when compared to half-energy PDT (p = 0.124). Conclusions: Using our novel method of analysis of change in choroidal hyperpermeability following treatment for chronic CSC,greater change was found in eyes with good response, and the superior outcome of half-energy PDT over ranibizumab may beattributed to greater influence on choroidal hyperpermeability.

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