비증식당뇨망막증과 증식당뇨망막증에서 범망막광응고술 후형광안저조영술로 측정한 망막순환시간의 변화
Changes in Retinal Circulation Time after Panretinal Photocoagulation in Patients with Nonproliferative and Proliferative Diabetic Retinopathy
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목적: 심한 비증식당뇨망막병증과 초기 증식당뇨망막병증 환자에게 범망막광응고술 시행 후 망막순환시간의 변화량을 통해 범망막광응고술의 망막혈류 순환 개선 효과가 당뇨망막병증 중증도별로 차이가 있는지 비교하고자 한다. 대상과 방법: 심한 비증식당뇨망막병증과 초기 증식당뇨망막병증 환자 중 범망막광응고술이 필요하다고 판단되는 환자들을 대상으로 범망막광응고술 시행 전후로 비디오 형광안저혈관조영술을 시행하여 동맥순환시간, 동정맥통과시간, 정맥충만시간의 변화를 당뇨망막병증의 중증도에 따른 환자군으로 나누어 비교 분석하였다. 결과: 총 33명 환자에 심한 비증식당뇨망막병증 환자 17명과 초기 증식당뇨망막병증 환자 16명이 포함되었다. 동맥순환시간과 동정맥통과시간은 심한 비증식당뇨망막병증 환자군(p=0.927, p=0.138)과 초기 증식당뇨망막병증 환자군(p=0.137, p=0.268)에서 범망막광응고술 전후로 유의한 차이가 없었다. 정맥충만시간은 심한 비증식당뇨망막병증 환자군(p=0.000)과 초기 증식당뇨망막병증 환자군(p=0.022) 모두 범망막광응고술 시행 후 유의하게 단축되었다. 하지만 정맥충만시간의 단축 정도는 심한 비증식당뇨망막병증 환자군과 초기 증식당뇨망병증 환자군 사이에 유의한 차이가 없었다(p=0.217). 결론: 정맥충만시간의 감소를 통해 심한 비증식당뇨망막병증 환자와 초기 증식당뇨망막병증 환자에게 범망막광응고술 시행 후 망막혈류 순환 개선 효과를 확인할 수 있었다. 따라서, 심한 비증식당뇨망막병증 환자와 초기 증식당뇨망막병증 환자에서 범망막광응고술시행을 통해 얻을 수 있는 혈류 개선 효과가 비슷하다고 유추해볼 수 있다.
Abstract
Purpose: To explore whether panretinal photocoagulation (PRP) improved retinal blood circulation in patients with diabetic retinopathyof various levels of severity based on changes in the retinal circulation time as measured by video fluorescein fundusangiography. Methods: We recruited patients with severe diabetic retinopathy indicated for PRP; we performed video fluorescein fundus angiographybefore and after PRP. We measured changes in the arterial circulation time (ACT), arteriovenous passage time (APT),and venous filling time (VFT) in patients with diabetic retinopathy of varying severity, and compared the findings. We recordedHbA1c levels and hypertension status. Results: We enrolled 33 patients, 17 with severe nonproliferative diabetic retinopathy (NPDR) and 16 with early proliferative diabeticretinopathy (PDR). After PRP, neither the ACT nor the APT changed significantly in patients with severe NPDR (p = 0.927,p = 0.138) or early PDR (p = 0.137, p = 0.268). After PRP, the VFT was significantly reduced in patients with both severe NPDR(p = 0.000) and early PDR (p = 0.022). The VFT reductions were similar in both groups (p = 0.217). Conclusions: In patients with severe NPDR and early PDR, improvements in retinal blood circulation after PRP are reflected byreductions in the VFT evident on video fluorescein fundus angiography. We speculate that the improvements are similar in patientswith severe NPDR and early PDR.
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