습성 나이관련황반변성 환자에서 유리체강내 항혈관내피성장인자항체 주사 치료 후 읽기 속도 변화
Reading Speed after Anti-vascular Endothelial Growth Factor Therapy in Patients with Wet Age-related Macular Degeneration
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목적: 습성 나이관련황반변성 환자에서 유리체강내 항혈관내피성장인자항체 주사 치료에 따른 읽기 속도의 변화를 조사하였다. 대상과 방법: 2019년 5월부터 9월까지 습성 나이관련황반변성으로 유리체강내 항혈관내피성장인자항체 주사 치료 중인 환자를 대상으로 하였다. 대상 환자를 초기 부하 용량 치료군과 재발 유지 치료군으로 분류하여 주사 전후 최대교정시력, 읽기 속도, 빛간섭단층촬영 검사 결과를 각각 조사하였다. 추가로 재발 유지 치료군에서 빛간섭단층촬영과 관련된 여러 가지 생체표지자(biomarker)의 호전유무가 읽기 속도 변화에 영향을 주는지 조사하였다. 결과: 총 74명 환자를 대상으로 하였다. 초기 부하 용량 치료군(38명)에서는 주사 전후 최대교정시력(p=0.01), 중심망막두께(p=0.001), 읽기 속도 중 두 가지 항목(words per minute [WPM] reading, WPM speaking)에서 유의한 호전(p=0.035, p=0.013)을 보였다. 한편, 재발 유지 치료군(36명)에서는 주사 전후 최대교정시력, 중심망막두께, 읽기 속도에 통계적으로 유의한 변화가 없었지만 생체표지자중 망막색소상피박리가 호전되면 읽기 속도가 유의하게 호전되는 경향을 보였다. 결론: 읽기 속도 검사는 환자의 삶의 질과 관련된 주관적 증상 호전을 확인할 수 있는 지표로서 습성 나이관련황반변성 치료 결과평가에 유용하게 쓰일 수 있다. 특히 재발 유지 치료군 환자에서 빛간섭단층촬영 관련 생체표지자의 호전 여부가 읽기 속도 호전의예측인자가 될 수 있으므로, 진료 시 이에 대한 정밀한 평가와 지속적인 모니터링이 필요하다.
Abstract
Purpose: To demonstrate the changes in reading speed after anti-vascular endothelial growth factor (VEGF) treatment in wet age-related macular degeneration (wAMD) patients. Methods: This retrospective study enrolled wAMD patients who were treated with intravitreal anti-VEGF injection from May 2019 to September 2019. The reading speed was measured before anti-VEGF treatment and at the next injection visit using an iPad application for the assessment of reading speed. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were also analyzed. In addition, we investigated whether the improvement in optical coherence tomography (OCT)-related biomarkers affected the change in reading speed after anti-VEGF injection. As a subgroup analysis, patients were further divided into a loading dose group and a maintenance group. Results: Seventy-four patients were enrolled in this study. In the loading dose group (n = 38), there were significant improvements in BCVA (p = 0.01) and CRT (p = 0.001); additionally, the reading speed improved significantly in two of the four areas (words per minute (WPM) reading [p = 0.035] and WPM speaking [p = 0.013]) after anti-VEGF injection. In the maintenance group (n = 36), BCVA, CRT, and reading speed showed some improvement; however, the results were not statistically significant. In the maintenance group, reading speed improved significantly as the size of the pigment epithelial detachment decreased after anti-VEGF injection. Conclusions: Reading speed may be useful as an index for measuring visual function related to the quality of life of wAMD patients. Precise evaluation and continuous monitoring of OCT biomarkers are necessary for the treatment of wAMD especially in the maintenance group because they can be predictors of reading speed improvement.
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