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유리체절제술 후 발생한 낭포황반부종에서 브롬페낙 점안약의 효과

Effect of Topical Bromfenac as a Treatment of Cystoid Macular Edema Following Pars Plana Vitrectomy

박동근|사공민|문철원
대한안과학회 (The Korean Ophthalmological Society)|2020.12|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제61권 제12호|pp. 1467-1476

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Macular edemaNon-steroidal anti-inflammatory agentsVitrectomyBromfenac sodiumIrvine-Gass syndrome
주제분류안과학

초록

목적: 유리체절제술을 시행한 후 발생한 낭포황반부종에서 비스테로이성 항염증제제 점안약인 Bromfenac의 기능적, 해부학적 효과를 알아보고자 하였다. 대상과 방법: 유리체절제술 후 발생한 낭포황반부종으로 치료를 시행한 53안을 후향적으로 분석하였다. Bromfenac 점안약을 사용한 군(nonsteroidal anti-inflammatory drug [NSAID]군)이 37안이었고, 후테논낭하 트리암시놀론주사술을 사용한 군(injection군)이 16안이었다. NSAID군 중 27안은 유리체절제술과 백내장수술을 동시에 시행한 동시수술군이었고, 10안은 유리체절제술만 실시한 단독수술군이었다. 치료 후 6개월간 최대교정시력과 중심황반두께, 안압 변화를 비교하였다. 결과: 평균 최대교정시력은 모든 경과 관찰 기간 동안 두 군 사이에 서로 유의한 차이가 없었고, 평균 중심황반두께는 injection군에서 4개월까지 유의하게 더 많은 감소를 보였으나 이후 두 군 사이에 차이는 없었다. 안압은 injection군에서 상승이 관찰되었으나(2개월째 p=0.035) NSAID군에서는 나타나지 않았다. NSAID군을 백내장 동시수술 여부에 따라 비교하였을 때 평균 최대교정시력은 모든 경과 관찰 시점에서 두 군 사이에 유의한 차이가 없었고 평균 중심황반두께는 초진 시 동시수술군이 더 두꺼웠으나(p=0.023) 이후 유의한 차이를 보이지 않았다. 결론: 유리체절제술로 인한 낭포황반부종에 Bromfenac 점안약의 사용은 백내장 동시수술 여부와 관계없이 적은 부작용으로 시력개선과 중심황반두께 감소 효과를 보였다.

Abstract

Purpose: To investigate the functional and anatomical effectiveness of bromfenac sodium hydrate ophthalmic solution for the treatment of cystoid macular edema (CME) after pars plana vitrectomy (PPV). Methods: A retrospective chart review of 53 patients was performed. Thirty-seven eyes received topical 0.1% bromfenac sodium hydrate ophthalmic solution (nonsteroidal anti-inflammatory drug [NSAID] group), and 16 eyes were treated with subtenon triamcinolone acetonide injection (injection group). Of the NSAID group, 27 eyes underwent PPV with cataract surgery, and 10 eyes underwent PPV without cataract surgery. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured at baseline and monthly after treatment initiation over a 6-month period. Results: No significant difference in mean BCVA from baseline was found for either group over the 6-month follow-up. The injection group showed significantly greater improvement in CMT than the NSAID group at 4 months; however, there was no significant difference between the two groups at the 5-month follow-up visit. IOP was significantly higher in the injection group (p = 0.035 at 2 months), but not in the NSAID group. In the NSAID group, neither PPV group, with and without cataract surgery, showed any significant difference in mean BCVA from baseline over the 6 months of follow-up. The baseline CMT was significantly greater in the PPV with cataract surgery group than in the PPV without cataract surgery group (p = 0.023). However, at the 1-month follow-up, no significant difference in mean CMT from baseline values was observed in either group over the remaining follow-up examinations, up to 6 months. Conclusions: Topical bromfenac resulted in an improvement in the BCVA and a reduction in the CMT, with a less adverse effect in the treatment of CME after PPV, regardless of whether cataract surgery was performed at the same time.

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