치료 경험이 없는 당뇨황반부종에서 유리체내 덱사메타손삽입물- 베바시주맙 병합요법과 베바시주맙 단독 요법의 단기 치료 결과 비교
Short-term Results of Intravitreal Dexamethasone Implant Combined with Bevacizumab versus Intravitreal Bevacizumab for Treatment-naive Diabetic Macular Edema
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목적: 치료 경험이 없는 당뇨황반부종에서 유리체강내 베바시주맙과 덱사메타손삽입물(Ozurdex®) 병합주사요법과 베바시주맙 단독주사요법에 대한 치료 효과를 비교하였다. 대상과 방법: 당뇨황반부종이 있는 환자 41명 41안의 의무기록을 후향적으로 분석하였으며 이 중 20안은 베바시주맙 단독요법을 시행받았고 21안은 덱사메타손삽입물과 베바시주맙 병합요법을 시행 받았다. 시술 전과 시술 후 1, 3, 6개월의 최대교정시력, 중심황반두께, 안압, 재치료 빈도를 비교 분석하였다. 결과: 병합요법군에서는 주사 후 3개월, 6개월째 최대교정시력이 유의하게 상승되었다. 단독요법군에서는 3개월까지는 유의한 값을 보이지 않았으나 6개월째에는 치료 전과 비교하여 유의한 시력호전이 관찰되었다. 중심황반두께는 3개월까지는 병합요법군이 단독요법군보다 유의하게 감소하였다. 병합요법군에서 1개월째 중심황반두께는 264.39 ± 54.95 μm였고 단독요법군에서는 349.00 ± 112.18 μm로 유의한 차이가 있었다(p=0.011). 병합요법군에서 3개월째의 중심황반두께 역시 단독요법군과 비교하였을 때 유의한 차이가 있었으나(p<0.001), 6개월에는 두 군 간 차이가 없었다. 6개월간 평균 재주사 횟수는 병합요법군이 0.45회, 단독요법군이 1.15회였다. 병합요법군에서 6개월간 두 단계 이상 진행된 피질혼탁과 후낭혼탁성 백내장 발생은 7%, 15%였다. 결론: 당뇨황반부종에서 베바시주맙과 덱사메타손삽입물의 병합요법은 베바시주맙 단독요법과 비교하여 첫 3개월 동안 중심황반두께의 감소 효과가 있었고 재주사의 빈도를 감소시켰다.
Abstract
Purpose: To compare the visual and anatomical outcomes of intravitreal bevacizumab combined with the dexamethasone intravitreal implant (Ozurdex®) and bevacizumab monotherapy in eyes with treatment-naive diabetic macular edema. Methods: We retrospectively reviewed 41 eyes of 41 patients with diabetic macular edema who underwent either intravitreal bevacizumab (1.25 mg) (21 eyes, intravitreal bevacizumab [IVB] group) injection alone or simultaneous injection of bevacizumab (1.25 mg) and dexamethasone implant (0.7 mg) (20 eyes, intravitreal dexamethasone [IVD] group). Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure, and retreatment percentages were accessed 1, 3, and 6 months after injection. Results: At 3 and 6 months, the IVD group showed a significant improvement in BCVA compared to the baseline. Only a slight improvement in BCVA was observed in the IVB group during the initial 3 months; however, significant improvement was evident at 6 months compared with the baseline. During the first 3 months, the IVD group showed significant improvement in CMT compared with the IVB group; at 1 month after the initial injection, the CMT was 264.39 ± 54.95 μm for the IVD group versus 349.00 ± 112.18 μm for the IVB group (p = 0.011). At 3 months, the CMT in the IVD group had improved significantly compared with that of the IVB group (p < 0.001). The average number of additional intravitreal injections during the 6-month follow-up was 0.45 and 1.15 for the IVD and IVB groups, respectively. In the IVD group, cortical (7%) and posterior subcapsular (15%) cataracts developed by two grades or more during follow-up in phakic eyes. Conclusions: In patients with diabetic macular edema, simultaneous therapy combining a dexamethasone implant plus bevacizumab showed significant improvement in CMT during the initial 3 months and the combined treatment group had fewer additional intravitreal injections.
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