망막분지정맥폐쇄에서 황반부미세혈관 변화와 주변부 허혈 간의 상관관계
Correlations between Macular Microvascular Alterations and Peripheral Ischemia in Patients with Branch Retinal Vein Occlusion
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목적: 망막분지정맥페쇄환자에서 빛간섭단층촬영혈관조영을 이용한 망막미세혈관 변화와 초광범위형광안저혈관조영에서 측정한 주변부 망막허혈 간의 상관관계를 알아보고자 하였다. 대상과 방법: 망막분지정맥폐쇄환자 23명 23안을 후향적으로 분석하였다. 빛간섭단층촬영혈관조영을 이용해 혈관 밀도와 망막중심오목무혈관부위 면적을 측정하였고, 초광범위형광안저혈관조영을 이용해 중심와를 중심으로 망막을 구획하여 주변부 허혈 면적과 허혈 지수를 측정하였으며, 이들 간의 관계를 분석하였다. 빛간섭단층촬영혈관조영 인자들을 이용해 허혈 지수를 예측하기 위한 receiver operating characteristic 곡선 분석을 시행하였다. 결과: 표층모세혈관총의 혈관 밀도는 허혈 면적에 대해서는 모든 망막 영역에서 연관성을 보였고 허혈 지수에 대해선 바깥주변부 영역을 제외한 모든 망막 영역의 허혈 지수와 상관관계를 보였다. 심부모세혈관총의 혈관 밀도는 바깥주변부 영역을 제외한 모든 망막 영역의 허혈 면적 및 허혈 지수와 유의한 상관관계를 보였다. 다변량선형회귀분석에서 혈관 밀도는 허혈 지수와 유의한 상관관계를 보였고, 표층모세혈관총과 심부모세혈관총의 혈관 밀도가 24.7%, 26.1% 이하로 감소하는 경우 10% 이상의 허혈 지수를 보이는 심한 허혈 상태를 예측할 수 있었다. 결론: 망막분지정맥폐쇄에서 혈관 밀도 감소는 주변부 허혈의 심한 정도와 연관을 보였다. 이는 임상적으로 망막분지정맥폐쇄환자에서 침습적 형광안저혈관조영이 필요한 고위험군을 감별하는 데 도움을 준다.
Abstract
Purpose: We used optical coherence tomography angiography (OCTA) to investigate the correlation between retinal microvascular alteration and peripheral retinal ischemia (evaluated with the aid of ultra-widefield fluorescein angiography [UWFA]) in patients with branch retinal vein occlusion (BRVO). Methods: We retrospectively analyzed 23 eyes of 23 patients with BRVO. Vessel density (VD) and the foveal avascular zone area were measured using OCTA; UWFA was employed to measure the peripheral ischemic area and the ischemic indices (ISIs) of the entire retina and concentric retinal zones. We derived correlations between these factors. Receiver operating characteristic curves were used to predict ISI employing OCTA parameters. Results: The VDs of the superficial capillary plexus (SCP) correlated with the ischemic areas of all retinal zones, and the ISIs of all zones except the far-peripheral area (FPA). The VD of the deep capillary plexus (DCP) correlated significantly with the ischemic areas and ISIs of all retinal zones except those of the FPA. On multivariate linear regression analysis, the VD was significantly correlated with the ISI; when the VDs of the SCP and DCP decreased to 24.7 and 26.1% respectively, this raised a suspicion of severe ischemic conditions with ISI > 10%. Conclusions: A decrease in the BRVO VD was associated with the severity of peripheral ischemia. Our findings may aid identification of high-risk patients who require invasive fluorescein angiography.
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