중심장액맥락망막병증에서 광역학치료의 장기 결과 및 재발과 지속 위험인자에 대한 고찰
Long-term Outcomes of and Recurrence Risk Factors Associated with Photodynamic Therapy to Treat Central Serous Chorioretinopathy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 광역학치료 이후 1년 이상 장기 경과 관찰이 이루어진 환자를 대상으로 중심장액맥락망방병증이 지속되거나 및 재발되는 위험인자에 대해 알아보고자 하였다. 대상과 방법: 2005년 1월부터 2016년 2월까지 중심장액맥락망막병증으로 광역학치료를 받은 환자의 의무기록을 후향적으로 분석하였다. 광역학치료 후 시력 호전 여부에 상관없이 3개월 이상 망막하액이 남아있거나 추가적인 치료가 3개월 이전에 이루어진 경우는 중심장액맥락망막병증이 지속되었다고 판단하였으며 망막하액이 완전히 흡수된 이후 다시 망막하액이 발생한 경우는 재발되었다고 판단하였다. 결과: 총 73명 77안이 포함되었으며 경과 관찰기간은 최소 12개월부터 최대 144개월로 평균 48.9 ± 31.3개월이었다. 지속군은 10안(13%)이었으며, 재발군은 17안(22%)이었고 재발까지의 평균기간은 39.8 ± 23.3개월로 최소 3개월에서 최장 91개월의 분포를 보였다. 이 중 치료 경험이 없는 환자군은 50명 52안이었다. 지속군은 4안(8%), 재발군은 10안(19%)으로 재발까지 평균기간은 48.4 ± 30.0개월이었다. 전체 환자를 대상으로 하였을 때 광역학치료 전 유리체강내 항혈관내피주입술 혹은 국소망막광응고술의 치료를 받은 과거력이 있을 경우 교차비가 2.94로 통계적으로 유의하였다(p=0.031). 결론: 치료의 과거력을 가진 중심장액맥락망막병증 환자는 광역학치료 후에도 지속 및 재발 가능성이 높을 수 있음을 고려하여야할 것으로 생각된다.
Abstract
Purpose: We sought risk factors for the development of persistent or recurrent central serous chorioretinopathy (CSC) in patients under long-term follow-up (>1 year) after photodynamic therapy (PDT). Methods: We retrospectively reviewed the medical records of patients who received PDT to treat CSC from January 2005 to February 2016. CSC was considered persistent if subretinal fluid (SRF) was evident for longer than 3 months or if additional treatment was required before 3 months. Also, CSC was regarded as recurrent when SRF re-appeared after initial complete resorption. Results: We enrolled 73 patients (77 eyes). The mean follow-up period was 48.9 ± 31.3 months (12 to 144 months). The persistent group consisted of 10 eyes (13%) and the recurrent group 17 eyes (22%). The mean time to recurrence was 39.8 ± 23.3 months, ranging from 3 to 91 months. Fifty patients (52 eyes) were enrolled in the treatment-naive group. The persistent group consisted of four eyes (8%) and the recurrent group 10 eyes (19%). The mean time to recurrence was 48.4 ± 30.0 months. On chi-squared analysis of recurrence risk factors in all patients, the odds ratio for eyes with a history of both focal laser and anti- vascular endothelial growth factor treatments prior to PDT was 2.94 (p = 0.031). Conclusions: CSC patients with histories of other treatment are likely to exhibit persistent or recurrent disease after PDT.
참고문헌 (25)
- Gass JDM, "Pathogenesis of disciform detachment of the neuroepithelium II. Idiopathic central serous choroidopathy", Am J Ophthalmol, 63, pp.587~615 (1967)
- Jalkh AE, "Retinal pigment epithelium decompensation. I. Clinical features and natural course", Ophthalmology, 91, pp.1544~1548 (1984)
- Ie D, "Subretinal exudative deposits in central serous chorioretinopathy", Br J Ophthalmol, 77, pp.349~353 (1993)
- Iida T, "Cystoid macular degeneration in chronic central serous chorioretinopathy", Retina, 23, pp.1~7 (2003)
- Loo RH, "Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy", Retina, 22, pp.19~24 (2002)
- Leaver P, "Argon laser photocoagulation in the treatment of central serous retinopathy", Br J Ophthalmol, 63, pp.674~677 (1979)
- Robertson DM, "Direct, indirect and sham laser photocoagulation in the management of central serous chorioretinopathy", Am J Ophthalmol, 95, pp.457~466 (1983)
- Artunay O, "Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy : a prospective, controlled clinical study", Curr Eye Res, 35, pp.91~98 (2010)
- Schaal KB, "Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy", Eur J Ophthalmol, 19, pp.613~617 (2009)
- Seong HK, "Intravitreal bevacizumab to treat acute central serous chorioretinopathy : short-term effect", Ophthalmologica, 223, pp.343~347 (2009)
- Brinkmann R, "Selective retina therapy (SRT): a review on methods, techniques, preclinical and first clinical results", Bull Soc Belge Ophtalmol, pp.51~69 (2006)
- Roider J, "Selective retina therapy(SRT)for clinically significant diabetic macular edema", Graefes Arch Clin Exp Ophthalmol, 248, pp.1263~1272 (2010)
- Lai FH, "A multicenter study on the long-term outcomes of half-dose photodynamic therapy in chronic central serous chorioretinopathy", Am J Ophthalmol, 170, pp.91~99 (2016)
- Haga F, "Long-term prognostic factors of chronic central serous chorioretinopathy after half-dose photodynamic therapy: a 3-year follow-up study", PLoS One, 12, pp.e0181479~ (2017)
- Chan WM, "Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy : one-year results of a randomized controlled trial", Ophthalmology, 115, pp.1756~1765 (2008)
- Fujita K, "One-year outcomes with half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy", Ophthalmology, 122, pp.555~561 (2015)
- Tseng CC, "Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy", Br J Ophthalmol, 99, pp.1070~1077 (2015)
- Rouvas A, "Long-term results of half-fluence photodynamic therapy for chronic central serous chorioretinopathy", Eur J Ophthalmol, 22, pp.417~422 (2012)
- Lai TY, "Long-term outcome of half-dose verteporfin photodynamic therapy for the treatment of central serous chorioretinopathy (An American Ophthalmological Society Thesis)", Trans Am Ophthalmol Soc, 113, pp.T8~ (2015)
- Nicoló M, "Half-fluence versus half-dose photodynamic therapy in chronic central serous chorioretinopathy", Am J Ophthalmol, 157, pp.1033~1037 (2014)
- Nicolò M, "Association between the efficacy of half-dose photodynamic therapy with indocyanine green angiography and optical coherence tomography findings in the treatment of central serous chorioretinopathy", Am J Ophthalmol, 153, pp.474~480.e1 (2012)
- 오재령, "만성중심장액맥락망막병증에서의 광역학치료의 효과: 다기관 공동연구", 대한안과학회지, 50(3), pp.390~398 (2009), 대한안과학회
- Son BK, "Long-term outcomes of full-fluence and half-fluence photodynamic therapy for chronic central serous chorioretinopathy", Ophthalmologica, 241, pp.105~115 (2019)
- Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group, "Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials--TAP report", Arch Ophthalmol, 117, pp.1329~1345 (1999)
- Inoue R, "Association between the efficacy of photodynamic therapy and indocyanine green angiography findings for central serous chorioretinopathy", Am J Ophthalmol, 149, pp.441~446 (2010)