당뇨황반부종에서 베바시주맙 치료 반응도에 따른 덱사메타손 삽입물의 효과 비교
Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab
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목적: 당뇨황반부종환자에서 이전 베바시주맙 치료의 시행 여부 및 반응 정도에 따라 유리체내 덱사메타손삽입물 치료 효과를 비교해보고자 한다. 대상과 방법: 당뇨황반부종으로 유리체내 덱사메타손삽입물 주입술을 시행한 49명 49안을 후향적으로 분석하였다. 처음 치료를 받는 환자군(treatment-naïve group)이 13안이었고, 유리체내 베바시주맙주입술을 받은 적 있는 환자군(previously-treated group)이 36안이었다. 이전에 치료를 받았던 36안 중 24안은 이전 치료에 반응이 없었던 난치군(refractory group)이었고, 12안은 이전 치료에서 반응을 보였던 반응군(responder group)이었다. 치료 후 6개월간 최대교정시력과 중심황반두께 변화, 재치료 여부를 비교 분석하였다. 결과: 첫 치료군에서는 6개월 동안 유의한 시력호전을 보였으나, 반응군에서는 재치료가 시작된 2개월째부터 유의한 시력호전을 보였고 난치군에서는 시력호전이 없었다. 중심황반두께는 6개월 동안 세 군 모두 치료 전에 비해 유의한 감소를 보였고 세 군 간의 유의한 차이가 없었다. 부종의 재발로 재치료가 필요했던 경우는 첫 치료군에서 5안(38.5%), 난치군에서 19안(79.2%), 반응군에서 9안(75.0%)으로 세 군 간에 유의한 차이를 보였다(p=0.034). 결론: 당뇨황반부종환자에서 유리체내 덱사메타손삽입물 주사 치료는 이전 베바시주맙 치료 여부 및 반응도와 관계없이 유의한 해부학적인 호전을 보였지만 시력은 첫 치료군, 반응군 순서로 호전을 보였고, 난치군은 그 회복이 제한적이었다.
Abstract
Purpose: To compare the efficacy of intravitreal dexamethasone implants according to previous response to bevacizumab treatment in patients with diabetic macular edema (DME). Methods: Forty-nine eyes of 49 patients who received intravitreal dexamethasone implants for DME were reviewed retrospectively. Of these patients, 13 were treatment-naïve and 36 had previously received intravitreal injections of bevacizumab. Of the 36 previously treated patients, 24 comprised a refractory group showing no response to previous injections, and 12 comprised a responder group showing a response to previous treatments. The best-corrected visual acuity, central macular thickness (CMT), and retreatment percentages were assessed monthly for 6 months. Results: After the intravitreal dexamethasone implants, visual acuity improved significantly over 6 months in the treatment-naïve group, while in the responder group, a significant improvement in visual acuity was seen at the 2-month follow-up. In the refractory group, there was no significant improvement in visual acuity during the follow-up period. The CMT showed a significant decrease in all three groups, and there was no significant difference in the CMT among the three groups at any time point. Five patients in the treatment-naive group (38.5%), 19 patients in the refractory group (79.2%), and nine patients in the responder group (75.0%) needed retreatment for recurrent macular edema, and there was a significant difference among the three groups in the rate of recurrence (p = 0.034). Conclusions: In DME patients, intravitreal dexamethasone implants were associated with a significant anatomical improvement irrespective of previous bevacizumab treatment response. However, the treatment-naïve and responder groups showed improvements in visual acuity, whereas the refractory group showed limited improvement.
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