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혈관빛간섭단층촬영을 이용한 정상인과 당뇨망막병증 환자에서의 망막중심오목 무혈관부위 분석

Optical Coherence Tomography-angiography: Comparison of the Foveal Avascular Zone between Diabetic Retinopathy and Normal Subjects

이주은|김인근
대한안과학회 (The Korean Ophthalmological Society)|2017.08|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제58권 제8호|pp. 952-959

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키워드

Diabetic retinopathyOptical coherence tomography angiographyFoveal avascular zone
주제분류안과학

초록

목적: 당뇨망막병증 환자를 대상으로 혈관빛간섭단층촬영을 이용하여 망막중심오목 무혈관부위를 측정하고 정상 대조군과 비교하여 혈관빛간섭단층촬영의 임상적 유용성에 대해 알아보고자 하였다. 대상과 방법: 당뇨망막병증 50명 85안과 정상 대조군 25명 50안을 비교 대상으로 하였다. Optovue Avanti RTVue XR optical coherence tomography를 이용하여 망막중심오목 무혈관부위의 혈관 영상을 얻은 후 면적측정 기능을 이용하여 망막중심오목 무혈관부위의 면적을 측정하고, 정상인과 당뇨망막병증 환자에서의 차이, 당뇨망막병증의 진행정도에 따른 차이를 비교하였다. 당뇨망막병증 환자는 진행 정도에 따라 경도-중등도 비증식당뇨망막병증, 심한 비증식당뇨망막병증, 그리고 증식성당뇨망막병증으로 나누어 비교하였다. 결과: 당뇨망막병증 환자의 망막중심오목 무혈관부위(0.46 mm2)는 정상 대조군(0.30 mm2)에 비해 의미 있게 넓게 측정되었다(p=0.001). 망막중심오목 무혈관부위를 당뇨망막병증의 정도에 따라 비교했을 때 세 군 간의 의미 있는 차이를 보였다(경도-중등도비증식당뇨망막병증; 0.40 mm2, 심한 비증식당뇨망막병증; 0.45 mm2, 증식성당뇨망막병증; 0.53 mm2, p=0.03). FAZ의 면적과 최대교정시력과의 연관성을 조사하였을 때 FAZ가 넓어질수록 시력이 떨어지는 음의 상관관계를 보였다(p=0.002). 결론: 혈관빛간섭단층촬영은 당뇨망막병증 환자에서 망막중심오목 무혈관부위를 비침습적으로 측정하고 이를 정량화할 수 있어, 당뇨망막병증의 경과 관찰에 유용하게 활용할 수 있을 것으로 사료된다.

Abstract

Purpose: To evaluate the effectiveness of optical coherence tomography angiography (OCTA) in investigating changes in the area of the foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) and normal subjects. Methods: Eighty-five eyes of 50 DR patients and 50 eyes of 25 normal subjects were included. OCTA images of the FAZ were acquired using the split-spectrum amplitude decorrelation angiography algorithm of Optovue Avanti RTVue XR OCT. Patients were divided into three groups according to DR severity: mild-to-moderate non-proliferative diabetic retinopathy (NPDR) group, severe NPDR group, and proliferative DR group. The area of the FAZ was measured using built-in software and was compared between the patients and normal subjects and among the three groups. Results: The area of the FAZ in patients with diabetic retinopathy (0.46 mm2) was significantly larger than that in normal subjects (0.30 mm2, p = 0.001). A significant difference was observed depending on DR severity: 0.40 mm2 in the mild-to-moderate NPDR group, 0.45 mm² in the severe NPDR group, and 0.53 mm2 in the PDR group (p = 0.03). Correlation between area of the foveal avascular zone and visual acuity showed a tendency toward reduction in visual acuity (p = 0.002). Conclusions: OCTA effectively detected changes in the FAZ area in DR patients. OCTA has the potential to be used for noninvasive quantification and monitoring of the FAZ.

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