망막분지정맥폐쇄에 동반된 황반부종에서 유리체내 베바시주맙주입술 후 초기 시력 반응의 의의
Significance of Early Visual Responses to Bevacizumab for Macular Edema in Branch Retinal Vein Occlusion
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목적: 망막분지정맥폐쇄로 인한 황반부종 환자에서 베바시주맙 치료 시 초기 시력 반응 정도와 12개월 후 치료 성적과의 연관성을 알아보고자 하였다. 대상과 방법: 망막분지정맥폐쇄로 인한 황반부종 진단 후 유리체내 베바시주맙 주입술로 치료하면서 12개월 이상 경과관찰이 가능했던 환자 60명을 대상으로 의무기록을 후향적으로 분석하였다. 첫 치료 후 황반부종이 남아 있는 경우 흡수될 때까지 매달 주사를 시행하였고 이후에는 필요시 추가 주사를 시행하였다. 치료 후 1개월째 최대교정시력 상승 정도(<1, 1‒<3, ≥3줄; logMAR)에 따른 12개월째 치료 결과를 비교 분석하였다. 결과: 첫 주사 후 1개월째 1줄 미만의 시력 향상을 보인 군은 19명(31.7%), 1줄 이상 3줄 미만의 시력 향상을 보인 군은 17명(28.3%), 3줄 이상 시력 향상을 보인 군은 24명(40%)이었다. 세 군은 첫 1개월 이후 추가적 시력 향상이 1줄을 넘지 않았으며, 시력 향상 정도는 1개월째 3줄 이상 시력 향상을 보인 군에서 다른 군에 비해 유의한 차이를 보였다. 로지스틱 회귀분석 및 선형 회귀분석에서 주사 후 1개월째 3줄 이상의 시력 향상 여부가 12개월째 3줄 이상의 시력 상승과 시력 향상 정도가 유의한 상관관계를 보였다. 결론: 망막분지정맥폐쇄로 인한 황반부종 환자에서 베바시주맙 치료 후 초기 1개월째 시력 반응이 12개월째 시력 예후와 연관성이 높았다.
Abstract
Purpose: To determine whether early visual acuity response to intravitreal bevacizumab in macular edema (ME) secondary to branch retinal vein occlusion (BRVO) is associated with 12-month follow-up outcome. Methods: Sixty treatment-naïve patients (60 eyes) with ME secondary to BRVO treated with intravitreal bevacizumab (1.25 mg) were retrospectively included. Initially, all patients were injected monthly to achieve fluid resolution and followed up with a pro re nata regimen for at least 12 months. The relationship between early (month 1) and late (month 12) visual acuity response (mean change from baseline in best-corrected visual acuity [BCVA]; categorized improvement [<1, 1‒3, or ≥3 logMAR lines in BCVA]) was explored. Results: The proportions of eyes with <1, 1-<3, and ≥3-line improvements at 1 month were 19 eyes (31.7%), 17 eyes (28.3%), and 24 eyes (40%), respectively. Within each of the three response categories, the mean BCVA change from baseline at 12 months and onward did not vary by more than 1 line from the observed mean BCVA improvement at 1 month. Inter-cohort differences across the three response categories in mean BCVA change from baseline were statistically significant at each time point. Early BCVA response at 1 month showed significant associations with ≥3 line improvement and BCVA response at 12 months in multiple logistic and linear regression analyses. Conclusions: Early BCVA responses to bevacizumab are associated with subsequent responses over the entire 12-month duration of treatment.
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