망막분지정맥폐쇄로 인한 황반부종에서 과거 베바시주맙 치료 반응도에 따른 덱사메타손 삽입물의 효과 비교
Intravitreal Dexamethasone Implant for Macular Edema in Branch Retinal Vein Occlusion According to Previous Responses to Bevacizumab
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목적: 황반부종을 동반한 망막분지정맥폐쇄 환자에서 이전 베바시주맙 치료의 시행 여부 및 그 반응 정도에 따른 유리체내 덱사메타손 삽입물의 치료 효과의 차이를 알아보고자 한다. 대상과 방법: 황반부종을 동반한 망막분지정맥폐쇄로 유리체내 덱사메타손 삽입물 주입술 시행 후 6개월간 추적관찰이 가능했던 60 명 60안을 대상으로 후향적 의무기록 분석을 시행하였다. 이 중 31명은 처음으로 치료를 받는 환자들(Naïve group)이었고, 29명은 유리체내 항혈관내피성장인자 주입술을 받은 적 있는 환자들(Previously-treated group)이었다. 이미 치료를 받았던 29명 중 17명은 이전 치료에서 반응이 없어 교체 투여한 난치군(Refractory group)이었으며, 12명은 이전 치료에서 반응을 보였으나 황반부종이 재발하여 교체 투여한 반응군(Responder group)이었다. 치료 후 6개월 동안 매달 각 군의 최대교정시력과 중심와두께 변화, 재치료 여부를 비교 분석하였다. 결과: 모든 군에서 첫 유리체내 덱사메타손 삽입물 주입술 후 재치료가 한 번도 이루어지지 않았던 초기 3개월 동안 비교에서 첫 치료군은 매달의 추적관찰 기간 동안 치료 전에 비해 유의한 시력 호전을 보였으나 난치군과 반응군에서는 초기 2개월에서만 유의한 시력 호전을 보였다. 중심와두께는 3개월 동안 세 군 모두 치료 전에 비해 유의한 감소를 보였지만, 중심와두께 변화량을 비교해 보았을 때 1, 2, 3개월째 모두 첫 치료군에서 감소의 폭이 다른 두 군에 비해 크게 나타났고, 3개월째의 중심와두께 변화량은 세 군 간의 유의한 차이를 보였다(p<0.001). 이후 부종의 재발로 재치료가 필요했던 경우도 첫 치료군에서 18안(58.1%), 난치군에서 16안(94.1%), 반응군에서 6안(50.0%)으로 세 군 간에 유의한 차이를 나타내었다(p=0.016). 결론: 유리체내 덱사메타손 삽입물 치료는 과거 치료 여부에 관계없이 망막분지정맥폐쇄로 인한 황반부종 환자에게 좋은 대안으로 고려될 수 있으며, 그중 과거 항혈관내피성장인자에 반응이 적었던 난치군을 치료할 때에는 반응군보다 그 치료 효과가 짧게 지속됨을 고려하여 좀 더 주의 깊은 추적관찰과 함께 적극적인 재주사를 계획할 필요가 있다.
Abstract
Purpose: To compare the efficacy of intravitreal dexamethasone implant according to previous responses to Bevacizumab treatment in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: Sixty eyes of 60 patients who received an intravitreal dexamethasone implant for ME secondary to BRVO and followed up for at least 6 months were retrospectively reviewed. Of these, 31 patients were treatment naïve and 29 patients had previously received intravitreal injection of anti-vascular endothelial growth factor (VEGF). Out of these previously-treated patients, 17 patients were categorized as a refractory group who did not respond to previous injection and 12 patients were categorized as a responder group who showed recurrent ME despite a good response to previous anti-VEGF treatment. The best corrected visual acuity (BCVA), central macular thickness (CMT) and recurrence of ME were assessed monthly for 6 months. Results: At each 3-month follow-up, the BCVA improved significantly from baseline in the naïve group, while the refractory group and the responder group showed significant improvement for only 2 months. At each 3-month follow-up, the CMT showed significant decreases in every group. However, the mean change in CMT from baseline showed significant differences between the 3 groups at month 3 (p < 0.001). During follow-up, 18 eyes in the naïve group (58.1%), 16 eyes in the refractory group (94.1%), and 6 eyes in the responder group (50.0%) received retreatment for the recurrence of ME, and there was a significant difference in the retreatment rate between the three groups (p = 0.016). Conclusions: Intravitreal dexamethasone implant showed early good functional and anatomical improvements irrespective of the response to the previous treatment in patients with ME secondary to BRVO. However, when treating the refractory group, more careful observation and intensive retreatment are required, considering the short duration of its efficacy.
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