망막정맥폐쇄에서 유리체강내 베바시주맙 주사 후 신경절세포층의 두께 변화
Ganglion Cell Layer Thickness after Anti‐Vascular Endothelial Growth Factor Treatment in Retinal Vein Occlusion
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목적: 망막정맥폐쇄 환자에서 반복적인 베바시주맙 주입술이 망막 신경절세포에 영향을 주는지 알아보고자 하였다. 대상과 방법: 후향적 연구로 치료 기왕력이 없는 60명의 망막정맥폐쇄 환자(망막분지정맥폐쇄 환자 35명 35안, 망막중심정맥폐쇄환자 25명 25안)를 대상으로 하였다. 3회 이상의 유리체내 베바시주맙 주입술을 시행 받은 전후로 spectral domain optical coherence tomography (SD-OCT)를 이용하여 망막 신경절세포층 두께를 측정하여 비교하였다. 망막신경절세포층의 두께는 9곳의 Early Treatment Diabetic Retinopathy Study (ETDRS) 격자(grid) 영역에서 각각 측정되었고, 그 변화는 나이, 유리체내 주입술의 횟수, 안압의 변화, 중심망막두께의 변화 등과 연관성이 있는지도 알아보았다. 결과: 반복적인 유리체내 베바시주맙 주사 후 망막 신경절세포층의 평균 두께는 42.99 ± 5.39 μm에서 38.99 ± 5.53 μm로 유의한 감소를 보였다(p＜0.001). 망막 신경절세포층의 두께 변화는 중심망막두께의 변화와 유리체내 주입술 횟수와 연관이 있었다(respectively, p=0.02, p=0.048). 하지만 다변량 선형회귀분석 결과 중심망막두께의 변화만이 치료 후 망막 신경절세포층의 두께 변화에 영향을 미치는 요인으로 나타났다(p＜0.001). 결론: 망막정맥폐쇄 환자에서 반복적인 유리체내 항혈관내피성장인자 주입술 후 망막 신경절세포층의 두께는 유의하게 감소하였다. 이는 중심망막두께의 변화가 가장 큰 영향을 끼치는 것으로 보인다.
Abstract
Purpose: To evaluate the effect of repeated intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) on the thickness of the ganglion cell layer (GCL) in patients with retinal vein occlusion. Methods: The present retrospective study included 60 patients with branch retinal vein occlusion and central retinal vein occlusion who received more than 3 anti-VEGF injections. GCL thickness was measured using spectral-domain optical coherence tomography. GCL thickness measurements were made at 9 Early Treatment Diabetic Retinopathy Study grid regions. We evaluated correlations between changes in the GCL thickness and other factors such as intraocular pressure, times of injection, and changes in central macular thickness (CMT). Results: As a result of multiple intravitreal anti-VEGF treatments, GCL thickness was significantly decreased from 42.99 ± 5.39 to 38.99 ± 5.53 (p < 0.001). Changes in GCL thickness were correlated with CMT and the number of injections (p = 0.02 and p = 0.048, respectively). However, multivariate analysis showed the change in mean GCL thickness in the retinal vein occlusion (RVO) was strongly associated only with CMT (p < 0.001). Conclusions: As a result of multiple intravitreal injections of anti-VEGF, GCL thickness decreased significantly in RVO patients and changes in GCL thickness and CMT were correlated.
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