망막분지정맥폐쇄에 동반된 황반부종에서 유리체강내 베바시주맙주입술의 반복성에 관련된 인자
Factors Related to Repeatability of Intravitreal Bevacizumab Injections in Branch Retinal Vein Occlusion Macular Edema
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목적: 망막분지정맥폐쇄에 동반된 황반부종에 대한 치료로 유리체강내 베바시주맙 주입술을 시행 시 어떠한 인자가 시술의 반복성에영향을 미치는지 알아보고자 하였다. 대상과 방법: 망막분지정맥폐쇄로 인한 황반부종으로 진단 받고 유리체강내 베바시주맙 주입술을 시행 받은 후 1년 이상 경과 관찰이가능하였던 환자 26명의 의무기록을 후향적으로 조사하였다. 초진 시의 시력, 정맥폐쇄의 위치, 정맥폐쇄와 황반중심 간의 거리, 황반부 두께, 황반부종의 형태, 황반 출혈의 유무, 모세혈관 비관류 유무를 평가하고, 시력 저하를 보이면서 황반 부종이 악화될 때 베바시주맙을 반복 주사하였으며, 1년 동안 추가적인 주입술 없이 1회 주사만으로 황반부종이 호전된 경우에 관련된 인자를 알아보았다. 결과: 유리체강내 베바시주맙 주입 후 1년의 경과 관찰 중 초진 시력이 logMAR 0.5 이하인 경우 52.6%에서 재발 없이 유지되었고, 초과인 경우 14.3%에서 유지되었다(p＜0.01). 황반중심에서 정맥폐쇄의 거리가 2.5 disc diameter (DD) 미만인 경우 57.1%에서 유지되었고, 같거나 먼 경우에는 25.0%에서 유지되었다(p=0.04). 황반분지폐쇄군의 경우 64.3%가 유지되었고 일차분지폐쇄군은 16.7%에서 유지되었다(p=0.01). 결론: 분지망막정맥폐쇄 환자의 초진 시력이 좋고, 황반중심과 폐쇄된 정맥의 거리가 가까우며, 황반분지폐쇄의 형태를 가진 경우에는1회의 유리체강내 베바시주맙 주입술만으로 황반부종의 재발 없이 유지될 가능성이 높으므로 그 예후를 예측하는 데 도움이 될 것으로 생각된다.
Abstract
Purpose: To identify the factors related to repeatability of intravitreal bevacizumab injections in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: The present study included 26 patients with macular edema secondary to BRVO occurring within 1 month of diagnosis. Initial best corrected visual acuity, type of BRVO according to the involved vein branch, distance between fovea and occlusion vein, central macular thickness, type of macular edema, presence of macula hemorrhage, and presence of capillary nonperfusion were evaluated at the time of diagnosis. The patients received an intravitreal bevacizumab injection at the time of diagnosis and reinjections when macular edema and visual acuity were aggravated. According to the factors considered, the reinjection‐ free rate which was considered a survival rate was evaluated for 1 year after the first injection. Results: The patients with initial visual acuity lower than log MAR 0.5 showed 52.6% survival rate within 1 year compared with 14.3% of the patients with visual acuity higher than log MAR 0.5 (p < 0.01). The patients with occluded vein closer than a distance of 2.5 disc diameters (DD) from the foveal center had a 57.1% survival rate and the patients with occluded vein farther than a distance of 2.5 DD from the foveal center had a 25.0% survival rate (p = 0.04). Macular BRVO and major BRVO patients had 64.3% and 16.7% survival rates, respectively (p = 0.01). Conclusions: The patients with BRVO may have less chance of repetitive intravitreal bevacizumab injections due to macular edema when initial visual acuity is lower than log MAR 0.5, occluded vein is closer than 2.5 DD from the foveal center, and macular branch is involved at the initial diagnosis. These factors can be utilized to predict the prognosis of BRVO patients and the probability of repetitive intravitreal bevacizumab injections.
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