녹내장 환자에서 유리체강 내 베바시주맙 주사가 망막신경섬유층에 미치는 영향
Changes in the Retinal Nerve Fiber Layer after Intravitreal Injections of Bevacizumab in Glaucoma Patients
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목적: 녹내장 환자에서 유리체강 내 베바시주맙 주사 후 망막신경섬유층의 변화를 비녹내장 환자와 비교하여 알아보고자 하였다. 대상과 방법: 망막질환으로 유리체강 내 베바시주맙 주사가 필요한 104명의 104안에서 유리체강 내 베바시주맙 주사(1.25 mg/0.05mL)를 표준 방법으로 시행하였다. 안압 하강제로 선처치를 시행한 군에서는 주사 시행 30분 전에 브리모니딘(brimonidine)을 1회 점안하였다. 주사 전과 주사 후 3개월 이상 경과한 시점에서 안압을 측정하고, 시간영역 빛간섭단층촬영기를 이용하여 망막신경섬유층의 두께를 측정하였다. 결과: 주사 30분 후에, 안압하강제를 이용하여 선처치를 하지 않은 군에서는 안압이 30 mmHg를 넘는 비율이 6.4%였으나, 선처치를한 군에서는 30 mmHg 이상의 안압상승이 나타나지 않았다. 망막질환만을 가지는 환자들에서는 선처치 여부와 상관 없이 망막신경섬유층의 두께의 변화는 나타나지 않았으나, 녹내장성 손상을 동반한 환자에서는 선처치를 하지 않은 군에서 망막신경섬유층의 상부(p=0.036), 이측부(p=0.048)에서 유의한 두께 감소가 관찰되었다. 결론: 유리체강 내 베바시주맙 주사는 일반적으로 망막신경섬유층의 두께 감소를 일으키지는 않으나, 안압하강제로 선처치를 하지않은 녹내장 환자에서는 망막신경섬유층의 두께가 유의하게 감소하였다.따라서 녹내장 환자에서 유리체강 내 베바시주맙 주사 전안압하강제 선처치가 필요하다고 생각한다.
Abstract
Purpose: To examine retinal nerve fiber layer (RNFL) changes after intravitreal injection of bevacizumab in patients with or withoutunderlying glaucoma. Methods: A total of 104 eyes of 104 patients with retinal disease undergoing intravitreal injection of bevacizumab were prospectivelyinvestigated. Bevacizumab injections (1.25/0.05 mg/mL) were performed using a standardized technique. In the patientwho had pretreatment with intraocular pressure (IOP)-lowering medication, 1 drop of brimonidine was instilled 30 minutesbefore the injection. Before and after the intravitreal injections, the patients were monitored for IOP and evaluated with optical coherencetomography using Stratus at least 3 months after the injection. Results: Thirty minutes after injection, 6.4% of patients had an IOP over 30 mm Hg in the non-pretreatment group while no patienthad an IOP over 30 mm Hg in the pretreatment group. In eyes with only retinal diseases, the RNFL thickness did not changesignificantly after the injection regardless of pretreatment, whereas in eyes with underlying glaucomatous damage and no pretreatment,significant decrease in RNFL thickness was observed at the superior (p = 0.036) and temporal (p = 0.048) sectors ofthe optic nerve head without pretreatment. Conclusions: Intravitreal injection of bevacizumab did not typically cause significant changes in RNFL thickness; however, ineyes with underlying glaucoma without pretreatment, a significant decrease in RNFL thickness was observed in the superior andtemporal sectors of the optic nerve head. Therefore, applying IOP-lowering pretreatment medication before intravitreal injectionof bevacizumab is required for protection of RNFL in glaucoma patients.
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