망막분지정맥폐쇄에 동반된 황반부종의 자연경과와 유리체강내 베바시주맙 주입술 결과의 비교
Macular Edema Following Branch Retinal Vein Occlusion: A Comparison of Natural Course and Treatment with Intravitreal Bevacizumab Injection
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목적: 황반부종을 동반한 망막분지정맥폐쇄의 자연경과와 유리체강내 베바시주맙 주입술의 결과에 대하여 비교하고자 하였다. 대상과 방법: 안저검사에서 망막분지정맥폐쇄로 인하여 황반부종이 동반된 환자 중 12개월 이상 추적관찰이 가능하였던 환자를 대상으로 후향적으로 비교 분석하였다. 2007년 2월을 전후하여 자연경과관찰군(관찰군: 27안)과, 베바시주맙을 유리체강내로 1회 주사 후필요에 따라 시행한 군(주사군: 30안)으로 분류하여 1, 3, 6, 12개월의 최대교정시력 변화를 알아보았다. 중심황반두께가 300 μm 이상으로 지속되거나 이전보다 100 μm 이상 증가한 경우 재치료를 시행하였다. 결과: 두 군에서 나이, 초진시력은 유의한 차이가 없었고, 주사군에서 평균 주사횟수는 2.7회였다. 초진시와 3, 12개월의 최대교정시력(logMAR)은 관찰군에서는 0.61 ± 0.48, 0.44 ± 0.46, 0.34 ± 0.40로, 주사군에서는 0.67 ± 0.40, 0.31 ± 0.26, 0.27 ± 0.25로호전되어 관찰군의 시력변화에 비해 주사군에서의 시력변화가 주사후 3개월째에는 유의하게 컸으나 12개월 시점에서는 두 군 사이에유의한 차이를 보이지 않았다(p=0.018, p=0.187). 결론: 망막분지정맥폐쇄에 동반된 황반부종에 대한 유리체강내 베바시주맙 주입술시, 자연경과에 비해 장기적인 시력 우위를 보이기위해서는 본 연구에서의 재치료 기준에 의한 필요시 재주사 방법보다 적극적인 치료기준이 필요할 것으로 생각한다.
Abstract
Purpose: To assess long-term comparisions of intravitreal bevacizumab injection (IVB group) with natural course (Natural course group) in patients with macular edema after branch retinal vein occlusion (BRVO). Methods: Fifty-seven patients were included in this retrospective study and were followed-up for at least 12 months. Patients in the Natural course group (27 eyes of 27 patients) were enrolled before February 2007, and patients in the IVB group (30 eyes of 30 patients) underwent intravitreal bevacizumab injection as-needed after February 2007. The main efficacy outcome was reported as the mean change from baseline best corrected visual acuity (BCVA), and all patients were measured at the initial visit and after 1, 3, 6, and 12 months. Retreatment criteria included central subfield macular thickness (CSMT) greater than 300 μm or increased CSMT of at least 100 μm between visits. Results: There were no statistically significant differences in age or initial BCVA between the 2 groups. Mean changes of BCVA at initial visit and at 3 and 12 months were 0.61 ± 0.48, 0.44 ± 0.46 and 0.34 ± 0.40 in the Natural course group and 0.67 ± 0.40, 0.31 ± 0.26 and 0.27 ± 0.25 in the IVB group, respectively. Improvement in BCVA was observed in both groups at 12 months, although the IVB group improved significantly more at 3 months and not at 12 months (p = 0.018, p = 0.187,respectively). Conclusions: More frequent bevacizumab injection schedule appears necessary to achieve better long-term visual outcome for patients with macular edema following BRVO.
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