망막분지정맥폐쇄에 합병된 황반부종에서 유리체강내 베바시주맙 주입과 격자광응고술 병합요법
Combined Therapy of Bevacizumab and Grid Photocoagulation for Macular Edema in Branch Retinal Vein Occlusion
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 망막분지정맥폐쇄로 인한 황반부종 환자에서 유리체강내 베바시주맙 주입술 단독요법과 격자광응고술과의 병합요법의 임상적결과를 비교하였다. 대상과 방법: 망막분지정맥폐쇄에 의한 황반부종으로 베바시주맙 주입술을 받은 환자의 의무기록을 후향적으로 분석하였다. 병합요법군과 단독요법군으로 나누어 술전과 술후 1, 2, 그리고 6개월에 교정시력 및 빛간섭단층촬영의 중심황반두께를 조사하고 황반부종의재발 빈도를 비교하였다. 결과: 총 49안 중 18안에서 술후 평균 1.2개월에 격자광응고술을 하였으며 31안은 광응고술을 시행하지 않았다. 시력은 병합요법군에서술후 2, 6개월에, 단독요법 군에서 술후 1, 2, 6개월에 유의하게 향상되었고, 중심황반두께는 두 군 모두 술후 모든 시기에서 유의하게감소하였으나, 시력과 중심황반두께에서 두 군 사이에 유의한 차이는 없었다. 주사 후 6개월간 황반부종의 재발은 단독요법군에서14안(45%)으로 병합요법군의 3안(17%)에 비해 유의하게 많았다(p=0.046). 결론: 망막분지정맥폐쇄에서 베바시주맙의 유리체강내 주사와 병합하여 시행한 격자광응고술은 황반부종의 재발로 인한 반복적인 재주입술을 줄일 수 있었다.
Abstract
Purpose: To evaluate clinical outcomes of a combined therapy of intravitreal bevacizumab and grid laser photocoagulation for macular edema in branch retinal vein occlusion (BRVO). Methods: In the present retrospective study, medical records of patients who were treated with intravitreal bevacizumab injection for macular edema due to BRVO were reviewed. The eyes were divided into 2 groups, the combined therapy group of intravitreal bevacizumab and grid laser photocoagulation, and the monotherapy group of intravitreal bevacizumab. Visual acuity and central subfield macular thickness were investigated at 1, 2 and 6 months. Recurrence rate was compared between the 2 groups. Results: Among 49 eyes, 18 eyes underwent macular grid photocoagulation and 31 eyes did not receive laser treatment. Laser photocoagulation was performed at 1.2 months after injection on average. Visual acuity improved significantly at 2and 6 months in the combined therapy group, and at 1, 2 and 6 months in the monotherapy group. Macular thickness decreased significantly compared to baseline at all visits in both groups. There was no significant difference in visual acuity and foveal thickness between the 2 groups. Recurrence at 6 months was significantly less frequent in the combined therapy group (3 eyes, 17%) then in the monotherapy group (14 eyes, 45%, p = 0.046). Conclusions: Combined grid photocoagulation after intravitreal bevacizumab injection lowered the recurrence rate of macular edema complicated with BRVO.
참고문헌 (34)
- Klein R, "The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study", Trans Am Ophthalmol Soc, 98, pp.133~141 (2000)
- Mitchell P, "Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study", Arch Ophthalmol, 114, pp.1243~1247 (1996)
- Klein R, "The 15-year cumulative incidence of retinal vein occlusion: the Beaver Dam Eye Study", Arch Ophthalmol, 126, pp.513~518 (2008)
- Rehak J, "Branch retinal vein occlusion: pathogenesis, visual prognosis, and treatment modalities", Curr Eye Res, 33, pp.111~131 (2008)
- Wong TY, "Clinical practice. Retinal-vein occlusion", N Engl J Med, 363, pp.2135~2144 (2010)
- Noma H, "Intravitreal levels of vascular endothelial growth factor and interleukin-6 are correlated with macular edema in branch retinal vein occlusion", Graefes Arch Clin Exp Ophthalmol, 244, pp.309~315 (2006)
- Silva RM, "Blood-retina barrier in acute retinal branch vein occlusion", Graefes Arch Clin Exp Ophthalmol, 233, pp.721~726 (1995)
- Arnarsson A, "Laser treatment and the mechanism of edema reduction in branch retinal vein occlusion", Invest Ophthalmol Vis Sci, 41, pp.877~879 (2000)
- "Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group", Am J Ophthalmol, 98, pp.271~282 (1984)
- Battaglia Parodi M, "Grid laser treatment in macular branch retinal vein occlusion", Graefes Arch Clin Exp Ophthalmol, 237, pp.1024~1027 (1999)
- Riese J, "Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion", Graefes Arch Clin Exp Ophthalmol, 246, pp.1671~1676 (2008)
- Scott IU, "A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular Edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6", Arch Ophthalmol, 127, pp.1115~1128 (2009)
- Stahl A, "Bevacizumab in retinal vein occlusion-results of a prospective case series", Graefes Arch Clin Exp Ophthalmol, 245, pp.1429~1436 (2007)
- Russo V, "Bevacizumab compared with macular laser grid photocoagulation for cystoid macular edema in branch retinal vein occlusion", Retina, 29, pp.511~515 (2009)
- Jaissle GB, "One-year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion", Graefes Arch Clin Exp Ophthalmol, 247, pp.27~33 (2009)
- Gutman FA, "The natural course of temporal retinal branch vein occlusion", Trans Am Acad Ophthalmol Otolaryngol, 78, pp.178~192 (1974)
- Hayreh SS, "Ocular neovascularization with retinal vascular occlusion-III. Incidence of ocular neovascularization with retinal vein occlusion", Ophthalmology, 90, pp.488~506 (1983)
- Magargal LE, "Temporal branch retinal vein obstruction: a review", Ophthalmic Surg, 17, pp.240~246 (1986)
- Roseman RL, "Krypton red laser photocoagulation for branch retinal vein occlusion", Ophthalmology, 94, pp.1120~1125 (1987)
- Weiter JJ, "The influence of the photoreceptor-RPE complex on the inner retina. An explanation for the beneficial effects of photocoagulation", Ophthalmology, 87, pp.1133~1139 (1980)
- Arnarsson A, "Laser treatment and the mechanism of edema reduction in branch retinal vein occlusion", Invest Ophthalmol Vis Sci, 41, pp.877~879 (2000)
- "Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group", Am J Ophthalmol, 98, pp.271~282 (1984)
- Rosenfeld PJ, "Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for macular edema from central retinal vein occlusion", Ophthalmic Surg Lasers Imaging, 36, pp.336~339 (2005)
- Abeqq M, "Treatment of branch retinal vein occlusion induced macular edema with bevacizumab", BMC Ophthalmol, 8, pp.18~ (2008)
- Campochiaro PA, "Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study", Ophthalmology, 117, pp.1102~1112 (2010)
- Gündüz K, "Intravitreal bevacizumab for macular oedema secondary to branch retinal vein occlusion", Eye (Lond), 22, pp.1168~1171 (2008)
- 이승욱, "분지망막정맥폐쇄에 합병된 황반부종에서 유리체강내 트리암시놀론 주입과 격자광응고술의 효과", 대한안과학회지, 50(5), pp.704~709 (2009), 대한안과학회
- Schatz H, "Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema", Arch Ophthalmol, 109, pp.1549~1551 (1991)
- Morgan CM, "Atrophic creep of the retinal pigment epithelium after focal macular photocoagulation", Ophthalmology, 96, pp.96~103 (1989)
- Lewen RM, "Subretinal neovascularization complicating laser photocoagulation of diabetic maculopathy", Ophthalmic Surg, 19, pp.734~737 (1988)
- Lewis H, "Choroidal neovascularization after laser photocoagulation for diabetic macular edema", Ophthalmology, 97, pp.503~510 (1990)
- Guyer DR, "Subretinal fibrosis after laser photocoagulation for diabetic macular edema", Am J Ophthalmol, 113, pp.652~656 (1992)
- Rutledge BK, "Sub-pigment epithelial membranes after photocoagulation for diabetic macular edema", Arch Ophthalmol, 111, pp.608~613 (1993)
- Striph GG, "Modified grid laser photocoagulation for diabetic macular edema. The effect on the central visual field", Ophthalmology, 95, pp.1673~1679 (1988)