비특이성안와염에서 고용량 부신피질호르몬 주사요법의 효과
Effect of Intravenous Methylprednisolone on Idiopathic Orbital Inflammation
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목적: 고용량 부신피질호르몬 주사요법이 필요하였던 비특이성안와염 환자를 대상으로 병변 위치에 따른 치료효과와 경과를 알아보고 자 하였다. 대상과 방법: 시력저하, 심한 안구운동장애, 복시, 심한 통증으로 고용량 부신피질호르몬 투여를 받은 비특이성안와염 환자 52명을 대상으로 하였다. 전산화단층촬영과 자기공명영상의 병변 위치로 앞안와성, 눈물샘성, 외안근성, 미만성, 첨부성으로 분류하여 치료경 과를 조사하였다. 결과: 외안근성과 미만성이 각각 15명, 14명으로 많았고, 첨부성도 8명이었다. 치료 반응률은 전체적으로 84.6%였고, 앞안와성은 100% 인 데 반해, 미만성은 71.4%였다. 평균 10.5개월 경과관찰 중 15.9%에서 재발하였고, 71.2%가 완치되었다. 투여중단 후 평균 5.7개월에 재발하였다. 재발한 7명의 평균 연령은 34.4세로 완치된 환자에 비해 유의하게 낮았으며, 이중 3명이 외안근성이었다. 결론: 비특이성안와염에서 고용량 부신피질호르몬 주사요법은 효과적이나 젊은 사람, 외안근성에서 재발이 많고 미만성에서는 효과가 적은 경향이 있어, 이런 환자에서는 감량 계획을 길게 잡거나 다른 치료를 병행하는 것이 필요할 것으로 생각된다.
Abstract
Purpose: To evaluate the efficacy of intravenous methylprednisolone pulse therapy in patients with idiopathic orbital inflammation. Methods: Fifty-two patients who received three-day pulse methylprednisolone for acute severe swelling, loss of visual acuity, limitation of eye movement, diplopia, or pain were included in the present study. The lesions were divided into five subtypes using computed tomography or magnetic resonance imaging; anterior, lacrimal, myositic, diffuse and apical. A case diagnosed as sclerotic type was excluded. The response rate, recurrence rate and cure rate were assessed. Results: The total response rate to intravenous methylprednisolone from all groups was 84.6%, with 100% in the anterior subtype and 71.4% in the diffuse subtype. During the mean follow-up period of 10.5 months, 15.9% of patients experienced a recurrence after a mean of 5.7 months. Overall, the cure rate was 71.2%. Recurrence was more common in the younger patients, and three of the seven patients with recurrence had myositic inflammation. Conclusions: Intravenous methylprednisolone was effective in patients with severe idiopathic orbital inflammation. However, combining other treatment modalities in patients with diffuse or myositic subtypes and in younger patients who show relatively low response or high recurrence is recommended.
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