당뇨망막병증에서 범망막광응고술과 추가적 베바시주맙 주입술이 망막혈관 직경에 미치는 영향
Retinal Vascular Caliber Changes in Diabetic Retinopathy after Panretinal Photocoagulation and Additive Bevacizumab Injections
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목적: 당뇨망막병증에서 범망막광응고술과 추가적인 유리체내 베바시주맙 주입술이 중심망막혈관 직경에 미치는 영향을 알아보고, 당뇨망막병증에서 망막혈관 직경의 특징을 알아보았다. 대상과 방법: 치료 받지 않은 당뇨망막병증으로 내원한 64안에 대하여 범망막광응고술 시행 전과 완료 6개월 후 중심망막혈관 변화를 후향적으로 분석하고 추가적으로 유리체내 베바시주맙 주입술을 시행한 군에서 중심망막혈관 직경에 미치는 영향도 분석하였다. 중심망막혈관 직경 및 동정맥 비는 안저사진으로부터 Interactive Vessel Analysis (IVAN) 프로그램과 Big 6 공식을 이용하여 구하였다. 결과: 6개월 뒤 두 군 모두에서 통계학적으로 유의한 중심망막동맥과 중심망막정맥 직경의 감소가 있었으나(p＜0.001, p=0.008) 동정맥 비의 변화는 유의하지 않았다(p=0.338). 추가적인 유리체내 베바시주맙 주입술은 범망막광응고술만 시행한 군과 비교하여 중심망막혈관 직경에 유의한 변화를 가져오지 않았다. 진행한 당뇨망막병증의 망막혈관 직경은 기존에 알려진 당뇨가 없거나 있는 한국인의 망막혈관 직경과 비교 시 더 작은 중심망막동맥 직경, 더 큰 중심망막정맥 직경, 감소한 동정맥 비를 보였으며 연령에 따른 유의한 변화는 없었다. 결론: 당뇨망막병증 환자에서 범망막광응고술 완료 6개월 후 유의한 중심망막혈관 직경의 감소가 있었으며 추가적인 유리체내 베바시주맙 주입술은 추가적인 중심망막혈관 직경의 유의한 변화를 가져오지 못하였다. 본 연구의 결과를 통하여 당뇨망막병증 환자에서 평균적인 망막혈관 직경의 기준을 세울 수 있으며 망막병증이 있을 시 혈관 직경에 미치는 영향을 알아볼 수 있었다.
Abstract
Purpose: To evaluate the effect of panretinal photocoagulation and additive intravitreal bevacizumab injections on central retinal vessel diameters and characteristic retinal vascular caliber changes in diabetic retinopathy. Methods: Changes in central retinal vessel diameters were retrospectively analyzed before and 6 months after panretinal photocoagulation with or without additive intravitreal bevacizumab injections in 64 eyes first diagnosed with diabetic retinopathy. Vessel diameters and arteriovenous ratio (AVR) were measured using Interactive Vessel Analysis (IVAN) software and the Big six formula. Results: There were significant decreases in central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) in both groups, with and without additive intravitreal bevacizumab injections, 6 months after completion of panretinal photocoagulation (p < 0.001, p = 0.008), but no significant change in AVR (p = 0.338). Additive intravitreal bevacizumab injections did not produce significant changes in central retinal vessel diameters after 6 months compared to vessel diameters treated with panretinal photocoagulation only. Retinal vascular caliber of progressed diabetic retinopathy showed smaller CRAE, larger CRVE, and smaller AVR compared to those of normal or diabetic Korean subjects in a previous study and showed no significant association with age. Conclusions: CRAE and CRVE decreased significantly 6 months after panretinal photocoagulation in diabetic retinopathy, but additive intravitreal bevacizumab injections did not cause significant additive changes to central retinal vascular calibers in this study. We established the standard retinal vascular caliber of Korean subjects in diabetic retinopathy and analyzed the effects of retinopathy on retinal vessel caliber.
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