나이관련황반변성과 당뇨황반부종에서 브루크막 개방 최소 시신경유두테 폭의 반복성
Repeatability of Bruch’s Membrane Opening-minimum Rim Width in Age-related Macular Degeneration and Diabetic Macular Edema
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목적: 스펙트럼영역 빛간섭단층촬영에서 망막신경섬유층(retinal nerve fiber layer, RNFL) 두께와, 브루크막 개방 최소 시신경유두테폭(Bruch’s membrane opening-minimum rim width, BMO-MRW)은 높은 반복성을 보인다는 연구들이 있었지만, 다양한 망막질환에서 반복성에 대한 연구는 아직 부족하다. 따라서 삼출성 나이관련황반변성 및 당뇨황반부종 환자에서 RNFL 두께 및 BMO-MRW의반복성에 대해 연구하였다. 대상과 방법: 본 연구는 전향적인 연구로, RNFL 두께와 BMO-MRW를 총 2회 촬영하였고, 급내상관계수와 상대표준편차를 통해 반복성을 분석하였다. 시신경유두주위막(optic disc membrane)이 확인되는 경우 중증도에 따라 3가지 그룹으로 나누어 분석하였다. 결과: 삼출성 나이관련황반변성 48안과 당뇨황반부종 환자 51안이 본 연구에 참여하였다. 급내상관계수는 삼출성 나이관련황반변성의 평균 RNFL 두께와 평균 BMO-MRW 측정값에서 각각 0.996와 0.997이었으며, 당뇨황반부종에서는 각각 0.994와 0.996이었다. 상대표준편차는 삼출성 나이관련황반변성에서 0.60%, 0.73%이고, 당뇨황반부종에서 1.10%, 1.21%였다. 평균 BMO-MRW의 반복성에 영향을 주는 인자로 시신경유두주위막이 확인되었다(B=0.814, p＜0.001). 결론: 당뇨황반부종과 삼출성 나이관련황반변성 환자에서 RNFL 두께와 BMO-MRW 측정은 매우 좋은 반복성을 보여주었으나, 시신경유두주위에 시신경유두주위막이 중증인 경우 반복성에 영향을 줄 수 있으므로 BMO-MRW 결과 해석에 주의가 필요하다.
Abstract
Purpose: To evaluate the repeatability of retinal nerve fiber layer (RNFL) thickness and Bruch’s membrane opening-minimum rim width (BMO-MRW) measurements by spectral-domain optical coherence tomography (SD-OCT) in wet age-related macular degeneration (wAMD) and diabetic macular edema (DME). Methods: This was a prospective study. The RNFL thickness and BMO-MRW parameters for each sector and global average were measured twice by SD-OCT. Repeatability was evaluated using the intraclass correlation coefficient (ICC) and coefficient of variation (CV). If the optic disc membrane was confirmed, it was analyzed by dividing it into three groups based on severity. Results: A total of 99 eyes (48 with wAMD, 51 with DME) were included in the analysis. The ICCs of the global RNFL thickness and global BMO-MRW measurements were 0.996 and 0.997, respectively, in wAMD and 0.994 and 0.996, respectively, in DME eyes. The CV values of global RNFL thickness and BMO-MRW were 0.60% and 0.73%, respectively, in wAMD eyes and 1.10% and 1.21%, respectively, in DME eyes. The disc membrane on the optic nerve head significantly affected global BMO-MRW repeatability (B = 0.814, p < 0.001). Conclusions: Both RNFL thickness and BMO-MRW measurements showed good repeatability in eyes with wAMD and DME. The severity of the optic disc membrane significantly affected the repeatability of BMO-MRW measurements in eyes with wAMD and DME. Therefore, physicians should examine the BMO-MRW in eyes with severe optic disc membrane.
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