망막분지정맥폐쇄의 황반부종과 당뇨황반부종에 무보존제 트리암시놀론 유리체내주사 후 안압상승 비교
Intraocular Pressure: Intravitreal Preservative-free Triamcinolone Injection in Diabetic Macular Edema and Branch Retinal Vein Occlusion
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목적: 당뇨황반부종과 황반부종이 동반된 망막분지정맥폐쇄에서 무보존제 트리암시놀론 유리체내주사 후 안압상승의 변화에 대해고찰하고자 한다. 대상과 방법: 당뇨황반부종으로 진단받은 36명과 망막분지정맥폐쇄로 진단받은 44명을 대상으로 무보존제 트리암시놀론(Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) 유리체내주사를 시행하여, 6개월간 안압 및 안압상승 비율과 기간을 비교하였고, 빛간섭단층촬영(optical coherence tomography)을 이용하여 중심와두께(central foveal thickness)를 비교하였다. 결과: 당뇨황반부종과 망막분지정맥폐쇄 사이에서 유리체내주사 당시, 1개월, 2개월, 3개월, 6개월 뒤 안압 차이는 통계적 유의성이없었으나, 당뇨황반부종 14안(38.9%)에서 망막분지정맥폐쇄 7안(15.9%)에서 유의한 안압상승 비율을 보였다(p=0.02). 안압상승 기간은 망막분지정맥폐쇄에서 0.30 ± 1.20개월이었고, 당뇨황반부종에서 1.14 ± 1.85개월로 유의하게 길었다(p=0.03). 녹내장이 진행되어 수술을 받은 경우는 당뇨황반부종에서만 2안(5.6%)이었다. 중심와두께는 주사 후 6개월 뒤 당뇨황반부종에서 328 ± 103 μm, 망막분지정맥폐쇄에서 434 ± 189 μm로 유의한 차이를 보였다(p<0.01). 결론: 무보존제 트리암시놀론 유리체내주사는 당뇨황반부종과 망막분지정맥폐쇄에 동반된 황반부종에서 모두 치료 효과가 있었으나, 안압상승 합병증 측면에서 당뇨황반부종보다 망막분지정맥폐쇄에 동반된 황반부종에서 조금 더 안전하게 사용될 수 있다.
Abstract
Purpose: To compare the intraocular pressure (IOP) in diabetic macular edema (DME) patients and macular edema associated with branch retinal vein occlusion (BRVO) patients after intravitreal preservative-free Triamcinolone injection. Methods: This study included 36 patients diagnosed with DME and 44 patients diagnosed with BRVO with macular edema. Both groups were treated with intravitreal preservative-free Triamcinolone (Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) injection, and we compared the IOPs of the two groups determined before injection and at 1, 2, 3, and 6 months after injection. We also compared the IOP elevation ratios and durations, and central foveal thickness (CFT) changes using optical coherence tomography. Results: In both groups, there was no statistical significance in the IOP before injection and at 1, 2, 3, and 6 months after injection. However, the IOP elevation ratio in the DME patients (38.9%) was significantly higher than that in the BRVO patients (15.9%) (p = 0.02). The duration of IOP elevation in the DME patients (1.14 ± 1.85 months) was significantly longer than that in the BRVO patients (0.30 ± 1.20 months) (p = 0.03). When the IOP was not controlled, we used IOP-lowering agents, and two patients in the DME were treated with glaucoma surgery. There was no statistical significance in the CFT before injection and at 1, 2, or 3 months after injection between the two groups (p = 0.72, p = 0.26, p = 0.66, p = 0.34, respectively). However, the CFT after 6 months was 328 ± 103 μm in the DME group and 434 ± 189 μm in the BRVO; this difference was significant (p < 0.01). Conclusions: Intravitreal injection of preservative-free Triamcinolone was effective in the treatment of both DME patients and macular edema patients associated with BRVO. Furthermore, Triamcinolone was more safely injected in macular edema associated with BRVO patients than in DME patients.
참고문헌 (33)
- 김수영, "당뇨병에서의 동반질환 유병률 및 조합유병률", 보건정보통계학회지, 43(3), pp.237~244 (2018), 한국보건정보통계학회[DOI]
- Yang JY, "Prevalence and factors associated with diabetic retinopathy in a Korean adult population: the 2008-2009 Korea National Health and Nutrition Examination Survey", Diabetes Res Clin Pract, 102, pp.218~224 (2013)
- 이주용, "Baseline Characteristics and Risk Factors of Retinal Vein Occlusion: A Study by the Korean RVO Study Group", Journal of Korean Medical Science, 28(1), pp.136~144 (2013), 대한의학회
- Lee H, "Intravitreal triamcinolone as primary treatment of cystoid macular edema secondary to branch retinal vein occlusion", Retina, 25, pp.551~555 (2005)
- Gillies MC, "Five-year results of a randomized trial with open-label extension of triamcinolone acetonide for refractory diabetic macular edema", Ophthalmology, 116, pp.2182~2187 (2009)
- Zhu MD, "Development of experimental chronic intraocular hypertension in the rabbit", Aust N Z J Ophthalmol, 20, pp.225~234 (1992)
- 이창환, "망막정맥폐쇄에서 베바시주맙에 불응성인 황반부종에 대한 무보존제 트리암시놀론주입술의 효과", 대한안과학회지, 59(8), pp.730~737 (2018), 대한안과학회
- Becker B, "Diabetes mellitus and primary open-angle glaucoma. The XXVII Edward Jackson Memorial Lecture", Am J Ophthalmol, 71(1 Pt 1), pp.1~16 (1971)
- Podos SM, "High myopia and primary open-angle glaucoma", Am J Ophthalmol, 62, pp.1038~1043 (1966)
- Gaston H, "Steroid responsiveness in connective tissue diseases", Br J Ophthalmol, 67, pp.487~490 (1983)
- Park HY, "Intraocular pressure elevation after intravitreal triamcinolone acetonide injection", Korean J Ophthalmol, 19, pp.122~127 (2005)
- Gillies MC, "Intravitreal triamcinoloneinduced elevated intraocular pressure is associated with the development of posterior subcapsular cataract", Ophthalmology, 112, pp.139~143 (2005)
- Bashshur ZF, "Intravitreal triamcinolone acetonide : pattern of secondary intraocular pressure rise and possible risk factors", Clin Ophthalmol, 2, pp.269~274 (2008)
- Vasconcelos-Santos DV, "Secondary ocular hypertension after intravitreal injection of 4 mg of triamcinolone acetonide : incidence and risk factors", Retina, 28, pp.573~580 (2008)
- Kiddee W, "Intraocular pressure monitoring post intravitreal steroids : a systematic review", Surv Ophthalmol, 58, pp.291~310 (2013)
- Armaly MF, "Statistical attributes of the steroid hypertensive response in the clinically normal eye. I. The demonstration of three levels of response", Invest Ophthalmol, 4, pp.187~197 (1965)
- Armaly MF, "Dexamethasone ocular hypertension in the clinically normal eyes: II. The untreated eyes, outflow facility, and concentration", Arch Ophthalmol, 75, pp.776~782 (1966)
- Wordinger RJ, "Effects of glucocorticoids on the trabecular meshwork : towards a better understanding of glaucoma", Prog Retin Eye Res, 18, pp.629~667 (1999)
- Shaarawy T, "Glaucoma, Vol. 1", pp.438~ (2014), Saunders
- 강행구, "유리체강내 트리암시놀론 아세토나이드 주사 합병증에 대한 다각적 고찰: 발생률 및 위험요소", 대한안과학회지, 53(1), pp.76~86 (2012), 대한안과학회
- Jonas JB, "Intraocular pressure after intravitreal injection of triamcinolone acetonide", Br J Ophthalmol, 87, pp.24~27 (2003)
- Jonas JB, "Secondary chronic open-angle glaucoma after intravitreal triamcinolone acetonide", Arch Ophthalmol, 121, pp.729~730 (2003)
- François J, "Corticosteroid glaucoma", Ann Ophthalmol, 9, pp.1075~1080 (1977)
- Bernstein HN, "Steroid-induced elevation of intraocular pressure", Arch Ophthalmol, 70, pp.15~18 (1963)
- Kalina RE, "Increased intraocular pressure following subconjunctival corticosteroid administration", Arch Ophthalmol, 81, pp.788~790 (1969)
- Wingate RJ, "Intravitreal triamcinolone and elevated intraocular pressure", Aust N Z J Ophthalmol, 27, pp.431~432 (1999)
- Cho YK, "Early intraocular pressure and anterior chamber depth changes after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes : comparison of groups stratified by axial length", J Cataract Rafract Surg, 34, pp.1104~1109 (2008)
- Karakahya RH, "Ocular hypertension and glaucoma after intravitreal injection of triamcinolone acetonide", Middle Black Sea Journal of Health Science, 4, pp.24~30 (2018)
- Maia M, "Effects of intravitreal triamcinolone acetonide injection with and without preservative", Br J Ophthalmol, 91, pp.1122~1124 (2007)
- Chang YS, "In vitro benzyl alcohol cytotoxicity : implications for intravitreal use of triamcinolone acetonide", Exp Eye Res, 86, pp.942~950 (2008)
- Otsuka H, "Particle-induced endophthalmitis : possible mechanisms of sterile endophthalmitis after intravitreal triamcinolone", Invest Ophthalmol Vis Sci, 54, pp.1758~1766 (2013)
- Shimamura S, "A comparison of characteristic properties and qualitative difference between three kinds of triamcinolone acetonide", Tokai J Exp Clin Med, 42, pp.67~70 (2017)
- 안현민, "분지망막정맥폐쇄에 동반된 불응성 황반부종에서 유리체내 트리암시놀론 주사의 단기 치료 효과", 대한안과학회지, 57(11), pp.1731~1737 (2016), 대한안과학회