빛간섭단층촬영에 따른 당뇨황반부종의 형태학적 분류와 치료 후 임상경과
Analysis of Optical Coherence Tomographic Patterns and Clinical Courses in Diabetic Macular Edema after Treatment
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목적: 당뇨황반부종의 치료 후 빛간섭단층촬영(OCT)에 따른 형태학적 분류와 임상경과에 대해 알아보았다. 대상과 방법: 대상군은 당뇨황반부종을 동반한 65명 65안이었다. 황반부종의 OCT상 형태학적 유형에 따라, 1군은 미만성으로 망막이두꺼워진 경우, 2군은 낭포황반부종, 3군은 장액성 망막박리, 4군은 낭포황반부종 및 장액성 망막박리를 동반한 경우로 분류하였다. 치료는 유리체강내 베바시주맙/트리암시놀론 주입술, 레이저광응고술 및 유리체절제술 등이 시행되었다. 12개월간 형태학적 분류의변화 및 6, 12개월의 중심황반두께, 최대교정시력을 분석하였다. 결과: 초진 시 1군 9안(13.8%), 2군 21안(32.3%), 3군 13안(20.0%), 4군 22안(33.9%)이었다. 치료 후 황반부종의 형태학적 변화를 보인21안(32.3%)은 1군 2안(22.2%), 2군 3안(14.3%), 3군 4안(30.8%), 4군 12안(54.5%)의 분포를 보였으며(p=0.036), 형태를 유지한 44안(67.7%)에 비해 유의하게 많은 환자가 유리체절제술을 시행받았다(p=0.012). 중심황반두께는 초진, 6, 12개월 등 모든 시기에서 네군 중 4군에서 가장 두꺼웠으나(p＜0.001, 0.002, 0.029), 최대교정시력은 초진, 6, 12개월 중 어느 시기에도 네 군간의 유의한 차이를보이지 않았다(p＞0.05). 결론: 당뇨황반부종은 치료 후 형태학적 유형에 따라 서로 다른 임상경과를 보여, 4군은 해부학적으로 가장 불량한 예후를 보였다. 치료 후 형태학적 유형의 변화는 불량한 예후를 시사할 수 있다.
Abstract
Purpose: To analyze the optical coherence tomographic patterns and clinical courses of patients with diabetic macularedema (DME) after treatment. Methods: The charts of 65 patients with DME were retrospectively reviewed. Baseline optical coherence tomographic patternsof DME were categorized into the 4 groups: group 1 (9 eyes, 13.8%) showed diffuse retinal thickening, group 2 (21eyes, 32.3%) had cystoid macular edema (CME), group 3 (13 eyes, 20.0%) demonstrated serous retinal detachment(SRD) and group 4 (22 eyes, 33.9%) had combined CME and SRD. Treatments for DME included intravitreal bevacizumab/triamcinolone injection, focal laser photocoagulation and vitrectomy. During 12 months of follow-up, changes inthe patterns of DME were assessed. Additionally, the central retinal thickness (CRT) and best-corrected visual acuity(BCVA) were measured at baseline, 6 and 12 months. Results: During 12 months of follow-up, 21 eyes (32.3%) showed changes in the DME pattern: 2 eyes (22.2%) in group 1,3 (14.3%) in group 2, 4 (30.8%) in group 3 and 12 (54.5%) in group 4. A significantly greater proportion of eyes withchanges in DME pattern underwent vitrectomy compared with those without changes in DME pattern (p = 0.012). Therewas a significant difference in CRT among the 4 groups; group 4 demonstrated the largest CRT at baseline, 6 and 12months (p < 0.001, 0.002 and 0.029, respectively). However, there were no significant differences in BCVA among the 4groups at baseline, 6 or 12 months (p = 0.879, 0.375 and 0.246, respectively). Conclusions: Clinical courses varied according to the tomographic patterns of DME after treatment, and the poorest anatomicoutcome was found in group 4. Change in tomographic pattern of DME was correlated with the treatment of DME,which might suggest a poorer outcome in those patients than in the patients who maintained their DME patterns.
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