드러나지 않은 증식당뇨망막병증의 특징: 빛간섭단층혈관조영술 연구
Characteristics of Unexposed Proliferative Diabetic Retinopathy: An Optical Coherence Tomography Angiography Study
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목적: 심한 비증식성당뇨망막병증과 드러나지 않은 증식당뇨망막병증의 빛간섭단층혈관조영술 결과 차이를 알아보고, 예측인자들에대해 알아보고자 한다. 대상과 방법: 2018년 1월부터 2021년 12월까지 당뇨망막병증으로 처음 진단된 환자들 중 ‘심한 비증식당뇨망막병증’과 ‘드러나지 않은증식당뇨망막병증’으로 분류된 환자들을 후향적으로 조사하였다. 드러나지 않은 증식당뇨망막병증은 광각안저사진상 후극부에 신생혈관이 관찰되지 않고 주변부에서도 구분이 명확하지 않아 형광안저혈관조영술을 통해 확인할 수 있는 경우로 정의하였다. 진단 당시임상 양상과 빛간섭단층혈관조영술에 측정된 평균 혈관밀도, 표층모세혈관총 중심와무혈관부위 넓이, 평균망막두께를 비교하였다. 일반화 추정 방정식을 이용한 다변량 분석으로 두 군을 구분하는 예측인자도 확인하였다. 결과: 심한 비증식당뇨망막병증 61안, 드러나지 않은 증식당뇨망막병증 23안이 포함되었고, 드러나지 않은 증식당뇨망막병증군의 표층모세혈관총 중심와무혈관부위 면적이 유의하게 크고(p=0.031), 전체 영역 및 중심와부근 평균 내망막두께는 얇았다(각각 p=0.014, p<0.001). 두 군 간 혈관밀도 차이는 없었다(p>0.05). 다변량 분석에서는 표층모세혈관총 중심와무혈관부위 면적과 중심와부근 평균내망막두께가 유의한 인자로 확인되었다(각각 p=0.027, p=0.001). 결론: 심한 비증식당뇨망막병증 환자에서 표층모세혈관총 중심와무혈관부위 면적이 크거나 중심와부근 평균 내망막두께가 얇은 경우드러나지 않은 증식당뇨망막병증의 가능성을 고려할 수 있다.
Abstract
Purpose: To compare optical coherence tomography angiography (OCTA) findings between severe non-proliferative diabetic retinopathy (NPDR) and unexposed proliferative diabetic retinopathy (PDR), and identify predictive factors. Methods: Patients newly diagnosed with severe NPDR or unexposed PDR between January 2018 and December 2021 were reviewed retrospectively. Unexposed PDR was diagnosed using fluorescein fundus angiography, because new vessels could not be observed in the poster pole or clearly distinguished in the retinal periphery on wide fundus photography. Clinical features at the time of diagnosis, and OCTA measurements (mean vascular density, superficial capillary plexus (SCP) foveal avascular zone (FAZ) area, and mean retinal thickness), were compared between the two groups. Factors that could predict unexposed PDR were investigated using multivariate analysis with a generalized estimating equation. Results: A total of 61 severe NPDR and 23 unexposed PDR eyes were included. The unexposed PDR had significantly larger SCP-FAZ areas (p = 0.031) and lower total and parafoveal mean inner retinal thicknesses (p = 0.014 and p < 0.001, respectively). However, there were no differences in mean vascular density between the groups (p > 0.05). Multivariate analysis showed that SCP-FAZ area and parafoveal mean inner retinal thickness were significant predictors of unexposed PDR (p = 0.027 and p = 0.001, respectively). Conclusions: In severe NPDR patients, unexposed PDR may be considered a differential diagnosis when the SCP-FAZ area is large or the parafoveal mean inner retinal thickness is small.
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