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당뇨황반부종의 빛간섭단층촬영 분류에 따른 유리체강내 트리암시놀론과 베바시주맙의 효과 비교

Comparison of Intravitreal Triamcinolone Versus Bevacizumab in Bilateral Diabetic Macular Edema by Optical Coherence Tomography (OCT) Patterns

박정민|김상현
대한안과학회 (The Korean Ophthalmological Society)|2010|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제51권 제2호|pp. 210-219

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키워드

Macular edemaTriamcinoloneOCTBevacizumab
주제분류안과학

초록

목적: 양안 당뇨황반부종 환자에서 OCT결과에 따른 트리암시놀론과 베바시주맙 1회 주입의 중장기적인 치료 효과를 비교해 보고자한다. 대상과 방법: OCT 소견상 형태를 분류하여 제 1형은 균질의 저반사도를 가질 때, 제 2형은 낭포성 변화를 가지는 경우(낭포의 직경이300 μm이상), 제 3형은 장액성 망막박리가 있는 경우로 정의하였다. 양안의 황반부종의 형태가 같은 42명 84안을 대상으로 각각의눈에 트리암시놀론, 베바시주맙을 1회 주입한 후 술 전과 후 1, 3, 6월째 최대교정시력, 중심황반두께 변화를 비교하였다. 결과: 제 1형에서는 술 후 1개월째 베바시주맙을 주입한 군에서 황반두께의 감소가 있었고 제 2형에서는 트리암시놀론을 주입한 군에서 술 후 1, 3개월에 시력 및 황반두께의 호전이 있었고 베바시주맙의 경우는 술 후 1개월에만 유의하였다. 제 3형에서는 두 군 모두에서 시력의 상승이 유의하지 않았고 황반두께의 감소는 술 후 6개월까지 모두 유의하였다. 결론: 당뇨황반부종 환자에서 OCT 유형에 따라서 트리암시놀론 및 베바시주맙 주입술의 치료효과가 차이를 보였다. OCT 유형에 따라서 치료방법을 선택적으로 결정하는 것이 도움이 될 것이다.

Abstract

Purpose: To compare the effect of single intravitreal injection of triamcinolone acetonide and bevacizumab for the treatment of diabetic macular edema by optical coherence tomography (OCT) patterns. Methods: We classified diabetic macular edema by three OCT patterns: Type 1, diffuse retinal thickening; Type 2, increased retinal thickness associated with the presence of intraretinal cystoid spaces (cystoid spaces with horizontal diameter ＞300 μm);and Type 3, serous macular detachment. According to this classification, 84 eyes of 42 patients with bilateral diabetic macular edema by the same OCT pattern participated in this study.In each patient,one eye was treated with a single intravitreal injection of bevacizumab 1.25 mg/0.05 ml (IVBI group) and the other eye with a single intravitreal injection of 4 mg/0.1 ml triamcinolone (IVTI group). A comprehensive ophthalmic examination was performed at baseline and at one, three and six months after treatment. Main outcome measures included best corrected visual acuity (logMAR) and central macular thickness measured with OCT. Results: In Type 1, central macular thickness (CMT) reduced significantly in the IVBI group at one month.In Type 2, mean BCVA and CMT improved significantly in the IVTA group at one and three months and in the IVBI group at one month following treatment. In Type 3, CMT reduced significantly in both groups at one, three and six months.However, BCVA did not significantly increase in either group at one, three or six months after treatment. Conclusions: The effects of one single intravitreal injection of triamcinolone and bevacizumab differ by OCT patterns in bilateral diabetic macular edema patients.The correct therapeutic method, depending on OCT patterns of macular edema, should result in better improvement of visual acuity.

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