고용량 스테로이드 치료에 추가 트리암시놀론 구후주사가 구후시신경염의 시력회복에 미치는 영향
Additional Retrobulbar Triamcinolone Acetonide Injection for Retrobulbar Optic Neuritis Patients
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목적: 구후시신경염 환자에게 고용량 스테로이드 치료에 추가 시행한 트리암시놀론 구후주사가 초기 시력회복에 미치는 영향을 알아보고자 한다. 대상과 방법: 구후시신경염 환자 9명(Group 1)에게 고용량 스테로이드 치료를 시작한 첫날에 트리암시놀론 40 mg/1.0 ml를 구후 주사하고 1일, 1주, 2주, 1개월, 3개월째의 최대교정시력을 전향적으로 측정하였다. 고용량 스테로이드 치료를 받은 구후 시신경염 환자21명(Group 2)을 대조군으로 하여 두 군을 비교하였다. 결과: 진단시 시력(logMAR)은 Group 1 (1.00 ± 0.89)과 Group 2 (0.98 ± 0.75) 간의 차이가 없었다. 치료 1일째 시력은 Group 1(0.50 ± 0.42)이 Group 2 (0.73 ± 0.61)에 비해 빠른 호전을 보였으나 통계학적 의미는 없었다(p=0.07). 3개월째 시력 호전, 구심성동공운동장애의 회복, 색각 및 시야 호전에서도 두 군 간의 차이를 보이지 않았다. 결론: 구후시신경염 환자에서 고용량 스테로이드 치료에 추가로 시행한 트리암시놀론 구후주사는 초기에 보다 빠른 시력회복에 도움을줄 수 있을 것으로 보이나 추가적인 연구가 필요할 것으로 생각한다.
Abstract
Purpose: To evaluate the effect of additional retrobulbar triamcinolone acetonide (TA) injection on early recovery of visual acuity in retrobulbar optic neuritis patients. Methods: A prospective, randomized clinical study including 30 patients with retrobulbar optic neuritis was conducted between March 2003 and June 2007. Patients were divided into 2 groups: Group 1 (n = 9) with retrobulbar triamcinolone (TA,40 mg/1 ml) injection on the first day of ONTT protocol, and group 2 (n = 21) with conventional ONTT protocol. The following parameters were measured and analyzed: patient’s sex, age, pupillary reactions, color vision, visual field, and best-corrected visual acuity before treatment, and after 1 day, 1 week, 2 weeks, 1 month, and 3 months of follow-up. Results: Mean visual acuity before treatment was 1.00 ± 0.89 log MAR units in group 1 and 0.98 ± 0.75 log MAR units in group 2. One day after injection, visual acuity was better in group 1 (0.50 ± 0.42 log MAR units) than in group 2 (0.73 ± 0.61log MAR units), however, there was no statistically significant difference between the 2 groups (p = 0.07). There was no significant difference in visual acuity, recovery of RAPD, color vision, or visual field at 3 months of follow-up. No serious side effect related to retrobulbar TA injection was observed. Conclusions: Additional retrobulbar TA injection may help optic neuritis patients who have a need for prompt visual recovery. However, further studies are required to ascertain whether this procedure can help early recovery of visual acuity in retrobulbar optic neuritis patients.
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