빛간섭단층혈관조영술을 이용한 에탐부톨에 의한 독성시신경병증에서의 시신경 주위 혈관 분석
Analysis of Peripapillary Vessel Density in Ethambutol-induced Optic Neuropathy Using Optical Coherence Tomography Angiography
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목적: 빛간섭단층혈관조영술(OCTA)을 이용하여 에탐부톨에 의한 독성시신경병증 환자의 유두주위 및 황반부의 미세혈관 밀도의 변화를 분석하고자 한다. 대상과 방법: 에탐부톨에 의한 독성시신경병증으로 진단받은 환자들의 의무기록을 후향적으로 분석하였다. 연령, 성별, 복용량, 복용 기간, 최대교정시력, 색각검사, 시야검사 결과 등 안과 질환이 없는 환자를 대조군으로 하여 비교 분석하였다. 또 유두주위 망막신경섬유층(RNFL) 두께, 황반부 신경절세포/내망상층(GC/IPL) 두께를 비교하였고, 방사모양유두주위모세혈관(RPC) 밀도 및 황반부의 표층모세혈관총(SCP) 밀도를 비교하였다. 결과: 환자 22안과 대조군 31안이 대상에 포함되었다. 두 군의 OCTA 결과를 비교하였을 때 유두주위 RNFL 두께는 유의한 차이가 없었고, RPC 밀도는 이측부에서 환자군이 48.00 ± 8.23%로 대조군의 52.39 ± 5.58%에 비해 유의하게 낮았다(p=0.025). 황반부의 평균 GC/IPL 두께와 전체 SCP 밀도 또한 모두 유의하게 환자군에서 낮았다(p=0.001, p=0.008). 환자군 내에서 유두주위 RNFL의 평균 두께와 RPC 밀도가 양의 상관관계를 보였고(r=0.811, p＜0.001), 황반부의 최소 GC/IPL 두께와 전체 SCP 밀도 또한 유의한 양의 상관관계를 보였다(r=0.445, p=0.037). 결론: 환자군에서 이측부의 RPC 밀도 및 황반부의 SCP 밀도가 유의하게 낮음을 통해 에탐부톨의 안독성은 축삭의 변성뿐만 아니라 시신경유두 및 황반부 모세혈관의 기능장애에도 영향을 미침을 알 수 있다.
Abstract
Purpose: To investigate the changes in peripapillary and macular vessel density in ethambutol-induced optic neuropathy using optical coherence tomography angiography (OCTA). Methods: The medical records of patients diagnosed with ethambutol-induced optic neuropathy were analyzed retrospectively. Patient age, sex, daily dose (mg/day/kg), treatment duration, best-corrected visual acuity (logMAR), color vision (Ishihara color plate tests), and mean deviation of visual field test were evaluated in non-pathological individuals with age and sex controlled as the normal control group. Peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell/inner plexiform layer (GC/IPL) thickness, radial peripapillary capillary (RPC) density, and macular superficial capillary plexus (SCP) density were also compared between the patient and control groups. Results: The study included 22 patient eyes and 31 control group eyes. Comparing the OCTA results between the groups, there were no significant differences in peripapillary RNFL thickness, but the temporal RPC density was significantly (p = 0.025) lower in the patient group (48.00 ± 8.23%) than in controls (52.39 ± 5.58%). For macular structures, the mean GC/IPL thickness and whole SCP density were lower in the patients (p = 0.001 and p = 0.008, respectively). In the patients, the changes in peripapillary RNFL thickness and RPC density were significantly positively correlated (r = 0.811, p < 0.001), as were the mean macular GC/IPL thickness and whole SCP density (r = 0.445, p = 0.037). Conclusions: Patients with ethambutol-induced optic neuropathy had significantly lower temporal RPC and macular SCP densities. Ethambutol toxicity may affect not only axonal degeneration but also peripapillary and macular vascular function.
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