당뇨망막병증 진행 정도에 따른 빛간섭단층혈관촬영술
Optical Coherence Tomography Angiography According to Severity of Diabetic Retinopathy
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목적: 빛간섭단층혈관촬영술을 이용하여 당뇨 환자에서 당뇨망막병증 진행 정도에 따른 황반부 미세혈관의 변화 차이를 황반부 오목무혈관부위의 넓이 비교를 통해 분석하고자 하였다. 대상과 방법: 빛간섭단층혈관촬영술을 시행한 당뇨 환자 46명, 정상인 10명을 후향적으로 분석하였다. 당뇨 환자는 안저소견에 따른 국제 임상 당뇨망막병증 중증도 분류에 따라 경도, 중등도, 중증 비증식당뇨망막병증 및 증식당뇨망막병증으로 분류하였다. 빛간섭단층혈관촬영술은 중심와를 중심으로 3 × 3 mm 범위를 촬영하여 표층 및 심부모세혈관총의 오목무혈관부위 넓이를 측정하였다. 결과: 대조군, 비증식당뇨망막병증, 증식당뇨망막병증 세 군 간 표층 및 심층 오목무혈관부위 넓이는 당뇨망막병증의 진행 정도에 따라 증가하였으며 표층(p<0.001) 및 심층(p<0.001)에서 비증식당뇨망막병증과 증식당뇨망막병증 환자군 간에 유의한 차이가 있었다. 또한 비증식당뇨망막병증 내에서는 중등도와 중증 비증식당뇨망막병증군 간에 표층(p=0.011) 및 심층(p=0.038)에서 유의한 차이를 보였다. 결론: 빛간섭단층혈관촬영술을 통하여 오목무혈관부위의 넓이를 측정할 수 있었고, 당뇨망막병증 진행 정도에 따라 오목무혈관부위의 넓이가 증가함을 확인하였다. 본 연구에서는 비증식당뇨망막병증과 증식당뇨망막병증 환자군 간에, 그리고 중등도와 중증 비증식당뇨망막병증 환자군 간에 표층 및 심층 오목무혈관부위 넓이 비교에서 유의한 차이를 보였다. 이는 오목무혈관부위의 넓이가 당뇨망막병증의 진행 정도의 표지자가 될 수 있다는 것을 시사하며, 비침습적인 빛간섭단층혈관촬영술이 당뇨망막병증의 진행 여부 확인에 유용하게 사용될 수 있다.
Abstract
Purpose: To evaluate the extent of macular microvascular changes in diabetic retinopathy according to progression of diabetic retinopathy using optical coherence tomography angiography (OCTA). Methods: We retrospectively analyzed 46 diabetic patients and 10 normal patients who underwent OCTA. Diabetic patients were classified as mild, moderate, severe non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) according to international clinical diabetic retinopathy severity classification fundus findings. OCTA was performed on a 3 × 3 mm region centered on the fovea and parafoveal areas to measure the width of the fovea avascular zone (FAZ) of the superficial and deep capillary plexuses. Results: Among the control group, NPDR, and PDR, the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the FAZ increased with progression of diabetic retinopathy. In the SCP (p < 0.001) and DCP (p < 0.001), there was a significant difference in size between the NPDR and PDR groups. In the NPDR group, there were meaningful differences in SCP (p = 0.011) and DCP (p = 0.038) size between the moderate and severe NPDR groups. Conclusions: In this study, OCTA was used to measure the FAZ, and we aimed to determine if there was a significant difference in FAZ between the NPDR and the PDR groups and between the moderate and severe NPDR groups in terms of the degree of progression of diabetic retinopathy. The results suggest that the size of the FAZ could be a marker of progression of diabetic retinopathy, and noninvasive OCTA can be used to confirm such progression.
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