유리체강 내 베바시주맙에 불응성인 당뇨황반부종에서 트리암시놀론 주사의 효과와 특징 (Intravitreal Triamcinolone Injection in Diabetic Macular Edema Refractory to Intravitreal Bevacizumab Injection: Clinical Characteristics According to Response)

서지정보

· 발행기관 : 한국망막학회
· 수록지 정보 : Journal of Retina / 5권 / 1호 / 12 ~ 22페이지
· 저자명 : 최미현, 김성우

초록

목적: 베바시주맙 주사에 불응성인 당뇨황반부종 환자에서 유리체강 내 트리암시놀론 주사(intravitreal triamcinolone injection, IVTA) 효과와 이와 연관된 특징을 알아보았다.
대상과 방법: 총 50안 중 IVTA 이후 중심황반두께(central macular thickness, CMT)가 50 μm 이상 감소를 보이지 않거나 300 μm 이상으로 지속되는 환자를 비반응군(12안)으로 정의했다. IVTA 이전과 이후 1, 3, 6개월에서 logMAR 최대교정시력과 CMT를 측정하였다.
결과: IVTA 이전 및 1, 3, 6개월에 CMT (μm)는 각각 494.96, 338.67, 352.15, 382.04였고(모두 p ＜ 0.001), 최대교정시력은 0.74, 0.53 (p = 0.006), 0.37 (p = 0.001), 0.74 (p = 0.744)였다. 비반응군은 낮은 초기 시력(odds ratio [OR], 4.73; p = 0.008), 만성 신장 질환(OR, 8.4; p = 0.005), 외핵층의 거대 낭포(OR, 8.5; p = 0.005), 광수용세포의 내/외절의 완전 분열(OR, 9.0; p = 0.021), 20개 이상의 과반사점(OR, 4.3; p = 0.037)과 연관이 있었다.
결론: 베바시주맙 주사에 불응성인 당뇨황반부종 환자에서 IVTA는 효과적인 치료로 활용될 수 있으나, 만성 신장 질환, OCT에서 외핵층의 거대 낭포, 내/외절의 완전 분열, 다량의 과반사점이 보이는 환자에서는 반응이 적을 것으로 생각한다.

영어초록

Purpose: To evaluate the effects of intravitreal triamcinolone injection (IVTA) in diabetic macular edema (DME) refractory to intravitreal bevacizumab injection (IVB) and to find the clinical characteristics of patients who exhibited poor response to IVTA.
Methods: Fifty eyes with DME that did not respond to IVB injections were included in this retrospective study. IVTA non-responders were defined by a reduction of less than 50 μm in central macular thickness (CMT) or persistent macular edema greater than 300 μm after IVTA treatment (n = 12). For each patient, the best-corrected visual acuity (BCVA, LogMAR) and CMT on optical coherence tomography (OCT) were obtained pre-IVTA and at the 1-, 3-, and 6-month follow-up visits. OCT previous to IVTA was used to evaluate morphological features including the presence of subretinal fluid, size and location of intraretinal cysts, inner segment-outer segment (IS-OS) continuity and the number of hyperreflective foci (HRF). Correlations between OCT measures and response to IVTA were analyzed.
Results: The mean CMT (μm) was 494.96 at baseline, 338.67 at 1 month, 352.15 at 3 months, and 382.04 at 6 months (all p < 0.001) and mean BCVA was 0.74, 0.53 (p = 0.006), 0.37 (p = 0.001), and 0.74 (p = 0.744). Worse baseline BCVA (odds ratio [OR], 4.73; p = 0.008), chronic kidney disease (OR, 8.4; p = 0.005), giant outer nuclear layer (ONL) cyst (OR, 8.5; p = 0.005), complete disruption of the IS-OS layer (OR, 9.0; p = 0.021), and more than 20 HRF (OR, 4.3; p = 0.037) were all related to poor response to IVTA.
Conclusions: IVTA might be effective for treatment of DME refractory to IVB. Patients who had chronic kidney disease, giant ONL cysts, a large number of HRF, and complete disruption of IS-OS in OCT responded poor to IVTA than those without these features.

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