결절맥락막혈관병증에서 중심맥락막두께에 따른 애플리버셉트 유리체강내주입술의 효과 분석 = Analysis of Efficacy of Intravitreal Aflibercept According to Subfoveal Choroidal Thickness in Polypoidal Choroidal Vasculopathy

국문 초록 (Abstract)

목적: 결절맥락막혈관병증 환자에서 중심맥락막두께에 따른 애플리버셉트 유리체강내주입술의 효과 차이를 분석하고자 하였다.
대상과 방법: 본원에서 결절맥락막혈관병증으로 진단 받고 애플리버셉트 유리체강내주입술을 받은 환자 중 6개월 이상 경과 관찰이 가능했던 60명 60안의 의무기록을 후향적으로 분석하였다. 주사 전 측정한 중심맥락막두께에 따라 얇은 군, 중간 군, 두꺼운 군으로 나누고 주사 후 6개월 동안의 최대교정시력, 중심맥락막두께, 중심황반두께 및 최대 망막색소상피박리 높이의 변화와 3개월째 결절 폐쇄율, 6개월째 황반부종 소실률을 비교 분석하였다.
결과: 총 60안 중 얇은 군은 14안(23.3%), 중간 군은 33안(55.0%), 두꺼운 군은 13안(21.7%)이었으며, 주사 전 평균 중심맥락막두께는 각각 178.50 ± 28.42 μm, 287.03 ± 43.58 μm, 379.77 ± 17.09 μm였다. 세 군 간 초진 시 연령, 성비, 최대교정시력, 중심황반두께 및 최대 망막색소상피박리 높이는 유의한 차이가 없었다. 치료 6개월 후 최대교정시력은 얇은 군에서만 유의한 호전을 보였고 (p=0.005) 중간 군과 두꺼운 군에서는 호전은 되었지만 통계적 유의성은 없었다(p=0.063, p=0.692). 중심맥락막두께, 중심황반두께 및 최대 망막색소상피박리 높이는 세 군 모두에서 유의한 감소를 보였다. 중심맥락막두께가 얇을수록 첫 주사 후 3개월째 완전 결절 폐쇄율과 6개월째 황반부종 소실률이 높았다(p=0.013, p=0.004).
결론: 애플리버셉트 유리체강내주입술은 결절맥락막혈관병증의 치료에 있어서 효과적이었고, 중심맥락막두께가 얇을수록 더 좋은 치료 결과를 보였다.
<대한안과학회지 2016;57(10):1577-1585>

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV).
Methods: We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thickness was manually measured as the distance from the hyper-reflective line of Bruch’s membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes.
Results: Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 μm in the thin group (14 eyes, 23.3%), 287.03 ± 43.58 μm in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 μm in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively).
Conclusions: Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes.
J Korean Ophthalmol Soc 2016;57(10):1577-1585

목차 (Table of Contents)

• 대상과 방법
• 결 과
• 고 찰
• REFERENCES

참고문헌 (Reference)

1 이지웅, "한국인에 있어서 결절맥락막혈관병증의 역학과 임상소견" 대한안과학회 48 (48): 63-74, 2007

2 이광현, "두 종류의 스펙트럼영역 빛간섭단층촬영기를 사용한 정상 한국인의 맥락막 두께 측정의 재현성" 대한안과학회 54 (54): 1365-1370, 2013

3 양 헌, "결절맥락막혈관병증에서 유리체강내 애플리버셉트 주입술의 단기 효과" 대한안과학회 56 (56): 1728-1735, 2015

4 Coscas G., "Toward a specific classification of polypoidal choroidal vasculopathy : idiopathic disease or subtype of age-related macular degeneration" 56 : 3187-3195, 2015

5 Yuzawa M., "The origins of polypoidal choroidal vasculopathy" 89 : 602-607, 2005

6 Saito M., "Switching to intravitreal aflibercept injection for polypoidal choroidal vasculopathy refractory to ranibizumab" 34 : 2192-2201, 2014

7 Kang HM., "Subfoveal choroidal thickness as a potential predictor of visual outcome and treatment response after intravitreal ranibizumab injections for typical exudative age-related macular degeneration" 157 : 1013-1021, 2014

8 Introini U., "Stereotactic radiotherapy for polypoidal choroidal vasculopathy : a pilot study" 233 : 82-88, 2015

9 Inoue M., "Short-term efficacy of intravitreal aflibercept in treatment-naive patients with polypoidal choroidal vasculopathy" 34 : 2178-2184, 2014

10 Koizumi H., "Relationship between clinical characteristics of polypoidal choroidal vasculopathy and choroidal vascular hyperpermeability" 155 : 305.e1-313.e1, 2013

11 Sasahara M., "Polypoidal choroidal vasculopathy with choroidal vascular hyperpermeability" 142 : 601-607, 2006

12 Balaratnasingam C., "Polypoidal choroidal vasculopathy : a distinct disease or manifestation of many?" 36 : 1-8, 2016

13 Ciardella AP., "Polypoidal choroidal vasculopathy" 49 : 25-37, 2004

14 Yuzawa M., "Polypoidal choroidal vasculopathy" 116 : 200-231, 2012

15 Warrow DJ., "Pachychoroid pigment epitheliopathy" 33 : 1659-1672, 2013

16 Pang CE., "Pachychoroid neovasculopathy" 35 : 1-9, 2015

17 Gallego-Pinazo R., "Pachychoroid diseases of the macula" 3 : 111-115, 2014

18 Yang LH., "Optical coherence tomographic enhanced depth imaging of polypoidal choroidal vasculopathy" 33 : 1584-1589, 2013

19 Yamamoto A., "One-year results of intravitreal aflibercept for polypoidal choroidal vasculopathy" 122 : 1866-1872, 2015

20 Oishi A., "One-year result of aflibercept treatment on age-related macular degeneration and predictive factors for visual outcome" 159 : 853.e1-860.e1, 2015

21 Kawamura A., "Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types" 91 : e474-e481, 2013

22 Yannuzzi LA., "Idiopathic polypoidal choroidal vasculopathy(IPCV)" 10 : 1-8, 1990

23 Chung SE., "Engorgement of vortex vein and polypoidal choroidal vasculopathy" 33 : 834-840, 2013

24 Koh A., "EVEREST study : efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy" 32 : 1453-1464, 2012

25 Kim SW., "Comparison of choroidal thickness among patients with healthy eyes, early age-related maculopathy, neovascular age-related macular degeneration, central serous chorioretinopathy, and polypoidal choroidal vasculopathy" 31 : 1904-1911, 2011

26 Jirarattanasopa P., "Choroidal thickness, vascular hyperpermeability, and complement factor H in age-related macular degeneration and polypoidal choroidal vasculopathy" 53 : 3663-3672, 2012

27 Chung SE., "Choroidal thickness in polypoidal choroidal vasculopathy and exudative age-related macular degeneration" 118 : 840-845, 2011

28 Kuroda S., "Choroidal thickness in central serous chorioretinopathy" 33 : 302-308, 2013

29 Tanaka K., "Associations of complement factor H(CFH)and age-related maculopathy susceptibility 2(ARMS2)genotypes with subtypes of polypoidal choroidal vasculopathy" 52 : 7441-7444, 2011

30 Shin JY., "Association between choroidal thickness and the response to intravitreal ranibizumab injection in agerelated macular degeneration" 93 : 524-532, 2015

31 Wong CW., "Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians" 53 : 107-139, 2016

32 Inoue M., "Aflibercept for polypoidal choroidal vasculopathy : as needed versus fixed interval dosing" 36 : 1527-1534, 2016