연령관련황반변성에서 발생한 맥락막신생혈관에서 경동공온열법의 효과

Abstract

[한글]맥락막신생혈관막은 맥락막에서 기원한 혈관이 망막 또는 망막색소상피 아래로 증식하는 질환이다. 맥락막신생혈관막에 대한 치료로써 레이저광응고술, 약물치료, 수술적치료, 방사선치료, 광역학요법 등이 소개 되었다. 본 연구는 경동공온열치료가 연령관련황반변성에서 발생한 맥락막신생혈관의 치료에 효과가 있는지를 알아보고자 하였으며 경동공온열치료로 인한 합병증의 유무를 조사하였다.연령관련황반변성으로 진단된 환자 중 맥락막신생혈관이 발생하여 경동공온열치료를 시행받은 32명 33안의 의무기록을 후향적으로 조사하였다. 환자의 연령은 51세부터 87세까지로 평균 70.2세였고, 경과관찰기간은 2.5개월부터 46.5개월로 평균 14.8개월이였고, 최대교정시력은 0.025~0.5이였으며, 병변의 크기는 1800~4200㎛까지로 평균 2490㎛였다. 경동공온열치료는 20안에서 1차례, 11안에서 2차례, 1안에서 3차례, 1안에서 4차례 실시 되어 평균 1.4회 실시하였다. 치료 후 3개월째의 시력변화는 1줄 이상 시력증가가 있었던 경우는 10안(30%), 시력변화가 없는 경우는 15안(45%), 1줄 이상 시력 감소를 보인 경우는 8안(25%)이었다. 마지막 경동공온열치료 후 3개월째 1줄 이상 시력 증가된 경우는 6안(18%), 시력변화가 없는 경우는 11안(34%), 1줄 이상 시력 감소를 보인 경우는 16안(48%)이었다. 형광안저촬영소견상 전형(classic)이 8안, 잠복형(occult)이 22안,결절맥락막혈관증(ploypoidal choroidal neovascularization)이 3안이었다. 마지막 경동공온열치료 후 형광안저촬영상 형광 누출이 소실된 경우가 7안(21%), 누출이 감소된 경우는 8안(24%), 형광 누출의 변화가 없는 경우는 13안(40%)이었으며 누출이 증가된 경우도 5안(15%)에서 있었다. 경동공온열치료 전과 후에 빛간섭단층촬영을 실시할 수 있었던 21명 21안 중 19안(90.5%)은 황반 두께가 감소하였고, 마지막 내원시 실시한 안저촬영 소견상 11안에서 섬유화(fibrosis)를 보였다.경동공온열치료는 맥락막신생혈관으로부터의 유출을 감소시키고 망막하액 및 망막부종을 호전시켜서 ？은 추적관찰기간동안 시력을 안정화시킬 수 있었으나 시력저하의 원인이 되는 섬유화도 흔히 초래하였다.

[영문]Choroidal neovascularization in patients with age-related macular degeneration is a disease where an ingrowth of vessels originating from choroid is found underneath the retina or retina pigment epithelium.Attempts to treat choroidal neovascularization include laser photocoagulation, medication, surgery, radiation therapy, or photodynamic therapy. However, treatment options were limited for neovascularization membrane that grew into the bottom of macular. This study aims to find out whether transpupillary thermotherapy can achieve significant efficacy results in maintaining vision without significant adverse effects when used to treat age-related macular degeneration associated with choroidal neovascularization.The researcher made retrospective reviews of medical charts on 33 eyes of 32 patients diagnosed with age-related macular degeneration who received transpupillary thermotherapy due to the development of choroidal neovascularization. Patients’ age ranged from 51 to 87, with a mean value of 70.2 years of age. Follow-up period spanned from 2.5 months to 46.5 months, with a mean value of 14.8 months. Maximum adjusted vision ranged between 0.025 and 0.5. Size of the lesion ranged between 1800 and 4200㎛, with mean value being 2490㎛. The transpupillary thermotherapy was performed once on 20 eyes, twice on 11eyes, three times on 1 eye, and 4 times on 1 eye. On average, the therapy was performed 1.4 times. Three months after treatment, 10 eyes(30%) showed vision improvement by 1 line or above, 15 eyes(45%) showed no change in vision, and 8 eyes(25%) showed vision lowered by 1 line or more. Also, for those that received more than one occasion of transpupillary thermotherapy, the researcher checked for change in vision at three months from the last therapy. Three months after last therapy, 6 eyes(18%) showed vision improvement by 1 line or above, 11 eyes(34%) showed no change in vision, and 16 eyes(48%) showed worsening of vision by 1 line or more. According to fluorescein angiographic finding, 8 eyes were categorized as classic, 22 eyes as occult, and 3 eyes as polypoidal choroidal neovascularization. For those that received multiple therapy, fluorescein angiography after last transpupillary thermotherapy revealed 13 eyes(40%) with no angiographic evidence of leakage, 8 eyes(24%) with reduced leakage, 13 eyes(40%) with no change of leakage, and 5 eyes(15%) with increasing leakage. Of the 21 eyes of 21 patients who were able to get optical coherence tomography before and after transpupillary thermotherapy, 19 eyes(90.5%) showed reduction in macula thickness, and fundus photo taken during the latest hospital visit revealed 11 eyes showing fibrosis.As demonstrated from this review, transpupillary thermotherapy can be considered an effective and safe treatment option for stabilizing choroidal neovascularization. However, variations in subretinal fluid, pigmentation, and blood can influence laser absoption, which can ultimately lead to various tissue reactions. Thus, further research is needed to find more sophisticated ways of using transpupillary thermotherapy to the effect of minimizing fibrosis and/or chorioretinal atrophy, which can be causes for future vision degradation.