Two Cases of Long-Term Changes in the Retinal Nerve Fiber Layer Thickness after Intravitreal Bevacizumab for Diabetic Papillopathy

당뇨병유두병증에서 유리체강내 베바시주맙 주입술 후 망막시경섬유층 두께의 장기간 변화 2예

Purpose: To report long-term changes in the average retinal nerve fiber layer (RNFL) thickness in 2 patients who had intravitreal bevacizumab (IVB) injection for diabetic papillopathy. Case summary: A 36-year-old patient with diabetes complained of decreased visual acuity (20/200) in the right eye. The fundus examination showed optic disc swelling in both eyes. The average RNFL thickness based on optical coherence tomography (OCT) increased to $278{\mu}m$ and Goldmann perimetry showed nasal visual field defect in the right eye. The IVB was injected into the right eye. Three weeks after the IVB injection, RNFL thickness decreased to $135{\mu}m$ and visual acuity improved to 20/25 in the right eye. However, RNFL thickness increased from 126 to $207{\mu}m$ and visual acuity decreased to 20/32 in the left eye. Thus, IVB was injected into the left eye. In week 3, RNFL thickness decreased to $147{\mu}m$ and visual acuity improved to 20/20 in the left eye. At 12 months after IVB injection, RNFL thickness was $87{\mu}m$ in the right eye and $109{\mu}m$ in the left eye. A 57-year-old patient with diabetes complained of decreased visual acuity (20/200) and showed optic disc swelling in the right eye. The average RNFL thickness increased to $252{\mu}m$ and Goldmann perimetry showed an enlarged blind spot in the right eye. IVB was injected into the right eye. After 3 weeks, RNFL thickness decreased to $136{\mu}m$ and visual acuity improved to 20/70 in the right eye. Six months after IVB injection, RNFL thickness was $83{\mu}m$ in the right eye. Conclusions: Visual acuity progressively improved within 3 weeks and RNFL thickness measured by spectral domain OCT showed progressive thickness reduction in 2 cases of diabetic papillopathy patients who had IVB injections.

목적: 당뇨병유두병증에서 유리체강내 베바시주맙 주입술 후 망막신경섬유층 두께 변화를 장기간 측정한 2예를 보고하고자 한다. 증례요약: 36세 당뇨환자가 우안 시력저하(20/200)로 내원하였고 안저검사상 양안 시신경유두부종이 관찰되었다. 스펙트럼영역 빛간섭단층촬영기로 측정한 우안의 망막신경섬유층 두께 $278{\mu}m$로 증가 소견, 시야검사상 우안 코쪽에 국소적인 협착을 보였다. 우안 베바시주맙 주입술을 하였고 3주 후 두께는 $135{\mu}m$로 감소했으며 시력도 20/25로 호전되었으나, 좌안 시력저하(20/32)와 망막신경섬유층 두께가 $207{\mu}m$로 증가하였다. 좌안 베바시주맙 주입술을 하였고, 3주 후 두께는 $147{\mu}m$로 감소했고 시력도 20/20으로 호전되었다. 이 후 점차적으로 양안 망막신경섬유층 두께는 감소하였고, 1년 후 검사에서 우안 $87{\mu}m$, 좌안 $109{\mu}m$였다. 57세 당뇨환자가 우안 시력저하(20/200)로 내원하였고 우안의 시신경유두부종과 망막신경섬유층의 두께가 $252{\mu}m$로 증가된 소견 및 시야검사상 맹점확대를 보였다. 우안 베바시주맙 주입술 3주 후 두께는 $136{\mu}m$로 감소했고 시력은 20/70으로 호전되었으며, 3개월 후 $104{\mu}m$, 6개월에는 $83{\mu}m$로 감소했다. 결론: 본 증례에서 유리체강내 베바시주맙 주입술 후 3주내 시력의 상승과 스펙트럼영역 빛간섭단층촬영기를 통한 1년간 평균 망막신경섬유층 두께의 감소를 확인할 수 있었다.