Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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Intravitreal Anti-vascular Endothelial Growth Factor Injections to Treat Neovascular Age-related Macular Degeneration: Long-term Treatment Outcomes

삼출 나이관련황반변성에 대한 항혈관내피성장인자 유리체내주사 치료의 장기 임상 결과

  • Park, Yu Jeong (Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Son, Gi Sung (Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Yoon Jeon (Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, June-Gone (Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Young Hee (Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Joo Yong (Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine)
  • 박유정 (울산대학교 의과대학 서울아산병원 안과학교실) ;
  • 손지성 (울산대학교 의과대학 서울아산병원 안과학교실) ;
  • 김윤전 (울산대학교 의과대학 서울아산병원 안과학교실) ;
  • 김중곤 (울산대학교 의과대학 서울아산병원 안과학교실) ;
  • 윤영희 (울산대학교 의과대학 서울아산병원 안과학교실) ;
  • 이주용 (울산대학교 의과대학 서울아산병원 안과학교실)
  • Received : 2018.08.14
  • Accepted : 2018.11.23
  • Published : 2018.12.15
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Abstract

Purpose: We assessed the visual and anatomical outcomes, and the safety profile of long-term intravitreal anti-vascular endothelial growth factor (VEGF) injections (aflibercept, ranibizumab, and bevacizumab) given to treat neovascular age-related macular degeneration (NAMD). Methods: We analyzed medical records collected over 7 years of treatment-naive NAMD patients who received outpatient clinic-based intravitreal anti-VEGF injections. All were treated employing either "treat-and-extend" or "as needed" protocols at the discretion of the retinal specialist. The number of injections, adverse events associated with injection, and measures of visual acuity (VA), central foveal thickness (CFT), and intraocular pressure (IOP) were recorded. Results: Overall, we assessed 196 eyes of 196 patients (average age $68.6{\pm}9.6years$; 77 females). Patients received an average of $17.3{\pm}13.5$ injections over $78.0{\pm}16.5months$ of clinical follow-up. The initial mean VA (logMAR) was $0.75{\pm}0.58$ and the CFT was $349.7{\pm}152.6{\mu}m$. Both parameters exhibited maximal improvements at the 6-month visit (p < 0.05). However, the clinical outcomes worsened over the 7-year clinical course; the best-corrected visual acuity (BCVA) was $0.91{\pm}0.78$ and the CFT was $284.5{\pm}105.8{\mu}m$ at 7 years. The BCVA at 7 years was significantly correlated with the initial BCVA. IOP-related events increased 11-fold and anterior chamber reactions increased 3-fold over the years, but no significant complications such as endophthalmitis were recorded. Conclusions: The use of intravitreal anti-VEGF agents was associated with initial visual improvements over 6 months but did not prevent the worsening of NAMD over 5 years. The BCVA at the initial visit was a strong predictor of the final BCVA. A more intensive injection schedule might improve long-term outcomes.

목적: 삼출 나이관련황반변성에 대한 유리체내 항혈관내피성장인자 주사 치료의 장기 결과를 알아보고자 한다. 대상과 방법: 삼출 나이관련황반변성 진단 후 treat-and-extend 또는 as needed 방법으로 7년 이상 유리체내 항혈관내피성장인자 주사 치료를 시행 받은 환자들에 대한 후향적 의무기록 분석을 시행하였다. 주사 횟수, 최대교정시력 및 중심망막두께 등을 평가하였으며, 장기간 주사 치료에 따른 부작용 여부를 같이 조사하였다. 결과: 총 196명의 196안을 분석하였다(평균 나이 $68.6{\pm}9.6$세, 여성 77명). 평균 $78.0{\pm}16.5$개월 경과관찰하였고, 해당 기간 동안 평균 $17.3{\pm}13.5$회의 유리체내주사가 시행되었다. 치료 전 측정한 최대교정시력은 평균 $0.75{\pm}0.58$ logMAR, 중심망막두께는 $349.7{\pm}152.6{\mu}m$였고, 6개월째 두 수치 모두 최대 호전을 보였으나(p<0.05), 이후 점차 악화 소견을 보이며 7년째 최대교정시력 $0.91{\pm}0.78$ logMAR, 중심망막두께 $284.5{\pm}105.8{\mu}m$로 확인되었다. 주사 후 7년째 시력은 치료 전 시력과 강한 양의 상관관계를 보였다. 장기간 주사 동안 총 11회의 안압상승 및 3회의 전방 내 염증 증가 소견이 있었으나 안내염 등의 심각한 부작용은 관찰되지 않았다. 결론: 삼출 나이관련황반변성에서 유리체내 항혈관내피성장인자 주사 치료 후 초기 6개월간의 최대 시력 호전이 있었으나 5년 이상 경과 시 지속적인 시력 저하를 막지 못하였다. 진단 당시 시력이 장기 시력예후와 관련된 중요 예측 인자로 판단되며 적극적인 유리체 내주사 치료를 통해 더 나은 장기 시력 결과를 기대해 볼 수 있다.

Keywords

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