유의한 황반부종이 있는 비증식당뇨망막병증 환자의 범망막광응고술과 베바시주맙병합치료의 장기효과

The Effect of Intravitreal Bevacizumab Injection before Panretinal Photocoagulation in Patients with Clinically Significant Macular Edema

목적: 유의한 황반부종(clinically significant macular edema, CSME)이 있는 환자에서 범망막광응고술(panretinal photocoagulation, PRP) 전 시행한 유리체 내 베바시주맙 주입의 효과를 알아보고자 하였다. 대상과 방법: CSME가 있는 심한 비증식당뇨망막병증 환자(91안, 70명)의 의무기록을 후향적으로 분석, PRP 단독군(51안)과 PRP 전 유리체 내 베바시주맙 주입술(1.25 mg/0.05 mL)을 시행한 군(병합치료군, 40안)으로 분류하였다. 치료 시작 전, 치료 후 1, 3, 6, 12개월째 최대교정시력과 중심황반두께를 측정하였다. 결과: 평균 최대교정시력(logMAR, 괄호 내 Snellen)은 PRP군이 치료 전 0.24 (0.575), 1, 3, 6, 12개월째 각각 0.27 (0.537), 0.28 (0.525), 0.28 (0.525), 0.30 (0.501) (p=0.13, 0.15, 0.56, 0.79), 병합치료군은 0.32 (0.479), 0.25 (0.562), 0.26 (0.549), 0.27 (0.537), 0.36 (0.436) (p=0.02, 0.04, 0.02, 0.13)이었다. 평균 중심황반두께(μm)는 PRP군이 257.66, 285.16, 282.21, 289.65, 309.85 (p=0.00, 0.00, 0.00, 0.00), 병합치료군은 349.39, 312.17, 331.15. 353.30, 333.55 (p=0.04, 0.94, 0.79, 0.06)였다. 결론: CSME가 있는 환자에서 PRP를 시행할 때 병합치료는 단독치료에 비해 3개월 이내 단기간의 황반부종 억제효과 및 6개월까지의 시력호전을 보였다.

Purpose: To determine the effect of intravitreal bevacizumab injection before panretinal photocoagulation (PRP) in clinically sig-nificant macular edema (CSME) patients. Methods: A total of 91 eyes (70 patients) having severe nonproliferative diabetic retinopathy with CSME requiring PRP were en-rolled in the present study; the medical records were retrospectively reviewed and analyzed. The eyes were divided into the reg-ular PRP group (51 eyes) and PRP with preinjection of bevacizumab (1.25 mg) group (combination group, 40 eyes) and compared. Best corrected visual acuity (BCVA) and central macular thickness (CMT) at pretreatment and 1, 3, 6, and 12 months after PRP was evaluated. Results: BCVA (logarithm of the minimum angle of resolution, Snellen visual acuity in parentheses) at pretreatment and 1, 3, 6, and 12 months after PRP was 0.24 (0.575), 0.27 (0.537), 0.28 (0.525), 0.28 (0.525), and 0.30 (0.501) (p = 0.13, 0.15, 0.56 and 0.79) in the regular PRP group and 0.32 (0.479), 0.25 (0.562), 0.26 (0.549), 0.27 (0.537), and 0.36 (0.436) (p = 0.02, 0.04, 0.02 and 0.13) in the combination group, respectively. CMT (µm) at pretreatment and 1, 3, 6, and 12 months after PRP was 257.66, 285.16, 282.21, 289.65, and 309.85 (p = 0.00, 0.00, 0.00 and 0.00) in the regular PRP group and 349.39, 312.17, 331.15. 353.30, and 333.55 (p = 0.04, 0.94, 0.79 and 0.06) in the combination group, respectively. Conclusions: Pretreatment of anti-vascular endothelial growth factor injection before PRP affected the decrease of macular thickness for 3 months after PRP and improved visual acuity for 6 months after PRP when compared with PRP alone in patients with CSME.