1형 미숙아망막병증의 치료로서 일차 유리체강내 라니비주맙 주입술의 효과

정규철(Gyu Chul Chung),문성혁(Sung-Hyuk Moon) 대한안과학회 2017 대한안과학회지 Vol.58 No.9

Purpose: To evaluate the effectiveness and safety of primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity. Methods: Retrospective analysis of the medical records of patients diagnosed with retinopathy of prematurity and treated with intravitreal ranibizumab injection from January 1, 2013 to January 1, 2016 was performed. We complied with the standards for ‘prethresold, type 1’ established by the Early Treatment of Retinopathy of Prematurity study for intravitreal ranibizumab injection. The follow-up period after injection was at least 9 months. Patients who received additional treatment such as laser photocoagulation or intravitreal injection without reactivation of retinopathy of prematurity were excluded. Results: A total of 21 patients (39 eyes) were included in this study. Nine (16 eyes) were male and 12 (23 eyes) were female. The average duration between treatment decision and intravitreal ranibizumab injection was 2.1 ± 1.5 days. Complete regression of the plus sign occurred 18.2 ± 9.1days after injection. One eye with reactivation was treated with panretinal laser photocoagulation while four other eyes with reactivation were treated with intravitreal bevacizumab injection. There were 87.1% (34/39) eyes that underwent primary intravitreal ranibizumab injection with stable results without any reactivation. There were no systemic complications related to intravitreal ranibizumab injection. Conclusions: Primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity showed good efficacy and safety. However, thorough evaluation is needed after primary intravitreal ranibizumab injection due to the potential for reactivation. Long-term monitoring is needed after intravitreal ranibizumab injection. J Korean Ophthalmol Soc 2017;58(9):1080-1086

중심장액맥락망막병증에서 유리체강내 베바시주맙과 애플리버셉트 주입술의 비교

박민수(Min Soo Park),이승준(Seung Joon Lee) 대한안과학회 2021 대한안과학회지 Vol.62 No.7

목적: 중심장액맥락망막병증 환자에서 유리체강내 베바시주맙 주입술과 애플리버셉트 주입술 간의 치료 효과 차이를 알아보고자 한다. 대상과 방법: 처음 중심장액맥락망막병증으로 진단받고 유리체강내 항혈관내피성장인자 주사를 받은 환자 49명 51안을 대상으로 하여 의무기록을 후향적으로 분석하였다. 항혈관내피성장인자 주사 종류에 따라 유리체강내 베바시주맙을 주입한 군과 애플리버셉트를주입한 군으로 구분하였고, 시술에 대한 반응이 없거나 악화 시 동일한 약제로 반복 치료하였다. 치료 이후 3개월 이상의 추적 관찰을시행하였고, 최대교정시력과 중심맥락막두께 변화, 치료까지 시행된 주사 횟수 및 기간을 분석하였다. 결과: 유리체강내 베바시주맙 주입술과 애플리버셉트 주입술 모두 치료 전후 의미 있는 시력변화(p<0.0001, p=0.001)와 중심맥락막두께 변화를 보였다(p<0.0001, p=0.011). 하지만 주입 약제에 따른 치료 전후 최대교정시력 및 중심맥락막두께 변화량의 차이는 보이지 않았다. 또한 주입 약제에 따른 치료까지 시행된 주사 횟수 및 기간도 차이를 보이지 않았다. 결론: 중심장액맥락망막병증 환자에서 유리체강내 베바시주맙 주입술 또는 애플리버셉트 주입술 모두 중심장액맥락망막병증의 구조적 및 기능적 회복에 효과가 있었으나, 약제의 종류에 따른 기능적 그리고 해부학적 호전의 정도, 치료까지 시행된 주사 횟수 및 기간의 차이는 없었다. Purpose: We examined differences in the treatment effects of intravitreal bevacizumab injections and intravitreal aflibercept injections in patients with central serous chorioretinopathy. Methods: This retrospective analysis included 51 eyes of 49 patients who received intravitreal anti-vascular endothelial growth factor agent injections after initial diagnosis with central serous chorioretinopathy. The patients were divided into two groups: one received an intravitreal bevacizumab injection, and another one received an intravitreal aflibercept injection. Patients with no reaction to treatment or a worsened condition, received repeat treatment with the same therapy. After treatment, patients were monitored for >3 months. Data were collected regarding best- corrected visual acuity (BCVA), subfoveal choroidal thickness, injection number, and treatment duration. Results: Both intravitreal bevacizumab injections and intravitreal aflibercept injections led to significant differences in BCVA (p < 0.0001, p = 0.001) and subfoveal choroidal thickness (p < 0.0001, p = 0.011), compared between before and after treatment. However, no differences between groups were observed in mean change of BCVA or subfoveal choroidal thickness. In addition, there were no differences between groups in injection number and treatment duration. Conclusions: In patients with central serous chorioretinopathy, both intravitreal bevacizumab injections and intravitreal aflibercept injections are effective treatment methods. There were no differences between the two medicines in terms of functional and anatomical recovery, or the injection number and treatment duration.

당뇨황반부종에서 베바시주맙 단일주입과 저용량 베바시주맙-트리암시놀론 혼합주입 단기효과 비교

김병선,정인영,박종문,한용섭,Byoung Seon Kim,In Young Chung,Jong Moon Park,Yong Seop Han 대한안과학회 2014 대한안과학회지 Vol.55 No.8

Purpose: To report the effects and intraocular pressure results of intravitreal bevacizumab alone injection compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with diabetic macular edema. Methods: In total, 40 eyes of 40 patients diagnosed with diabetic macular edema were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL) and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness, and intraocular pressure of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection. Results: In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, BCVA increased significantly at 1 month, 2 months, and 3 months after injection (<em>p </em>< 0.05). In addition, in both groups, neither intraocular pressure (IOP) nor central macular thickness increased significantly at 1 month, 2 months, or 3 months after injection (<em>p</em> > 0.05). The BCVA, IOP, and central macular thickness (CMT) at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (<em>p</em> > 0.05). Conclusions: The BCVA of both groups increased significantly, and the CMT of both groups decreased significantly in patients with diabetic macular edema. The injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of diabetic macular edema. J Korean Ophthalmol Soc 2014;55(8):1155-1161

망막정맥폐쇄에서 베바시주맙에 불응성인 황반부종에 대한 무보존제 트리암시놀론주입술의 효과

이창환,장무환,서영승 대한안과학회 2018 대한안과학회지 Vol.59 No.8

Purpose: To evaluate the efficacy of intravitreal preservative-free triamcinolone acetonide (Maqaid®) injection for the treatment of macular edema secondary to retinal vein occlusion (RVO) refractory to intravitreal bevacizumab injections. Methods: This retrospective, observational study included 17 eyes of 17 patients with refractory macular edema secondary to RVO. The patients with macular edema unresponsive to intravitreal bevacizumab injections were treated with intravitreal preservative- free triamcinolone acetonide (Maqaid®) injection. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before intravitreal triamcinolone injection (IVTA), 1 month and 3 months after IVTA injection. intraocular pressure (IOP) changes were analyzed up to 6 months. Results: The logarithm of the minimal angle of resolution (logMAR) BCVA was decreased from 0.56 ± 0.32 to 0.41 ± 0.32 after 1 month with statistical significance (p = 0.006) and to 0.47 ± 0.36 after 3 months of IVTA without statistical significance (p = 0.204). CFT was significantly improved from 474.82 ± 91.91 μm to 262.58 ± 60.11 μm after 1 month and to 339.58 ± 152.48 μm after 3 months of IVTA injection (p ≤ 0.001 and 0.005, respectively). IOP was significantly increased from 13.11 ± 2.66 mmHg to 16.64 ± 5.66 mmHg after 1 month and to 17.05 ± 7.21 μm after 3 months of IVTA injection (p = 0.024 and 0.026, respectively). Treatment-associated IOP elevation was manageable with antiglaucoma medications. IOP was 15.13 ± 3.90 mmHg after 6 months of IVTA injection (p = 0.023). Conclusions: Intravitreal preservative-free triamcinolone (Maqaid®) Injection improves BCVA and reduces CFT in some patients with macular edema secondary to RVO refractory to intravitreal bevacizumab therapy. There were no serious vision-threatening complications associated with intravitreal preservative-free triamcinolone (Maqaid®) therapy during the study period. Intravitreal preservative-free triamcinolone (Maqaid®) could be considered as a treatment option for refractory macular edema associated with RVO. 목적: 망막정맥폐쇄에서 유리체 내 베바시주맙주입술에 반응하지 않는 황반부종에 대한 치료로 유리체 내 무보존제 트리암시놀론(마카이드®) 주입술의 효과를 알아보고자 하였다. 대상과 방법: 망막정맥폐쇄로 인한 황반부종으로 진단받고 유리체 내 베바시주맙주입술을 시행받은 환자 중 치료 효과가 나타나지 않아 유리체 내 무보존제 트리암시놀론(마카이드®) 주입술을 시행받은 17명 17안의 의무기록을 후향적으로 조사하였다. 트리암시놀론주입술 전과 주입술 후 1개월, 3개월째 최대교정시력 및 빛간섭단층촬영(optical coherence tomography, OCT)상 소견 등을 분석하였고 안압은 6개월까지 변화 추이를 분석하였다. 결과: 대상 환자들의 최대교정시력(logarithm of the minimal angle of resolution, logMAR)은 치료 전 logMAR 0.56 ± 0.32에서 1개월 후 logMAR 0.41 ± 0.32로 통계적으로 유의한 호전을 보였고(p=0.006), 3개월 후에는 logMAR 0.47 ± 0.36으로 좋아지는 경향을보였으나 통계학적으로는 유의하지 않았다(p=0.204). OCT상 중심와두께(central foveal thickness)는 치료 전 474.82 ± 91.91 μm에서 1개월 후 262.58 ± 60.11 μm, 3개월 후 339.58 ± 152.48 μm로 통계적으로 유의한 호전을 보였다(p≤0.001, 0.005). 안압(intraocular pressure)은 치료 전 13.11 ± 2.66 mmHg에서 1개월 후 16.64 ± 5.66 mmHg, 3개월 후 17.05 ± 7.21 mmHg로 통계적으로 유의하게 상승된 소견을 보였다(p=0.024, 0.026). 안압이 상승된 환자들은 안압하강제를 사용한 후 안압이 모두 조절되었으며, 치료6개월 후 안압은 15.13 ± 3.90 mmHg로 통계적으로 유의한 상승을 보였다(p=0.023). 결론: 망막정맥폐쇄에 동반된 황반부종 중 유리체 내 베바시주맙에 반응하지 않는 환자들에 있어 유리체 내 무보존제 트리암시놀론(마카이드®) 주입술은 최대교정시력과 중심와두께에 호전 소견을 보였으며 보존제로 인한 안 내 부작용을 최소화할 수 있어 안전한 치료 방법으로 제안될 수 있겠다.

Real-world incidence of endopthalmitis after intravitreal anti-VEGF injections in Korea: findings from the Common Data Model in ophthalmology

Yongseok Mun,Seng Chan You,Da Yun Lee,Seok Kim,Yoo-Ri Chung,Kihwang Lee,Ji Hun Song,Young Gun Park,Young Hoon Park,Young-Jung Roh,Se Joon Woo,Kyu Hyung Park,Rae Woong Park,Sooyoung Yoo,Dong-Jin Chang 한국역학회 2021 Epidemiology and Health Vol.43 No.-

OBJECTIVES: The aim of this study was to evaluate the real-world incidence of endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injections using data from the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). METHODS: Patients with endophthalmitis that developed within 6 weeks after intravitreal anti-VEGF injections were identified in 3 large OMOP CDM databases. RESULTS: We identified 23,490 patients who received 128,123 intravitreal anti-VEGF injections. The incidence rates of endophthalmitis were 15.75 per 10,000 patients and 2.97 per 10,000 injections. The incidence rates of endophthalmitis for bevacizumab, ranibizumab, and aflibercept (per 10,000 injections) were 3.64, 1.39, and 0.76, respectively. The annual incidence has remained below 5.00 per 10,000 injections since 2011 despite the increasing number of intravitreal anti-VEGF injections. Bevacizumab presented a higher incidence rate for endophthalmitis than ranibizumab and aflibercept (incidence rate ratio, 3.17; p=0.021). CONCLUSIONS: The incidence of endophthalmitis after intravitreal anti-VEGF injections has stabilized since 2011 despite the explosive increase in anti-VEGF injections. The off-label use of bevacizumab accounted for its disproportionately high incidence of endophthalmitis. The OMOP CDM, which includes off-label uses, laboratory data, and a scalable standardized database, could provide a novel strategy to reveal real-world evidence, especially in ophthalmology.

토끼에서 유리체강내 및 테논낭하 트리암시놀론 주사 후 시간에 따른 안내 농도변화

박용욱,임정훈,신재필,김시열.Yong Wook Park. M.D.. Jung Hoon Lim. M.D.. Jae Pil Shin. M.D.. Si Yeol Kim. M.D. 대한안과학회 2008 대한안과학회지 Vol.49 No.2

`Purpose: To improve our understanding of the pharmacokinetics of triamcinolone acetonide (TA) and TA concentration in ocular tissue, TA concentration was measured in ocular tissue after intravitreal and subtenon injection. Methods: Fifteen rabbit eyes underwent subtenon TA injection (40 mg/1 ml), and another 15 rabbit eyes underwent intravitreal TA (4 mg/0.1 ml) injection. All eyes were enucleated at 1, 2, 4, 8, and 12 weeks after subtenon and intravitreal injection, and TA concentration in the aqueous and vitreous humor and the retina-choroid were measured by high performance liquid chromatography (HPLC). Results: In cases of subtenon's TA injection, TA concentrations were 0 ng/ml, 136.7 ng/ml, 178.7 ng/ml, 0 ng/ml, and 0 ng/ml in the aqueous humor; 99.1 ng/ml, 125.7 ng/ml, 726.8 ng/ml, 0 ng/ml, and 0 ng/ml in the vitreous humor; 72.7 ng/ml, 304.6 ng/ml, 459.0 ng/ml, 0 ng/ml, and 0 ng/ml in the retina-choroid after 1, 2, 4, 8, and 12 weeks, respectively. In cases of intravitreal TA injection, the measured values were 0 ng/ml, 0 ng/ml, 0 ng/ml, 654.1 ng/ml, and 0 ng/ml in the aqueous humor; 28152.2 ng/ml, 13646.4 ng/ml, 11388.8 ng/ml, 10297.2 ng/ml, and 183.0 ng/ml in the vitreous humor; and 0 ng/ml, 27.9 ng/ml, 108.3 ng/ml, 0 ng/ml, and 0 ng/ml in the retina-choroid at each time point. Conclusions: Intravitreal TA injection may be more effective for drug delivery than subtenon TA injection, but subtenon TA injection seems to be an effective and safe technique.`

Factors Associated with Pain Following Intravitreal Injections

Seong Hwan Shin,Sung Pyo Park,Yong-Kyu Kim 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.3

Purpose: To investigate factors associated with pain intensity following intravitreal injection and factors that might be associated with changes in pain intensity in patients who received repeated injections. Methods: A total of 172 eyes (147 patients) were prospectively enrolled. Patients rated their pain from 0 to 10 using a visual analogue scale. Multiple linear regression analysis was used to evaluate factors associated with pain score. Sixty-eight patients evaluated their degree of pain more than once and were divided into three groups according to changes in pain during repeated injections. Clinical factors were compared among the three groups. Results: Pain scores of women (women, 3.1 ± 1.5 vs. men, 2.4 ± 1.2; p = 0.003), those who received dexamethasone implant injection (dexamethasone implant, 3.5 ± 1.1 vs. anti-vascular endothelial growth factor, 2.7 ± 1.4; p = 0.028), and those who did not undergo anterior chamber paracentesis (ACP) (ACP, 2.6 ± 1.3 vs. no ACP, 3.0 ± 1.6; p = 0.047) were significantly higher than those of the other groups. On multiple linear regression analysis, only female sex and ACP were significantly associated with degree of pain. The waiting time during the second injection was significantly associated with change in degree of pain in patients who received repeated injections. Conclusions: Women were more prone to perceive pain, and the ACP procedure reduced pain during intravitreal injections. Most patients who received repeated injections felt that pain was similar or decreased compared to that experienced during the previous injection. However, increased waiting time might have been associated with increased discomfort for patients who received repeated injections.

유리체강내 주입술 후 유리체 역류를 일으키는 인자

지동현(Donghyun Jee),김보윤(Bo Youn Kim),나태윤(Tae Yoon Ra) 대한검안학회 2010 Annals of optometry and contact lens Vol.9 No.2

목적: 유리체강내 주입술 후 발생하는 유리체 역류에 관여하는 위험인자를 분석하여 유리체 역류를 최소화시키는 방법을 알아보고자 하였다. 대상과 방법: 본원에서 베바시주맙 유리체강내 주입술을 받은 122명 122안을 대상으로 연구를 시행하였다. 유리체 역류의 정도는 주입술 후 발생하는 결막 수포의 최대 지름으로 측정하였고, 술 전 안압, 수정체의 유무, 공막창의 형태, 주사 바늘 제거 속도를 조사하여 유리체 역류에 영향을 주는 인자를 분석하였다. 결과: 술 전 안압의 변화와 수정체 유무에 따라 유리체 역류는 통계적으로 유의한 변화를 보이지 않았다. 주사바늘주입 형태에 따라 결막 수포의 지름은 수직주입군에 비해 터널주입군에서 역류량을 유의하게 줄일 수 있었다(p=0.004). 주사바늘을 제거 속도에 따라 결막 수포의 지름은 바늘을 빠르게 제거한 군에 비하여 주사바늘을 천천히 제거할 때 유의하게 역류가 적게 발생함을 확인할 수 있었다(p<0.001). 결론: 유리체강 내 주입술 시 터널형태 공막창을 만들어 주입 후 천천히 주사바늘을 제거하는 것이 유리체 역류를 줄일 수 있는 좋은 방법으로 기대된다. Purpose: To analyze the factors affecting the vitreous reflux after intravitreal (IV) injection. Methods: A prospective study was conducted for 122 eyes of 122 patients who had undergone intravitreal Bevacizumab (AvastinⓇ) injection. The amount of vitreal reflux was measured as the conjunctival blebs size by using caliper after IV injection. We investigated the pre-injection IOP, status of lens, injection technique, and speed of needle removal as risk factors and analyzed the factors affecting the vitreous reflux after IV injection by multivariate linear regression test. Results: There was no statistically significant correlation between pre-injection IOP and mean conjunctival bleb size (CBS) (p=0.084). The relationship between mean conjunctival bleb size and lens status was not statistically significant, (1.95±1.84 mm) in phakic eyes and (2.18±1.66 mm) in pseudophakic eyes (p=0.723). The relationship between mean CBS and injection technique was statistically significant (p=0.004). The mean CBS was less with the tunneled scleral injection (1.87±1.80 mm) than in eyes undergoing the straight scleral injection (2.03±1.80 mm). Also the mean CBS was statistically less with the slow group of needle removal (1.54±1.58 mm) than in eyes undergoing the fast group of needle removal (3.36±1.70 mm) (p<0.001). Conclusions: Slow removal of needle and the tunneled scleral incision can be expected to decrease the vitreal reflux after intravitreal injection.

30 게이지 주사바늘을 사용한 유리체강내 주사술 시행 후 주사바늘 첨단부의 전자현미경 관찰

김주영,이종혁,윤이나 대한안과학회 2010 대한안과학회지 Vol.51 No.7

Purpose: To observe the degree of damage in a 30-gauge injection needle by observing the changes in needle tip following an intravitreal injection with the use of a scanning electron microscope. Methods: The present study evaluated 11 injection needles collected following the use of an intravitreal injection of bevacizumab. Ten unused injection needles were selected as the control group. Needle examination was performed using a scanning electron microscope. Results: Following 11 intravitreal injections, seven bent needle tips, two stubbed needle tips and two almost normal needle tips were observed following intravitreal injections. In the control group, a single damaged needle tip was observed. Conclusions: Significant damage to the needle tip was observed following intravitreal injection using a 30-gauge injection needle. The results indicate that needles should be manipulated carefully during an intravitreal injection. Additionally, in the control group where no procedures were performed, a single injection needle with damaged status was found. These results indicate that needles should be replaced in cases in which resistance is perceived during the procedure.

유리체강 내 주사 후 발생한 비문증과 Inverse Tapping Technique의 효과

문준호,김용규,박성표,김경래 대한안과학회 2024 대한안과학회지 Vol.65 No.2

목적: 유리체강 내 항혈관내피성장인자 주사 후 비문증 발생 빈도와 주사 바늘을 아래로 하고 주사기를 두드려 공기방울의 주입을막는 방법(inverse tapping technique)의 효과를 분석하고자 한다. 대상과 방법: 삼출성 나이관련황반변성, 당뇨병성 황반부종으로 유리체강 내 주사 치료를 처음 시행받은 환자를 대상으로 inverse tapping technique 사용 여부로 실험군과 대조군을 나누었다. 연구에 동의한 환자들은 블록 무작위 배정법으로 무작위 배정을 통해inverse tapping군과 대조군으로 배정되었다. 주사 1주일 후 설문지를 이용해 비문증 발생 유무와 비문증을 호소한 환자에서 빛간섭단층촬영과 광각안저촬영을 시행하였다. 결과: 실험군 39명 중 2명(5.1%), 대조군 39명 중 8명(20.5%)이 주사 1주일 후 비문증을 호소하였고 통계적으로 유의한 차이를 보였다(p=0.042). 비문증을 호소한 환자군의 평균 연령이 호소하지 않은 환자군보다 통계적으로 유의하게 낮았다(48.40 ± 8.55 vs. 65.44 ± 11.50; p<0.001). 주사 치료 전 빛간섭단층촬영을 통해 평가한 후유리체박리의 존재 여부는 비문증을 호소한 환자군의 1안(10.0%) 에서 비문증을 호소하지 않은 환자군의 52안(76.5%)에서 관찰되었고, 통계적으로 유의한 차이를 보였다(p<0.001). 결론: 유리체강 내 주사 치료 후 발생하는 비문증은 연령과 후유리체박리의 발생 여부와 관련이 있으며, inverse tapping technique이주사 치료 후 비문증 발생을 줄이는 데 도움이 될 것으로 사료된다. Purpose: To analyze the incidence of vitreous floaters after intravitreal antivascular endothelial growth factor injection and the effectiveness of the inverse tapping technique, which involves tapping the syringe with the needle downwards to prevent the entry of air bubbles during injection. Methods: The study enrolled patients undergoing their first intravitreal injection for exudative age-related macular degeneration or diabetic macular edema. The patients were divided into two groups: those who received an injection after inverse tapping (IT group) and controls who received the injection without tapping. Patients who consented to the study were randomly assigned to the IT group and the control group through block randomization. One week after injection, a questionnaire was used to assess the presence of vitreous floaters; those who reported them were examined via optical coherence tomography and wide fundus photography. Results: Of the 39 patients in the IT group, two (5.1%) reported floaters 1 week after injection. By contrast, eight (20.5%) of the 39 controls reported them, with a significant difference (p = 0.042). Patients with floaters were significantly younger. Posterior vitreous detachment, as evaluated by pre-injection optical coherence tomography, was observed in 10.0% of those with floaters and 76.5% of those without them. Conclusions: The occurrence of vitreous floaters after intravitreal injection is related to age and the presence of posterior vitreous detachment. The use of the inverse tapping technique may help reduce these after intravitreal injection.