경두개 도플러초음파를 이용한 중심장액맥락망막병증 환자의 안동맥 혈류속도 측정 = Measurement of Ophthalmic-arterial Blood-flow Velocity Using Transcranial Doppler Ultrasonography in Patients with Central Serous Chorioretinopathy

국문 초록 (Abstract)

목적: 경두개 도플러 초음파를 이용하여 중심장액맥락망막병증 환자의 이환된 눈과 무증상 반대편 눈, 장액성망막박리의 관해를 보인 눈에서 안동맥 혈류속도를 측정하고 이를 비교하고자 하였다. 대상과 방법: 31명(20-52세)의 중심장액맥락망막병증으로 진단받은 환자에서 power motion mode Doppler 150 digital transcranial Doppler 초음파를 이용하여 이환된 눈과 반대편 눈의 안동맥 최대수축기혈류속도, 최대이완기혈류속도 및 저항지수를 측정하였다. 2개월 경과 후, 장액성망막박리가 소실된 23안에서 혈역학적 지표를 재측정하였다. 결과: 이환된 눈의 최대수축기 및 최대이완기혈류속도는 각각 30.05 ± 5.34 cm/sec, 14.07 ± 2.90 cm/sec로 반대편 눈의 측정치 33.03 ± 2.00 cm/sec, 17.17 ± 2.76 cm/sec에 비해서 낮았으며 이는 통계적으로 유의하였다(각각 p=0.004, p〈0.001). 저항지수는 이환된 눈에서 0.52 ± 0.08, 반대편 눈에서 0.43 ± 0.04로 이환된 눈에서 유의하게 높았다(p〈0.001). 2개월 경과 후, 관해를 보인 23안에서 최대수축기 및 최대이완기혈류속도는 32.94 ± 6.24 cm/sec, 15.54 ± 2.88 cm/sec로 처음 이환 시에 비해 높았으며 통계적으로 유의하였다(각각 p=0.031, p=0.045). 저항지수는 0.48 ± 0.04로 낮았으나 통계적 유의성은 없었다(p=0.073). 결론: 중심장액맥락망막병증 환자의 이환된 눈은 무증상 반대편 눈에 비해 안동맥 혈류속도의 감소, 저항지수의 증가 소견을 보였고, 이환된 눈의 관해에 따라 혈류속도 측정치가 증가하였으며 이는 중심장액맥락망망병증의 발생기전 및 병태생리에 안동맥의 혈류인자가 관련이 있음을 시사한다.

다국어 초록 (Multilingual Abstract)

Purpose: To measure and compare the ocular blood-flow velocity of ophthalmic artery in patients with central serous chorioretinopathy (CSC); affected eyes, asymptomatic fellow eyes, and CSC resolved eyes using transcranial Doppler ultrasonography. Methods: A total of 31 patients (age 20-52 years) with CSC were evaluated using power motion mode Doppler 150 digital transcranial Doppler ultrasonography. The peak systolic velocity (PSV), peak diastolic velocity (PDV), and resistance index (RI) were measured in the ophthalmic artery of both affected and asymptomatic fellow eyes. After 2 months, 23 patients with resolved serous retinal detachment underwent repeated measurement of the above hemodynamic indices. Results: The PSV and PDV of the ophthalmic artery were 30.05 ± 5.34 cm/sec and 14.07 ± 2.90 cm/sec in affected eyes and 33.03 ± 2.00 cm/sec and 17.17 ± 2.76 cm/sec in asymptomatic fellow eyes, respectively. Both indices were significantly lower in affected eyes (p = 0.004, p 〈 0.001, respectively). The RI was 0.52 ± 0.08 in affected eyes and 0.43 ± 0.04 in fellow eyes, a significant difference (p 〈 0.001). After 2 months, in 23 eyes with resolved CSC, the PSV and PDV were 32.94 ± 6.24 cm/sec and 15.54 ± 2.88 cm/sec, respectively. Both indices were significantly higher than at baseline (p = 0.031, p = 0.045, respectively). However, RI was 0.48 ± 0.04 and was not significantly different (p = 0.073). Conclusions: The CSC-affected eyes showed lower ocular blood-flow velocity and higher RI than the asymptomatic fellow eyes. The ocular blood-flow velocity was increased as CSC was resolved. These findings provide insights into the ophthalmic arterial vascular factors related to the pathogenesis of CSC.

목차 (Table of Contents)

• Abstract
• 대상과 방법
• 결과
• 고찰
• REFERENCES
• 국문초록

참고문헌 (Reference)

1 Von Graefe A, "Ueber centrale recidivierende retinitis" 12 : 211-215, 1866

2 Yannuzzi LA, "Type-A behavior and central serous chorioretinopathy" 7 : 111-131, 1987

3 Youn JW., "The measurement of ocular blood flow velocity using Doppler ultrasound in primary open angle glaucoma and ocular hypertension patents" 35 : 1651-1656, 1994

4 Yap EY., "The long-term outcome of central serous chorioretinopathy" 114 : 689-692, 1996

5 Chen Q., "Power M-mode transcranial Doppler examination of the ophthalmic artery in pregnancy : standard operating procedure and review of the literature" 32 : 1671-1675, 2013

6 Iida T., "Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy" 19 : 508-512, 1999

7 Donald J., "Pathogenesis of disciform detachment of the neuroepithelium: II. Idiopathic central serous choroidopathy" 63 : 587-515, 1967

8 Gass JD., "Pathogenesis of disciform detachment of the neuroepithelium" 63 (63): 1-139, 1967

9 Spitznas M, "Pathogenesis of central serous retinopathy : a new working hypothesis" 224 : 321-324, 1986

10 Aaslid R., "Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries" 57 : 769-774, 1982

11 Gelber GS., "Loss of vision due to central serous chorioretinopathy following psychological stress" 144 : 46-50, 1987

12 Spaide RF., "Indocyanine green videoangiography of older patients with central serous chorioretinopathy" 16 : 203-213, 1996

13 Bujarborua D., "Fluorescein angiographic features of asymptomatic eyes in central serous chorio-retinopathy" 25 : 422-429, 2005

14 Scheider A., "Fluorescein and indocyanine green angiographies of central serous choroidopathy by scanning laser ophthalmoscopy" 115 : 50-56, 1993

15 Kitaya N., "Features of abnormal choroidal circulation in central serous chorioretinopathy" 87 : 709-712, 2003

16 Hamidi C., "Evaluation of retrobulbar blood flow with color doppler ultrasonography in patients with central serous chorioretinopathy" 42 : 481-485, 2014

17 Kim YY., "Color Doppler imaging in diagnose ocular disorders" 40 : 261-266, 1999

18 Erickson SJ., "Color Doppler flow imaging of the normal and abnormal orbit" 173 : 511-516, 1989