망막분지정맥폐쇄 환자에서 유리체강 내 베바시주맙 주입술 전후 빛간섭단층혈관조영술을 이용한 황반부 혈관 밀도 분석 = Macular Vessel Density Analysis Using Optical Coherence Tomography Angiography before and after Intravitreal Bevacizumab Injection in Branch Retinal Vein Occlusion

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate macular vessel density (VD) change and its correlation with prognosis based on optical coherence tomography angiography (OCTA) before and after intravitreal bevacizumab injection in patients with branch retinal vein occlusion (BRVO) with macular edema.
Methods: We retrospectively examined 32 eyes of 32 patients who were followed for more than 12 months after intravitreal bevacizumab injection due to BRVO with macular edema. Follow-up was performed at 1-month intervals, and additional injections were performed if necessary. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before and 12 months after intravitreal bevacizumab injection. Using OCTA, the area of the foveal avascular zone (FAZ) and macular VD were measured before and 12 months after intravitreal bevacizumab injection. The correlation between change in macular VD and number of injections was analyzed.
Results: The BCVA and CRT improved 12months after intravitreal bevacizumab injection (p = 0.019, p = 0.017, respectively), and FAZ area showed a decrease after 12 months (p = 0.023). The parafoveal deep capillary plexus (DCP) VD and affected macular VD were significantly increased (p = 0.032, p = 0.012). The mean number of injections was 3.20 ± 1.92, and the larger was the decrease in macular DCP VD, the lower was the number of injections (β = -0.524, p = 0.015).
Conclusions: OCTA was able to quantitatively measure changes in macular vasculature in BRVO patients with macular edema. The VD in DCP significantly increased after intravitreal bevacizumab injection, and the larger was its decrease, the lower was the likelihood of recurrence of macular edema.

국문 초록 (Abstract)

목적: 황반부종을 동반한 망막분지정맥폐쇄 환자에서 유리체강 내 베바시주맙 주입술 전후 빛간섭단층혈관조영술에서 나타나는 황반부혈관 밀도의 변화 및 예후와의 상관관계를 평가하고자 하였다.
대상과 방법: 망막분지정맥폐쇄로 인한 황반부종으로 유리체강 내 베바시주맙 주입술 시행 후 12개월 이상 경과 관찰이 가능했던 환자32명 32안을 대상으로 의무기록을 후향적으로 분석하였다. 1개월 간격으로 경과 관찰하면서 필요시 추가적인 주사를 시행하였으며, 유리체강 내 베바시주맙 주입술 전과 12개월 후의 최대교정시력, 중심망막두께를 측정하였으며, 빛간섭단층혈관조영술을 이용하여 오목무혈관부위 면적 및 황반부 혈관 밀도를 측정하였다. 황반부 혈관 밀도 변화와 주사 횟수와의 상관관계를 분석하였다.
결과: 유리체강 내 베바시주맙 주입술 12개월 후 최대교정시력 및 중심망막두께는 호전되었으며(p = 0.019, p = 0.017) 오목무혈관부위 면적은 유의한 감소를 보였으며(p = 0.023) 중심와부근 심층혈관총 혈관 밀도와, 망막분지정맥폐쇄에 영향을 받은 황반부 심층혈관총 혈관 밀도는 유의하게 증가하였다(p = 0.032, p = 0.012). 평균 주사 횟수는 3.20 ± 1.92였으며 황반부 심층혈관총의 혈관밀도의 감소 정도가 클수록 주사 횟수는 줄어드는 경향을 보였다(β = -0.524, p = 0.015).
결론: 빛간섭단층혈관조영술은 황반부 미세혈관의 변화를 정량적으로 측정할 수 있었으며, 유리체강 내 베바시주맙 주입술 후 심층혈관총의 혈관 밀도는 유의하게 증가하였고, 심층혈관총의 혈관 밀도 감소율이 클수록 황반부종의 재발은 줄어드는 경향을 보였다.

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