편측성 중심망막동맥폐쇄 환자에서 맥락막 두께의 시간에 따른 변화 = Longitudinal Changes of the Choroidal Thickness in Patients with Unilateral Central Retinal Artery Occlusion

다국어 초록 (Multilingual Abstract)

Purpose: To investigate the changes in the choroidal thickness of patients with central retinal artery occlusion (CRAO) over time and compare it with the changes in the fellow eye.
Methods: Medical records were retrospectively reviewed for patients diagnosed with CRAO from November 2014 to May 2020. The central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) were measured at the time of diagnosis and at 1, 3, 6, and 12 months after diagnosis using optical coherence tomography and compared with the values of the fellow eye.
Results: This study included 32 patients, and the mean age was 76.3 ± 10.0 years. When classified according to the degree of obstruction, seven patients presented incomplete occlusion, 21 patients presented partial occlusion, and four patients presented total occlusion.
At diagnosis, the CFT of the eye with CRAO was thicker than that of the fellow eye (p = 0.017). It decreased continuously from 1 month to 12 months after diagnosis. The SFCT at baseline and 12 months after diagnoses did not differ significantly. However, from the time of diagnosis to 12 months after diagnosis, the decrease in the SFCT was greater in the eye with CRAO than in the fellow eye (p = 0.018).
Conclusions: The SFCT of the eye with CRAO significantly decreased 12 months after diagnosis, and this reduction was more than that in the fellow eye.

국문 초록 (Abstract)

목적: 중심망막동맥폐쇄 환자의 맥락막 두께의 변화를 시간에 따라 분석하고 반대안과 비교하여 살펴보고자 하였다.
대상과 방법: 2014년 11월부터 2020년 5월까지 중심망막동맥폐쇄로 진단받은 환자들을 대상으로 의무기록을 후향적으로 분석하였다. 빛간섭단층촬영을 이용하여 진단 시와 진단 후 1, 3, 6, 12개월 추적 관찰 시의 중심황반 두께, 중심와 아래 맥락막 두께를 측정하였고, 반대안과 그 값을 비교하였다.
결과: 총 32명이 포함되었으며 평균 연령은 76.3 ± 10.0세였고 폐쇄 정도에 따라 분류하였을 때 불완전폐쇄 7명, 부분폐쇄 21명, 전체폐쇄 4명이었다. 진단 시 중심황반 두께는 반대안에 비하여 두꺼웠으며(p = 0.017) 진단 후 1개월부터 12개월까지 지속해서 감소하였다. 진단 시와 진단 후 12개월에 중심와 아래 맥락막 두께는 양안 간에 차이가 없었으나 12개월 동안 중심와 아래 맥락막 두께의 감소량은 중심망막동맥폐쇄가 발생하였던 눈에서 반대안에 비하여 컸다(p = 0.018).
결론: 중심망막동맥폐쇄가 발생한 눈의 중심와 아래 맥락막 두께는 12개월 경과 관찰하였을 때 유의하게 감소하였고, 반대안에 비하여더 많은 양이 감소하였다.

참고문헌 (Reference)

1 황재형, "중심망막동맥폐쇄로 진단된 환자들의 장기 임상결과와 예후 인자" 한국망막학회 6 (6): 48-53, 2021

2 Augsburger JJ, "Visual prognosis following treatment of acute central retinal artery obstruction" 64 : 913-917, 1980

3 Grover S, "Visual acuity impairment in patients with retinitis pigmentosa at age 45 years or older" 106 : 1780-1785, 1999

4 McAnany JJ, "Visual acuity changes in patients with leber congenital amaurosis and mutations in CEP290" 131 : 178-182, 2013

5 Cugati S, "Treatment options for central retinal artery occlusion" 15 : 63-77, 2013

6 Dotan G, "The use of spectral-domain optical coherence tomography for differentiating long-standing central retinal artery occlusion and nonarteritic anterior ischemic optic neuropathy" 45 : 38-44, 2014

7 Vance SK, "The effects of sildenafil citrate on choroidal thickness as determined by enhanced depth imaging optical coherence tomography" 31 : 332-335, 2011

8 Recchia FM, "Systemic disorders associated with retinal vascular occlusion" 11 : 462-467, 2000

9 Wang H, "Subfoveal choroidal thickness and volume in severe internal carotid artery stenosis patients" 10 : 1870-1876, 2017

10 Wei WB, "Subfoveal choroidal thickness : the Beijing Eye Study" 120 : 175-180, 2013

11 Cornut PL, "Spectral domain OCT in eyes with retinal artery occlusion" 35 : 606-613, 2012

12 Kang HM, "Significant changes of the choroid in patients with ocular ischemic syndrome and symptomatic carotid artery stenosis" 14 : e0224210-, 2019

13 Lang GE, "Risk factors for retinal occlusive diseases" 211 : 217-226, 1997

14 Frayser R, "Retinal vascular response to breathing increased carbon dioxide and oxygen concentrations" 3 : 427-431, 1964

15 Hayreh SS, "Retinal artery occlu sion : associated systemic and ophthalmic abnormalities" 116 : 1928-1936, 2009

16 Ahn SJ, "Retinal and choroidal changes and visual outcome in central retinal artery occlusion : an optical coherence tomography study" 159 : 667-676, 2015

17 Schmidt DP, "Prognosis of central retinal artery occlusion : local intraarterial fibrinolysis versus conservative treatment" 23 : 1301-1307, 2002

18 Hayreh SS, "Ocular vascular occlusive disorders : natural history of visual outcome" 41 : 1-25, 2014

19 Hayreh SS, "Ocular neovascularization with retinal vascular occlusion. II. Occurrence in central and branch retinal artery occlusion" 100 : 1585-1596, 1982

20 Mason JO, "Ocular neovascularization in eyes with a central retinal artery occlusion or a branch retinal artery occlusion" 9 : 995-1000, 2015

21 Rudkin AK, "Ocular neovascularization following central retinal artery occlusion : prevalence and timing of onset" 20 : 1042-1046, 2010

22 Park SJ, "Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011" 121 : 1933-1938, 2014

23 Ramrattan RS, "Morphometric analysis of Bruch’s membrane, the choriocapillaris, and the choroid in aging" 35 : 2857-2864, 1994

24 Kim DY, "Measurement of choroidal perfusion and thickness following systemic sildenafil(Viagra(®))" 91 : 183-188, 2013

25 Chen SN, "Macular thickness measurements in central retinal artery occlusion by optical coherence tomography" 31 : 730-737, 2011

26 Hirata M, "Macular choroidal thickness and volume in normal subjects measured by sweptsource optical coherence tomography" 52 : 4971-4978, 2011

27 Schrag M, "Intravenous fibrinolytic therapy in central retinal artery occlusion : a patient-level meta-analysis" 72 : 1148-1154, 2015

28 Young Ho Jung, "Incidence and Clinical Features of Neovascularization of the Iris following Acute Central Retinal Artery Occlusion" 대한안과학회 30 (30): 352-359, 2016

29 Chen CS, "Efficacy of intravenous tissue-type plasminogen activator in central retinal artery occlusion: report from a randomized, controlled trial" 42 : 2229-2234, 2011

30 Atebara NH, "Efficacy of anterior chamber paracentesis and carbogen in treating acute nonarteritic central retinal artery occlusion" 102 : 2029-2034, 1995

31 Wakatsuki Y, "Correlation of aging and segmental choroidal thickness measurement using swept source optical coherence tomography in healthy eyes" 10 : e0144156-, 2015

32 Agawa T, "Choroidal thickness measurement in healthy Japanese subjects by three-dimensional high-penetration optical coherence tomography" 249 : 1485-1492, 2011

33 Yeung SC, "Choroidal thickness in patients with cardiovascular disease : a review" 65 : 473-486, 2020

34 Manjunath V, "Choroidal thickness in normal eyes measured using cirrus HD optical coherence tomography" 150 : 325-329, 2010

35 Ikuno Y, "Choroidal thickness in healthy Japanese subjects" 51 : 2173-2176, 2010

36 Zhang S, "Changes in choroidal thickness and choroidal blood perfusion in guinea pig myopia" 60 : 3074-3083, 2019

37 Schumacher M, "Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial" 117 : 1367-1375, 2010

38 Hayreh SS, "Central retinal artery occlusion. Retinal survival time" 78 : 723-736, 2004

39 Hayreh SS, "Central retinal artery occlusion and retinal tolerance time" 87 : 75-78, 1980

40 Hayreh SS, "Central retinal artery occlusion : visual outcome" 140 : 376-391, 2005

41 Hayreh SS, "Central retinal artery occlusion" 66 : 1684-1694, 2018

42 Duker JS, "A prospective study of acute central retinal artery obstruction. The incidence of secondary ocular neovascularization" 109 : 339-342, 1991

43 Margolis R, "A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes" 147 : 811-815, 2009