큰 망막색소상피 박리를 동반한 맥락막혈관신생에서의 복합치료

목적: 큰 망막색소상피박리(PED)를 동반한 신생혈관 나이관련황반변성에서 유리체강내 bevacizumab 주사와 광역학요법(PDT)의 복합치료 효과를 알아보았다. 대상과 방법: 맥락막혈관신생으로 진단된 9안, 맥락막혈관신생과 결절맥락막혈관병증 사이에 진단이 모호한 4안, 총 13안을 대상으로 하였다. Bevacizumab 주사 후 1주일 이내에 인도시아닌형광안저혈관조영에 따른 PDT를 시행하였다. 추가적인 주사는 4~6주, 추가적인 PDT는 늦어도 4개월 간격으로 시행하였다. 결과: 최종 검사 때 시력변화는 호전 3안(23.1%), 유지 7안(53.8%), 악화 3안(23.1%)이었다. PED의 변화는 소실 5안(38.5%), 소실 후 재발 2안(15.4%), 지속 4안(30.8%), 망막색소상피 파열이 2안(15.4%)이었다. 맥락막혈관신생 군은 66.7%(6/9), 진단이 모호한 군은 100% (4/4)에서 시력이 유지되거나 향상되었다. 결론: 큰 망막색소상피박리를 동반한 신생혈관 나이관련황반변성에서 복합치료는 시력유지 및 호전을 기대할 수 있는 선택적인 치료방법이다. 추후 장기간의 관찰과 항 혈관내피성장인자 항체의 단일치료와 대조연구가 필요하다. Purpose: To evaluate the efficacy of the combination therapy of intravitreal bevacizumab injection and photodynamic therapy in neovascular age-related macular degeneration associated with large retinal pigment epithelial detachment. Methods: A total of 13 eyes were reviewed, with 9 eyes diagnosed with definite choroidal neovascularization (CNV) and 4 eyes diagnosed with CNV or polypoidal choroidal vasculopathy (PCV) because the exact type could not be determined. Photodynamic therapy was performed within 1 week after bevacizumab injection according to indocyanine green angiography (ICGA). Additional bevacizumab injections were performed within a 4 to 6 week interval. Additional photodynamic therapy was performed within 4 months. Results: The visual acuity on final examination had improved in 3 eyes (23.1%), was maintained in 7 eyes (53.8%), and decreased in 3 eyes (23.1%). The change of the PED before and after treatment showed regression in 5 eyes (38.5%), recurrence after regression in 2 eyes (15.4%), persistence in 4 eyes (30.8%), and retinal pigment epithelial tear in 2 eyes (15.4%). The maintained or improved visual acuity rate was 66.7% (6/9) and 100% (4/4) in the CNV and CNV or PCV group, respectively. Conclusions: The combination therapy in neovascular age-related macular degeneration associated with large retinal pigment epithelial detachment is a viable alternative treatment in the stabilization and improvement of vision. However, further studies with long-term follow up and controlled studies with anti-vascular endothelial growth factor antibody monotherapy are required. J Korean Ophthalmol Soc 2009;50(6):877-886