중심장액맥락망막병증 환자에서 편평불규칙망막색소상피박리의 관찰 : 빛간섭단층혈관조영술 연구

Abstract

본 연구에서는 flat irregular pigment epithelial detachment(flat irregular PED)내 choroidal neovascularization(CNV)을 optical coherence tomography angiography(OCTA)로 CNV의 발생률을 구하고, CNV activity를 평가해 보았다. 또한 OCTA에서 발생할 수 있는 오류를 점검해보고자 하였다. 2016년 2월부터 2018년 2월까지 본원에 내원한 central serous chorioretinopathy(CSC) 환자 290명 328안의 의무기록을 후향적으로 분석하였다. 그 중 OCT 검사 상 flat irregular PED가 있는 환자군을 대상으로 en-face view와 cross-sectional view를 분석하여 CNV가 있는지 확인하였다. 또한 두 방법을 이용하여 CNV activity를 평가하였다. CSC 279안 중 93안(33.3%)에서 flat irregular PED가 진단되었다. 그 중 en-face view로 23안, cross-sectional view로 21안에서 CNV를 확인하였다.두 방법을 비교하였을 때 8안에서 결과의 불일치가 있었고 그 중 투사 오류 4안, 구획화 오류 1안, 위음성 3안이었다. CNV activity 평가에서는 en-face view에서 4안(19.5%), cross-sectional view에서 2안(9.5%)이 활동성 있는 것으로 나타났다. CNV는 flat irregular PED에서 발생할 수 있으며, OCTA가 진단에 도움이 된다. en-face view의 검사 과정에서 발생하는 오류를 간과해서는 안 되며, cross-sectional view가 flat irregular PED에 동반된 CNV 진단 및 활동성 평가에 도움이 될 수 있다.; Purpose In this study, we investigated choroidal neovascularization (CNV) in flat irregular pigmented epithelial detachment (flat irregular PED) by two methods, en-face view and cross-sectional view of optical coherence angiography(OCTA), to evaluate the incidence of CNV and compare the efficacy of both methods to check for possible errors in OCTA. In addition, in case of the presence of CNV at OCTA, we evaluated the activity of CNV by comparing the en-face view and cross-sectional view.

Method We retrospectively reviewed the medical records of the patients with central serous chorioretinopathy who visited the Department of Ophthalmology at Hanyang University Hospital between February 1, 2016 and February 1, 2018. Patients with flat irregular PED were included, we analyzed their en-face view and the cross-sectional view to confirm the presence of CNV at the OCTA image. In case of the presence of CNV, we evaluated the activity of CNV with en-face view and the cross-sectional view. Result A total of 279 eyes (256 eyes) were analyzed and 93 eyes of 88 patients were diagnosed with flat irregular PED (33.3%). Among the eyes with flat irregular PED, CNV was found in 23 eyes with the en-face view and 21 eyes with the cross-sectional view. In the en-face view, there are 8 misdiagnosed cases out of 23 eyes due to projection artifacts (4 cases), segmentation error (1 case), false negative (3 cases). When the activity of CNV was evaluated, active CNV was seen in 4 eyes in the en-face view and 2 eyes in the cross-sectional view.

Conclusion CNV may be present in flat irregular PED and OCTA can be helpful in diagnosing it. In our results, the errors with the en-face view of OCTA could not be ignored, therefore, the cross-sectional view of OCTA may help to diagnose CNV in flat irregular PED and evaluate the activity of CNV.