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대한안과학회지 2018 년제 59 권제 6 호 J Korean Ophthalmol Soc 2018;59(6):511-518 ISSN 0378-6471 (Print) ISSN 2092-9374 (Online) https://doi.org/10.3341/jkos.2018.59.6.511 Original Article 급성중심장액맥락망막병증에서경구스피로놀락톤과단순경과관찰의단기임상결과비교 Comparison of Short-term Clinical Outcomes between Oral Spironolactone and Observation in Acute Central Serous Chorioretinopathy 이종영 1,2 김동윤 3,4 이은경 1,2 이상윤 1,2 이혜진 1,2 정진호 1,2 김진영 1,2 Jong Young Lee, MD 1,2, Dong Yoon Kim, MD, PhD 3,4, Eun Kyoung Lee, MD 1,2, Sang-Yoon Lee, MD 1,2, Hye Jin Lee, MD 1,2, Jin Ho Jeong, MD, PhD 1,2, Jin Young Kim, MD 1,2 제주대학교의학전문대학원안과학교실 1, 제주대학교병원안과 2, 충북대학교의과대학안과학교실 3, 충북대학교병원안과 4 Department of Ophthalmology, Jeju National University School of Medicine 1, Jeju, Korea Department of Ophthalmology, Jeju National University Hospital 2, Jeju, Korea Department of Ophthalmology, Chungbuk National University College of Medicine 3, Cheongju, Korea Department of Ophthalmology, Chungbuk National University Hospital 4, Cheongju, Korea Purpose: To compare the short-term efficacy of oral spironolactone vs. observation in patients with acute central serous chorioretinopathy. Methods: Forty-seven eyes of 47 patients diagnosed as acute central serous chorioretinopathy from January 2013 to June 2016 were treated with oral spironolactone or were observed. This was a retrospective study involving patients analyzed for changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid height (SRFH). Results: Oral spironolactone was used to treat 24 eyes and 23 eyes were observed. There were no differences in baseline characteristics including age, sex, BCVA (logmar), CMT, and SRFH between the two groups. The mean BCVA, CMT, and SRFH improved compared with baseline at 1 month and 2 months in both groups. In comparison between the two groups, the mean BCVA of oral spironolactone group improved more than in the observation group at 2 months (p = 0.006). There was a significant difference in CMT between the two groups at 1 month and 2 months (p = 0.017 and p < 0.001, respectively), and there was a significant difference in subretinal fluid height between the two groups at 2 months (p = 0.007). Complete resolution of subretinal fluid was achieved in 33.3% (8/24) and 21.7% (5/23) of the eyes in the oral spironolactone group and the observation group, respectively, at 2 months (p = 0.374). There was no serious side effect in patients treated with oral spironolactone. Conclusions: Both oral spironolactone and observation were effective for the treatment of acute central serous chorioretinopathy. Oral spironolactone was more effective than observation when comparing the best-corrected visual acuity, central macular thickness, and subretinal fluid height. As a noninvasive method for treatment of acute central serous chorioretinopathy, oral spironolactone showed anatomical improvement and improved visual acuity during a short-term period. J Korean Ophthalmol Soc 2018;59(6):511-518 Keywords: Central serous chorioretinopathy, Observation, Spironolactone Received: 2017. 12. 28. Revised: 2018. 3. 2. Accepted: 2018. 5. 28. Address reprint requests to Jin Young Kim, MD Department of Opthalmology, Jeju National University Hospital, #15 Aran 13-gil, Jeju 63241, Korea Tel: 82-64-717-1730, Fax: 82-64-717-1029 E-mail: muse1016@naver.com * This study was presented as a poster at the 11th Asia-Pacific Vitreo-retina Society Congress (APVRS) 2017. * This work was supported by a research grant from Jeju National University Hospital development fund in 2016. * Conflicts of Interest: The authors have no conflicts to disclose. c2018 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 511

- 대한안과학회지 2018 년제 59 권제 6 호 - 중심장액맥락망막병증 (central serous chorioretinopathy, CSC) 은후극부에발생하는망막색소상피층의병적변화와이에동반된장액망막박리를특징으로하는질병으로급성의경우약 80% 에서특별한치료없이자연호전되며좋은시력예후를보인다. 1,2 그러나만성으로진행할경우후극부에장액성신경감각망막박리가지속되고망막색소상피위축, 망막하액 (subretinal fluid, SRF), 낭포황반부종및맥락막신생혈관등의합병증으로나쁜시력예후를보이기때문에적극적인치료가필요하다. 3-6 호전되지않는중심장액맥락망막병증 (non-resolving CSC) 의경우국소레이저광응고술 (focal laser photocoagulation), 광역학치료 (photodynamic therapy), 유리체강내항혈관내피성장인자 (vascular endothelial growth factor) 주입술과같은다양한치료방법들이시도되었다. 7,8 중심장액맥락망막병증의병리기전은아직명확하게밝혀지지않았지만맥락막혈관의비정상적인투과성증가에의한망막하액의축적이중심장액맥락망막병증의병인에관여한다고알려져있다. 9 Mirshahi et al 10 의연구에서인간의망막에광물코르티코이드수용체 (mineralocorticoid receptor) 가존재함이처음알려졌으며, 최근동물을대상으로한 Zhao et al 11 의연구에서맥락막혈관의광물코르티코이드수용체의활성화가맥락막혈관의확장과누출을야기시키는것으로밝혀지면서, 치유되지않는혹은만성적인경과를보이는중심장액맥락망막병증에서광물코르티코이드수용체길항제의치료효과에대한연구가활발히이루어지고있다. 12-14 특히스피로놀락톤 (spironolactone) 은비선택적광물코르티코이드수용체길항제로서일차성알도스테론증, 15 심부전, 16 저항성고혈압 17 치료에사용되어왔는데, 중심장액맥락망막병증에서도이러한광물코르티코이드수용체의활성화를차단함으로써맥락막혈관의확장과누출을막아망막하액을감소시키게된다. 12-14 최근급성및치료되지않는혹은만성적인경과를보이는중심장액맥락망막병증에서스피로놀락톤치료가망막하액의감소와시력개선에효과가있음이보고되고있다. 13,18,19 그러나아직까지국내환자들을대상으로중심장액맥락망막병증에서경구스피로놀락톤의치료효과에대한연구가많지않은상황이다. 이에본연구에서국내의급성중심장액맥락망막병증환자들을대상으로경구스피로놀락톤치료한경우와단순경과관찰한군간의비교분석을통하여단기간치료효과를알아보고자하였다. 대상과방법 2013 년 1 월부터 2016 년 6 월까지제주대학교병원과충북 대학교병원안과에내원한환자중급성중심장액맥락망막병증으로진단받은환자들을대상으로의무기록을후향적으로분석하였다. 다음의기준을충족하는환자들을연구에포함하였다 : (1) 안저검사및빛간섭단층촬영검사에서황반부의장액망막박리혹은망막색소상피박리가확인되고, 형광안저혈관조영술에서병변부위와연관된누출이있으며, 이에의한증상이자연호전되지않고 6주이상지속된경우, (2) 처음증상이발현된경우 (first attack), (3) 최소 2개월이상스피로놀락톤치료를받은경우, (4) 치료이후 2개월이상추적관찰이가능하였던경우. -6디옵터이하의고도근시, 맥락막신생혈관, 결절맥락막혈관병증, 연령관련황반변성, 당뇨망막병증, 망막혈관폐쇄, 포도막염등의시력저하를야기할수있는안질환이동반된경우와백내장수술을비롯한모든종류의안내수술병력을가진경우는연구에서제외하였다. 또한이전에국소레이저광응고술, 광역학치료, 유리체강내항혈관내피성장인자또는트리암시놀론주입술을받았던환자는연구에서제외하였다. 본연구는헬싱키선언을준수하였으며, 제주대학교병원의학연구윤리심의위원회 (Institutional review board, IRB) 의승인하에진행되었다 ( 승인번호 2017-11-001). 치료는안저및빛간섭단층촬영검사에서망막하액이관찰되고, 1-2개월경과관찰했음에도불구하고시력개선이없는경우, 경구스피로놀락톤치료에대해설명을하였으며, 이에대해동의를한환자들을대상으로경구스피로놀락톤 (spironolactone, Aldactone, Pfizer, New York, NY, USA) 을 1일 50 mg씩 2개월이상투여하였으며, 동의하지않은환자들에대해서는경과관찰을하였다. 망막하액의완전관해가이루어지거나약물과민반응, 고칼륨혈증, 근육경련, 저혈압및심각한위장관질환의합병증이발생했을때치료를중단하였다. 모든환자에서진단당시연령, 성별, 증상발현기간, 고혈압및당뇨동반여부, 국소혹은전신스테로이드제사용여부에대하여조사하였다. 안과적검진은진단당시와경과관찰기간에이루어진시력, 안압, 세극등현미경검사, 안저검사, 빛간섭단층촬영검사, 형광안저혈관조영술검사결과를토대로분석하였다. 시력은스넬렌 (Snellen) 시력표를이용하여측정하였으며, logarithm of the minimum angle of resolution (logmar) 시력으로변환하여분석하였다. 안압은비접촉성안압계로측정하였고, 세극등현미경검사를통해전안부및안저소견을조사하였다. 빛간섭단층촬영기 (optical coherence tomography [OCT], Carl Zeiss Meditec Inc., Dublin, CA, USA) 를이용하여중심와를기준으로 3 mm 직경원에해당하는부위를설정후중심황반두께 (central macular thickness, CMT) 를측정하였으며, 중심와 512

- 이종영외 : 급성장액맥락망막병증과스피로놀락톤 - 를지나는한단면을기준으로망막하액높이 (subretinal fluid height, SRFH) 를측정하였다. 중심황반두께는유리체- 망막경계부에서부터망막색소상피-브루크막경계까지의거리를말하며빛간섭단층촬영검사의 macular cube 512 128 combination scan을통하여얻을수있었으며, built-in segmentation-modifying tool을이용하여경계설정오류를보정하였다. 망막하액높이는중심와의망막색소상피안쪽경계에서부터신경감각망막의바깥경계까지의높이를직접측정하였다. 스피로놀락톤치료군과단순경과관찰군의초진당시최대교정시력을측정하고, 중심망막두께와망막하액의높이를비교하였다. 또한스피로놀락톤의단기치료효과를판정하기위해스피로놀락톤치료군과단순경과관찰군간의치료 1개월과 2개월에최대교정시력을측정하고안저검사와빛간섭단층촬영검사를시행하여망막하액의호전여부를조사하였다. 두군간의관해 (resolution) 여부를분석하였으며, 완전관해는망막하액이한번이라도완전히소실된경우로정의하였다. 7 또한경구스피로놀락톤의대표적인부작용인복통, 구역감, 다리저림, 두통, 어지럼증및무기력증의발생여부를조사하였다. 통계학적분석은 SPSS ver. 21.0 (SPSS, Inc., Chicago, IL, USA) 을사용하였으며, 먼저각자료들이정규성분포를따르는지분석하였다. 각치료군에서치료전후시력, 중심황반두께와망막하액높이의변화는반복측정분산분석 (repeated measures analysis of variance with Bonferroni s correction) 및사후검정을사용하여각시점간비교를하였으며, 각시점-치료군 (time-group) 의차이가있는경우에는사후분석으로독립표본 t 검정을이용하여두치료군을비교하였다. 각군의기본특성은카이제곱검정과 Fisher s exact test, 독립표본 t 검정을이용하여비교하였다. 모든통계학적평가에있어 p-value가 0.05 미만인경우를통계학적으로의미가있다고평가하였다. 결과 총 47명, 47안이연구에포함되었다. 총 47명중단순경과관찰한군이 23안, 경구스피로놀락톤치료군이 24안이었고, 각군의성비차이는없었다 (p=0.793). 진단당시환자들의평균연령은단순경과관찰한군이 44.90 ± 8.26, 경구스피로놀락톤치료군이 47.54 ± 8.29로두치료군간의차이는없었다 (p=0.277). 증상발생후진단에소요된시간은단순경과관찰한군이평균 6.82 ± 0.80, 경구스피로놀락톤치료군이평균 7.11 ± 1.35주로두군간의차이는없었으며 (p=0.352), 추적관찰기간은단순경과관찰한군이평균 10.64 ± 2.22주, 경구스피로놀락톤치료군이평균 10.61 ± 2.58주로역시두군사이에유의한차이는보이지않았다 (p=0.876) (Table 1). 본연구에포함된환자들중전신스테로이드제치료를받았던환자는없었다. 치료전최대교정시력 (logmar) 은단순경과관찰한군이평균 0.40 ± 0.25, 경구스피로놀락톤치료군이평균 0.35 ± 0.25로두군간의차이는없었다 (p=0.492). 치료전중심황반두께와망막하액높이에서역시두군간의유의한차이는없었다 ( 각각, p=0.586, p=0.431) (Table 2). 경구스피로놀락톤치료군에서치료 1개월째와치료 2개월째의평균 logmar 최대교정시력은평균 0.24 ± 0.18, 0.16 ± 0.17로시력개선효과 ( 각각, p=0.005, p=0.002) 가있었으며, 단순경과관찰한환자군에서는경과관찰기간동안감소하는경향은보였으나, 유의한차이는관찰되지않았다 ( 각각, p=0.077, p=0.058) (Fig. 1). 두군의효과를비교하였는데, 경과관찰 1개월째두군간의최대교정시력의차이는없었으나 (p=0.105), 경과관찰 2개월째에는유의한차이를보였다 (p=0.006) (Fig. 1, Table 2). 경구스피로놀락톤치료군의초기중심황반두께는평균 373.54 ± 96.97 μm였으며, 치료 1개월째평균 299.18 ± 78.37 μm, 치료 2개월째평균 239.00 ± 41.74 μm로치료후경과관찰기간동안현저한감소를보였다 ( 각각 p<0.001, p<0.001) (Fig. 2). 단순경과관찰군에서도초기중심황반두 Table 1. Baseline characteristics of patients in the two groups Spironolactone (n = 24) Control (n = 23) p-value Age (years) 47.54 ± 8.29 44.90 ± 8.26 0.277 * Sex (male:female) 19:5 16:7 0.793 Diabetes (n, %) 1 (4.2) 2 (8.5) 0.472 Hypertension (n, %) 7 (29.2) 5 (21.8) 0.641 Symptom duration (weeks) 7.11 ± 1.35 6.82 ± 0.80 0.352 * Follow up period (weeks) 10.61 ± 2.58 10.64 ± 2.22 0.876 * Values are presented as mean ± standard deviation or n (%) unless otherwise indicated. p-value < 0.05 was considered statically significant. * Independent t-test; Chi-square test; Fisher exact test. 513

- 대한안과학회지 2018 년제 59 권제 6 호 - Table 2. Changes in BCVA, CMT and SRFH during the follow-up period in the two groups Spironolactone (n = 24) Control (n = 23) Compared to p-value p-value * Compared to p-value * the baseline the baseline BCVA (logmar) Baseline 0.35 ± 0.25 0.40 ± 0.25 0.492 1 month 0.24 ± 0.18 0.005 0.34 ± 0.21 0.077 0.105 2 months 0.16 ± 0.17 0.002 0.32 ± 0.19 0.058 0.006 CMT (μm) Baseline 373.54 ± 96.97 388.48 ± 89.58 0.586 1 month 299.18 ± 78.37 <0.001 357.61 ± 80.01 0.139 0.017 2 months 239.00 ± 41.74 <0.001 327.35 ± 89.10 0.019 <0.001 SRFH (μm) Baseline 211.45 ± 92.86 192.04 ± 72.94 0.431 1 month 111.00 ± 88.87 <0.001 148.22 ± 104.42 0.042 0.219 2 months 51.28 ± 53.89 <0.001 128.04 ± 112.72 0.025 0.007 Values are presented as mean ± standard deviation unless otherwise indicated. p-value < 0.05 was considered statically significant. BCVA = best collected visual acuity; logmar = logarithm of the minimum angle of resolution; CMT = central macular thickness; SRFH = subretinal fluid height. * Repeated measures analysis of variances with the Bonferroni s correction; Independent t-test. Figure 1. Comparison of mean best corrected visual acuity (BCVA, logmar) between the groups over time. Spironolactone group showed significant difference at 1 and 2 months compared with baseline. No significant difference was found during follow-up period in observation group. There was a statistically significant difference between spironolactone and observation group at 2 months. Error bars represent standard errors. * p < 0.05 compared between groups. Figure 2. Comparison of mean central macular thickness (CMT, μm) between the groups over time. Spironolactone group showed significant difference at 1 and 2 months compared with baseline. In observation group, a significant decrease was shown at 2 months. A significant difference in CMT between the groups was observed at 1 and 2 months. Error bars represent standard errors. * p < 0.05 compared between groups. 께는 388.48 ± 89.58 μm였으며, 경과관찰 1개월째중심황반두께는평균 357.61 ± 80.01 μm, 경과관찰 2개월째평균 327.35 ± 89.10 μm로감소하는경향을보였다 ( 각각 p=0.139, p=0.019). 두군간의평균중심황반두께는경과관찰 1개월째 (p=0.017) 와 2개월째 (p<0.001) 에유의한차이를보였다 (Table 2, Fig. 2). 망막하액높이는경구스피로놀락톤치료군의경우, 치료 1개월째평균 111.00 ± 88.87 μm, 치료 2개월째평균 51.28 ± 53.89 μm로초기망막하액높이 (211.45 ± 92.86 μm) 에비해유의하게감소 ( 각각 p<0.001, p<0.001) 하였으며, 단순경과관찰군에서는경과관찰 1개월째평균 148.22 ± 104.42 μm, 2개월째평균 128.04 ± 112.72 μm로초기망막하액높이 (192.04 ± 72.94 μm) 에비해감소 ( 각각 p=0.042, p=0.025) 하였다 (Fig. 3, 4). 경과관찰 1개월째두군간의망막하액높이의차이는없었으나 (p=0.219), 경과관찰 2개월째는유의한차이를보였다 (p=0.007) (Table 2, Fig. 3). 경과관찰 2개월째완전관해는경구스피로놀락톤치료군이 8명 (33.3%) 이었으며, 단순경과관찰군이 5명 (21.7%) 으로두군간의유의한차이를보이지않았다 (p=0.374, Chi-square test). 경구스피로놀락톤치료를받은환자 24명중 1명이속쓰림증상을호소하였으나증상이경미하고지속되지않아치료를지속하였다. 경과관찰기간동안두군에서복통, 구역감, 다리저림, 두통, 어지럼증및무기력증이발생한 514

- 이종영외 : 급성장액맥락망막병증과스피로놀락톤 - 사례는없었다. 고 찰 중심장액맥락망막병증은신경감각망막층하부에장액이축적되는것을특징으로하는질환으로많은경우에서망 Figure 3. Comparison of mean subretinal fluid height (SRFH, μm) between the groups over time. Both groups showed a significant difference at 1 month, 2 months compared with baseline. A significant difference in SRFH between the groups was observed at 2 months. Error bars represent standard errors. * p < 0.05 compared between groups. 막하액이자연적으로흡수되지만, 일부에서는만성적인경과를보인다. 특히사회활동이활발한중년층에호발하기때문에망막하액이장기간지속되면, 일상생활및사회생활에큰불편함을초래할수있다. 중심장액맥락망막병증의병인은여러가지가설들이제시되고있지만, 맥락막혈관의과투과성이병인에관련있는것으로알려져있다. 9 글루코코르티코이드와광물코르티코이드의균형은인체의수분과전해질항상성에중요한역할을하며, 대부분의조직에서글루코코르티코이드는광물코르티코이드수용체의활성화에기여하지만, 광물코르티코이드수용체의과도한활성화는고혈압, 대사증후군및우울증과같은여러가지질환의병인으로작용할수있다. 20 특히맥락막혈관의광물코르티코이드수용체의활성화는중심장액맥락망막병증의병인에관여하는것으로알려져있다. 10,11 이러한연구결과들은광물코르티코이드수용체길항제치료의근거를제공하였고, 경구스피로놀락톤과에플레레논 (eplerenone, Inspra, Pfizer, New York, NY, USA) 은광물코르티코이드수용체길항제계열의약물로써만성적인경과를보이거나자연치료되지않은중심장액맥락망막병증환자에서치료대안으로써주목을받고있다. 14,21 Bousquet et al 21 의예비연구에서만성경과를보이는 13 A D B E C F Figure 4. Macular thickness map and optical coherence tomography (OCT) scan of the patients with central serous chorioretinopathy (CSC). OCT images of a 48-year-old man with CSC at baseline (A), at 1 month (B), and 2 months (C) after observation. OCT images of 54-years-old man with CSC at baseline (D), at 1 month (E), and 2 months (F) after oral spironolactone. 515

- 대한안과학회지 2018 년제 59 권제 6 호 - 명의중심장맥맥락망막병증환자에게경구에플레레논치료 3개월째최대교정시력, 중심황반두께및망막하액높이에서통계학적으로유의한호전을보였다. Daruich et al 14 의연구에서는망막하액이 4개월이상지속되는만성중심장액맥락망막병증환자 42명에서경구스피로놀락톤혹은경구에플레레논치료 1개월, 3개월, 6개월째망막하액과중심황반두께의유의한감소를보였다. Bousquet et al 13 연구에서는 16명의만성중심장액맥락망막병증환자를대상으로무작위배정교차설계연구결과 placebo 치료와비교하여경구스피로놀락톤치료를했을때치료 30일째망막하액의유의한감소효과를보였다. Sun et al 22 의전향적무작위연구에서는급성중심장액맥락망막병증환자를대상으로경구스피로놀락톤 40 mg을하루 2회복용치료한군과단순경과관찰한군간의단기간치료효과를비교하였는데, 경과관찰 2개월째두군모두에서최대교정시력의개선효과, 중심황반두께및망막하액높이의감소효과를보였다. 그러나경과관찰기간동안두군간의최대교정시력의유의한차이는보이지않았으며, 경과관찰 2개월째경구 spironolactone 치료군이단순경과관찰군에비해중심황반두께 (p=0.048) 와망막하액높이 (p=0.017) 의유의한감소효과를보였다. 본연구에서는국내급성중심장액맥락망막병증환자를대상으로경구스피로놀락톤 50 mg을하루한번복용치료한군과단순경과관찰한군의치료효과를비교하였는데 Sun et al 22 의결과와비슷하게치료 1개월째와치료 2개월째경구스피로놀락톤치료군에서최대교정시력의개선효과, 중심황반두께및망막하액높이의개선효과를보였다. Sun et al 22 의연구와달리본연구에서는경과관찰 2개월째경구스피로놀락톤치료군이단순경과관찰군에비해유의한시력개선효과 (p=0.006) 를보였으며, 치료 1개월째와 2개월째모두단순경과관찰군에비해중심황반두께감소에서유의한차이를보였다 ( 각각 p=0.017, p<0.001). 망막하액높이의감소정도는경구스피로놀락톤치료군이단순경과관찰군에비해치료 2개월째유의한차이 (p=0.007) 를보여 Sun et al 22 의연구결과와유사하였다. Sun et al 22 연구에서는증상이 3개월이내로지속된환자를대상으로경구스피로놀락톤치료의유용성을보고하였는데, 이와달리본연구는중심장액맥락망막병증으로처음진단받고증상이 6주이상지속된초기급성기환자를대상으로경구스피로놀락톤의치료효과를분석함으로써, 실제임상에서초기 1개월혹은 2개월경과관찰한환자를대상으로치료방법을결정하는데도움을줄수있겠다. 본연구에서는경구스피로놀락톤치료에따른심각한내과적인합병증은관찰되지않았다. 이전에보고된몇몇연구에서경구스피로놀락톤치료환자에서피로감, 현기 증, 위장관통증및고칼륨혈증의합병증이일부보고되었지만치료를중단하거나치료약제를변경했을때합병증이모두호전되었다. 14,18,23 본연구의제한점은다음과같다. 첫째, 연구의방법이후향적의무기록분석으로시행되었다는점이며, 따라서이에대한무작위배정을이용한전향적인연구가추가되어야할필요가있다. 둘째, 기존연구에서경구스피로놀락톤치료를한경우맥락막두께의현저한감소를보이는경우가있었는데, 본연구에서는과거본원에가지고있는빛간섭단층촬영장비의한계로인하여치료전후맥락막두께에대한분석을하지못하였다. 따라서향후연구에서는경구스피로놀락톤의광물코르티코이드수용체길항효과를알아보기위해경구치료전후맥락막두께의변화를분석해야하겠다. 또한본연구는환자수가적고, 단기간치료효과를비교한연구로추후경구스피로놀락톤의장기간치료효과, 재발및안정성에대한대규모전향적연구가필요하겠다. 본연구는국내환자를대상으로급성중심장액맥락망막병증에서경구스피로놀락톤의단기간치료효과를분석하였다. 경구스피로놀락톤치료군은관찰기간동안, 최대교정시력, 중심황반두께및망막하액높이에서호전이있었으며, 단순경과관찰군은중심황반두께와망막하액높이에서감소된소견을보였다. 두군과의비교결과에서는경구스피로놀락톤치료군이단순경과관찰군에비해시력개선, 중심황반두께와망막하액높이의감소효과가더뚜렷하였으며더욱빠른망막하액흡수효과를보였다. 이는중심장액맥락망막병증의여러가지의병인중광물코르티코이드수용체가중요한역할을하는것을나타낸다고하겠다. 이러한결과로급성중심장액맥락망막병증에서경구스피로놀락톤은국소레이저광응고술, 광역학치료및유리체강내항혈관내피성장인자주입술등침습적인치료에거부감이있는환자에게비침습적으로빠른시력개선및해부학적호전을기대할수있겠다. REFERENCES 1) Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol 1967;63(Suppl):1-139. 2) Daruich A, Matet A, Marchionno L, et al. Acute central serous chorioretinopathy: factors influencing episode duration. Retina 2017;37:1905-15. 3) Jalkh AE, Jabbour N, Avila MP, et al. Retinal pigment epithelium decompensation. I. Clinical features and natural course. Ophthalmology 1984;91:1544-8. 4) Ie D, Yannuzzi LA, Spaide RF, et al. Subretinal exudative deposits in central serous chorioretinopathy. Br J Ophthalmol 1993;77:349-53. 516

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- 대한안과학회지 2018 년제 59 권제 6 호 - = 국문초록 = 급성중심장액맥락망막병증에서경구스피로놀락톤과단순경과관찰의단기임상결과비교 목적 : 급성중심장액맥락망막병증에서경구스피로놀락톤과단순경과관찰의단기간치료효과를비교하고자하였다. 대상과방법 : 2013 년 1 월부터 2016 년 6 월까지, 급성중심장액맥락망막병증으로진단받고경구스피로놀락톤치료또는단순경과관찰한 47 명, 47 안을대상으로후향적연구를진행하였으며, 최대교정시력, 중심황반두께및망막하액높이의변화를조사하였다. 결과 : 경구스피로놀락톤치료군이 24 안, 단순경과관찰군이 23 안이었다. 치료전두군간의연령, 성별, 최대교정시력, 중심황반두께및망막하액높이의차이는없었다. 경구스피로놀락톤치료군에서치료 1 개월째와 2 개월째최대교정시력이개선되었으나 ( 각각, p=0.005, p=0.002), 단순경과관찰군에서는통계적으로유의한변화는없었다 ( 각각, p=0.077, p=0.058). 중심황반두께는경구스피로놀락톤치료군에서경과관찰기간모두에서유의하게감소하였고 ( 각각, p<0.001, p<0.001), 단순경과관찰군에서는치료 2 개월째유의한감소를보였다 (p=0.019). 망막하액높이감소는두군모두에서 1 개월과 2 개월째유의한감소를보였다 ( 경구스피로놀락톤치료군, 각각, p<0.001, p<0.001; 단순경과관찰군, 각각 p=0.042, p=0.025). 두군의효과를서로비교하였을때, 치료 2 개월째시력호전에있어경구스피로놀락톤치료군이더나은결과를보였다 (p=0.006). 중심황반두께감소정도는치료 1 개월과치료 2 개월에서유의한차이가있었다 ( 각각, p=0.017, p<0.001). 또한치료 2 개월에두군에서망막하액높이감소정도의유의한차이를보였다 (p=0.007). 경과관찰 2 개월에서망막하액의완전관해는경구스피로놀락톤치료군이 8 명 (33.3%), 단순경과관찰군이 5 명 (21.7%) 으로, 두군간의유의한차이를보이지않았다 (p=0.374, Chi-square test). 경구스피로놀락톤치료에따른심각한부작용은관찰되지않았다. 결론 : 급성장액맥락망막병증에서경과관찰 2 개월동안경구스피로놀락톤치료군이단순경과관찰군에비해시력개선, 중심황반두께와망막하액높이의감소효과가더뚜렷하였다. 경구스피로놀락톤은급성장액맥락망막병증에서비침습적으로단기간에빠른시력개선및해부학적호전을기대할수있겠다. < 대한안과학회지 2018;59(6):511-518> 518