안와염증에 동반된 급성망막괴사 (Acute Retinal Necrosis Masked by Clinical Features of Orbital Inflammation)

서지정보

· 발행기관 : 대한안과학회
· 수록지 정보 : 대한안과학회지 / 61권 / 8호 / 965 ~ 970페이지
· 저자명 : 박서진, 변석호, 이준원

초록

목적: 안와염증 증상으로 내원하여 급성망막괴사로 진단된 사례를 경험하였기에 이를 보고하고자 한다.
증례요약: 33세 여자 환자가 우안 충혈, 결막부종 및 통증을 주소로 본원 내원하였다. 내원 당시 우안 나안시력 1.0, 전방 내 염증세포는 2+로 관찰되었으며, 포도막염 및 안와염증을 동반한 후공막염 소견으로 고용량 스테로이드 정맥주사를 시행하였다. 이후 주변부 망막괴사와 폐쇄혈관염이 관찰되면서 급성망막괴사로 판단하고, acyclovir 정맥주사를 포함한 foscarnet 유리체강내 주사, 장벽레이저술을 시행하였고, 퇴원 후에도 valacyclovir 복용하면서 경과 관찰하였다. 치료 3달째, 우안의 유리체혼탁, 만성 시신경부종 및 허혈성 변화, 황반부의 변성 및 만성 부종으로 우안 시력은 안전 수동이나, 양안 새로운 병변의 발생 없이 안정적으로 유지되고 있다.
결론: 드물게 급성망막괴사가 안와염증의 형태를 동반할 경우 진단이 늦어질 수 있다. 따라서 안와염증 및 포도막염이 동반된 환자의 경우, 급성망막괴사의 가능성을 생각하고 주변부 망막검사를 철저히 하는 것이 필요하다.

영어초록

Purpose: To describe a case of acute retinal necrosis with clinical features of orbital inflammation.
Case summary: A 33-year-old female presented with right eye injection, chemosis, and pain. At the first visit, the uncorrected visual acuity and intraocular pressure of her right eye were 20/20 and 20 mmHg, respectively. Slit-lamp examination showed inflammatory cell 2+ in the anterior chamber of the right eye; an evaluation of the peripheral retina was not conducted. The next day, computed tomography (CT) was performed due to aggravation of the orbital inflammation. High-dose intravenous methylprednisolone injection was initiated on the finding of posterior scleritis with orbital inflammation on CT scans; peripheral retinal necrosis and obstructive vasculitis were also noted. Clinically determined to be acute retinal necrosis, the patient began systemic antiviral therapy. A diagnostic anterior chamber paracentesis was positive for herpes simplex virus type 2 by polymerase chain reaction. The patient was treated with intravenous acyclovir and intravitreal injections of foscarnet, as well as barrier laser therapy. After two weeks of treatment, the patient was discharged with oral valacyclovir. During the three months of follow-up, the visual acuity of the right eye was hand motion, due to chronic optic disc swelling with chronic macular edema and macular degeneration. Neither eye showed retinal lesion progression.
Conclusions: Rarely, acute retinal necrosis is accompanied by clinical manifestations of orbital inflammation. Therefore, if patients have uveitis with orbital inflammation, it is important to consider the possibility of acute retinal necrosis and to examine the peripheral retina carefully.

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