소아에서 스테로이드 안약 및 경구약 사용 후 발생한 급격한 안압상승 2예
Two Cases of Sudden Intraocular Pressure Elevation in Children after Steroid Treatment
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목적: 소아에서 스테로이드 사용 후 발생한 급격한 안압상승 2예를 보고하고자 한다. 증례요약: (증례 1) 8세 남아가 덱사메타손 점안 3일 뒤 발생한 구토, 두통으로 내원하였다. 안압은 우안 55 mmHg, 좌안 62 mmHg였으며 전방의 특이 소견은 관찰되지 않았다. 기존 안약 중단 후 안압하강제 하루 2회 점안과 2회 만니톨 정맥 주사 후 다음 날 안압은양안 18 mmHg였다. (증례 2) 10세 남아가 3일 전 코로나바이러스-19 감염증으로 진단받고, 메틸프레드니솔론 4 mg 하루 2회를 처방받아 하루 복용한 뒤 시작된 두통, 안구통 및 시력저하를 주소로 내원하였다. 안압은 우안 41 mmHg, 좌안 54 mmHg로 측정되었으며전방의 이상 소견은 없었다. 약제 중단 후 안압하강제 점안을 시작하였으며 만니톨 정맥 주사 후 다음 날 안압은 우안 7 mmHg, 좌안16 mmHg로 낮아졌다. 좌안의 시신경섬유층 두께 및 신경절세포-내망상층 두께의 감소가 지속적으로 관찰되었다결론: 소아에서는 스테로이드 약제 사용 하루 만에도 급격한 안압상승이 발생할 수 있고, 빠른 치료를 시행하여도 구조적인 손상이남을 수 있다. 따라서 비전형적인 안압상승을 염두에 두고 주의를 기울여야 할 것이다.
Abstract
Purpose: We report two cases of sudden intraocular pressure (IOP) elevation in children after steroid treatment. Case summary: (Case 1) An 8-year-old boy visited the hospital with vomiting and headache that had begun 3 days after application of dexamethasone eyedrops. IOPs were 55 and 62 mmHg in the right and left eyes, respectively; both anterior chambers were normal. The eyedrops were stopped and timolol/dorzolamide was applied twice daily. After intravenous mannitol injection, the IOPs of both eyes decreased to 18 mmHg within 24 hours. (Case 2) A 10-year-old boy diagnosed with coronavirus disease 2019 three days prior had been prescribed methylprednisolone 4 mg twice daily; he visited the hospital with headache, eye pain, and decreased vision that began 1 day after medication. IOPs were 41 and 54 mmHg in the right and left eyes, respectively; both anterior chambers were normal. After drug discontinuation, timolol/dorzolamide, brimonidine, and latanoprost eyedrops were applied. Subsequently, after intravenous mannitol injection, the IOPs decreased within 24 hours to 7 and 16 mmHg in the right and left eyes, respectively; they remained stable. However, thinning was observed in the retinal nerve fiber and ganglion cell-inner plexiform layer. Conclusions: Children can develop rapid IOP elevation after even 1 day of steroid use; residual structural damage may be present, despite prompt treatment. Clinicians must closely monitor such patients for atypical IOP elevation.
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