나이관련황반변성에서 광역학 치료 후 레이저 조사 부위에 발생한 다량의 망막하액 합병증 2예
Two Cases of Massive Subretinal Fluid Accumulation after Photodynamic Therapy for Age-related Macular Degeneration
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목적: 나이관련황반변성에서 광역학 치료 후 레이저 조사 부위와 일치하여 다량의 망막하액이 발생한 2예를 경험하여 보고하고자한다. 증례요약: (증례1) 양안 결절성 맥락막혈관병증 환자를 절반 용량 광역학 치료로 치료를 하였다. 광역학 치료 다음 날 환자는 양안의시력저하를 호소하였고, 안저검사상 양안 모두 레이저 조사 부위에 대량의 망막하액이 발생하였다. 추가 치료 없이 망막하액은 재흡수되었고 시력은 회복되었다. (증례2) 우안의 신생혈관막과 망막하액이 동반된 나이관련황반변성 환자를 절반 용량 광역학 치료로치료를 하였다. 다음 날 환자는 우안 시력저하를 호소하였고, 안저검사상 우안의 망막하액이 치료 전에 비해 5배 이상 증가하였다. 일주일 후 시력의 호전이 있었으며, 망막하액은 감소되었으나 삼출액이 남아있었다. 추가적인 유리체강 내 베바시주맙 치료를 통해삼출액 흡수되었으며, 안정적인 안저 소견을 보였다. 결론: 나이관련황반변성에서 광역학 치료를 시행하는 경우, 드문 합병증으로 다량의 망막하액이 발생할 수 있다. 망막하액은 자연적으로 흡수되었으나, 광역학 치료 후 시력저하가 발생 시 망막하액 발생 가능성을 염두에 두고 면밀한 관찰이 필요하다.
Abstract
Purpose: To report two cases of massive subretinal fluid accumulation at laser irradiated sites after photodynamic therapy in patients with age-related macular degeneration (ARMD). Case summary: (Case 1) A patient with bilateral polypoidal choroidal vasculopathy, who was treated with half-dose verteporfin photodynamic therapy (PDT), developed decreased visual acuity. On fundus examination, massive subretinal fluid accumulation was observed in the laser irradiated sites of both eyes. The subretinal fluid was reabsorbed without further treatment, and the patient's visual acuity has recovered. (Case 2) A patient with ARMD, accompanied by a choroidal neovascular membrane and accumulation of subretinal fluid in the right eye, developed decreased visual acuity on the treated eye a day after receiving half-dose PDT treatment. On fundus examination, the subretinal fluid in the right eye had increased more than 5-fold compared to pre-treatment levels. After one week, the amount of subretinal fluid decreased and the patient's visual acuity improved. However, since retinal exudate still remained, intravitreal bevacizumab treatment was administered. Thereafter, the patient’s fundus findings were unremarkable. Conclusions: In the case of photodynamic therapy for ARMD, a large amount of subretinal fluid may occur as a rare complication. The subretinal fluid was naturally absorbed, but close observation is needed with the possibility of developing subretinal fluid in the event of decreased vision after photodynamic therapy.
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