유리체강 내 브롤루시주맙 주입술 후 발생한 폐쇄성 망막혈관염
Retinal Occlusive Vasculitis after Intravitreal Injection of Brolucizumab
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목적: 유리체강 내 브롤루시주맙 주입술 후 발생한 폐쇄성 망막혈관염 2예를 경험하였기에 이를 보고하고자 한다. 증례요약: 2명의 환자가 습성 나이관련황반변성으로 유리체강 내 브롤루시주맙 주입술 1달 후 시력저하가 있었다. 증례1의 85세 남성은 좌안 스넬렌시력 0.2에서 안전수동으로 저하되었고, 증례2의 70세 여성은 우안 시력 0.4에서 안전수지 50 cm로 저하되었다. 두환자 모두 내원 당시 전방 내 염증세포가 관찰되었고 형광안저촬영에서 망막동맥의 충만시간이 지연되어, 폐쇄성 망막혈관염 진단하에 스테로이드 점안 및 정맥 주사 치료를 시행하였다. 증례1의 경우 인공수정체 후방의 염증막에 대한 유리체절제술을 추가로 시행하였다. 두 증례 모두 적극적인 치료에도 시력은 호전되지 않았다. 결론: 유리체강 내 브롤루시주맙 주입술 후 안구 내 염증으로 인한 폐쇄성 망막혈관염이 발생할 수 있으며 적극적인 치료에도 시력장애를 초래할 수 있기 때문에 주의를 요한다.
Abstract
Purpose: To report two instances of retinal arterial occlusive vasculitis following intravitreal injection of brolucizumab. Case summary: Two patients noted decreased visual acuity approximately one month after receiving intravitreal brolucizumab injections to treat wet age-related macular degeneration. In case 1, an 85-year-old male reported a reduction in visual acuity in his left eye, declining from a Snellen measurement of 0.2 to hand motion. In case 2, a 70-year-old female experienced a decline in visual acuity in her right eye from 0.4 to finger count at 50 cm. Both patients presented with anterior chamber reactions, and fluorescein angiography demonstrated delayed retinal artery filling time, leading to the diagnosis of retinal occlusive vasculitis. They were treated with both topical and systemic corticosteroids. For case 1, a subsequent vitrectomy was performed to remove the inflammatory membrane located behind the intraocular lens. However, despite aggressive interventions, neither patient showed visual improvement. Conclusions: Retinal occlusive vasculitis, which can result from intraocular inflammation, may occur after intravitreal brolucizumab injection. This condition can lead to significant visual impairment even with aggressive treatment.
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