맥락막비후가 있는 녹내장 안에서 아메드밸브삽입술 후 발생한 황반부 장액망막박리 증례
A Case of Macular Serous Retinal Detachment after Ahmed Valve Implantation in an Eye with Pachychoroid
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목적: 맥락막비후가 있는 환자에서 아메드밸브삽입술 후 발생한 저안압과 관련된 황반부 장액망막박리를 보고하고자 한다. 증례요약: 77세 남자 환자가 좌안의 조절되지 않는 안압을 주소로 방문하였다. 좌안 안압은 최대약물치료에도 불구하고 32 mmHg였고, 전방을 가득 채운 유리체가 발견되었다. 파장가변 빛간섭단층촬영검사에서 맥락막두께는 약 510 μm로 측정되어 맥락막비후가관찰되었다. 전방 내 유리체를 제거하기 위해 유리체절제술을 시행하였고, 술 후 3주에 안압은 32 mmHg였다. 좌안에 아메드밸브삽입술을 시행하였고, 술 후 10일째 저안압이 발생하였다. 맥락막박리와 함께 빛간섭단층촬영검사에서 황반부 장액망막박리가 관찰되었다. 중심소와 아래 맥락막두께는 빛간섭단층촬영검사의 측정 범위를 넘어서 증가되었다. 저안압 교정을 위해 술 후 18일째 튜브 부분결찰술을 시행하였다. 술 후 6주에 안압은 14 mmHg로 상승하였고, 장액망막박리는 사라졌고, 맥락막두께는 술 전 수치로 감소하였다. 결론: 맥락막비후가 있는 환자에게서 아메드밸브삽입술 후 저안압이 발생하면 맥락막비후가 악화되며, 황반부 장액망막박리의 형태로저안압 황반병증이 발생할 수 있다.
Abstract
Purpose: We report a case of macular, serous retinal detachment associated with hypotony in a patient with pachychoroid disease developing after Ahmed valve implantation. Case summary: A 77-year-old male visited our clinic with uncontrolled intraocular pressure (IOP; 32 mmHg) in his left eye despite maximal tolerable medical therapy. A prolapsed vitreous filled the anterior chamber. Swept-source optical coherence tomography (SS-OCT) revealed that the subfoveal choroidal thickness was about 510 μm, indicating pachychoroid. Vitrectomy was performed to remove the prolapsed vitreous. The IOP remained 32 mmHg 3 weeks after vitrectomy. Ahmed valve implantation was performed and hypotony developed 10 days postoperatively. Choroidal detachment was apparent and SS-OCT revealed macular accumulation of subretinal fluid. The subfoveal choroidal thickness increased to a level beyond the SS-OCT measurement range. Partial tube ligation was performed to treat the hypotony 18 days after Ahmed valve implantation; the IOP decreased to 14 mmHg at 6 weeks postoperatively. The macular, serous retinal detachment disappeared and the subfoveal choroidal thickness fell to the preoperative value. Conclusions: Hypotony after Ahmed valve implantation can manifest as serous retinal detachment under the fovea accompanied by an increase in choroidal thickness in an eye with underlying pachychoroid.
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