눈 매독에 동반된 견인 망막박리 1예
A Case of Traction Retinal Detachment Accompanied by Ocular Syphilis
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목적: 국내에 보고된 적 없는 눈 매독에 동반된 견인 망막박리 1예를 경험하여 보고하고자 한다. 증례요약: 20세 남자 환자가 좌안 시력저하를 주소로 내원하였다. 최대교정시력은 0.3이었고 전방 내 염증 소견은 없었으나 유리체내염증세포가 다수 확인되었다. 안저검사상 삼출성 망막박리가 아래쪽에서 발견되었고 빛간섭단층촬영에서 황반부 망막앞막이 확인되었다. 플루레신조영촬영에서는 망막박리 부위에 초기와 후기 모두 저형광 소견을 보였다. 혈청검사상 매독이 확인되어 ceftriaxone 2 g 정맥내 주사를 14일간 시행하였다. 이후 유리체내 염증은 호전되었으나 견인 막이 증식하면서 견인 망막박리가 나타나 유리체절제술, 견인 막 제거술, 유리체강 내 항생제주입술을 시행하였다. 이후 14일 동안 penicillin G 20 MU정맥 내 주사 후 퇴원하였다. 유리체절제술 3달 후 외래 내원 시 최대교정시력은 0.8로 호전되었고 견인 망막박리의 재발은 관찰되지 않았다. 결론: 눈 매독 환자에서 전신 항생제 치료에도 불구하고 망막박리가 생길 수 있다. 수술적 치료의 가능성을 염두에 두어야 하며 적절한 시기에 유리체절제술을 시행하여 좋은 결과를 얻을 수 있다.
Abstract
Purpose: We report a first case of traction retinal detachment accompanied by ocular syphilis in Korea. Case summary: A 20-year-old male visited with poor left-eye vision. His best-corrected visual acuity was 0.3; no inflammation was evident in the anterior chamber, but many inflammatory cells were found in the vitreous cavity. Fundus examination revealed inferior exudative and tractional retinal detachment. Optical coherence tomography revealed an epiretinal membrane; fluorescein angiography showed that the inferior (detached) retina did not fluoresce. Syphilis was serologically detected; ceftriaxone (2 g daily) was intravenously injected for 14 days. The vitreous cavity inflammation improved, but the tractional membrane proliferation triggered tractional retinal detachment. We performed vitrectomy to remove the tractional membrane and prescribed intravitreal antibiotics. The patient was discharged after intravenous injection of penicillin G (20 MU daily) for 14 days. Three months after surgery, the best-corrected left-eye visual acuity had improved to 0.8, and no recurrence of the retinal detachment was noted. Conclusions: Patients with ocular syphilis may evidence retinal detachment despite initial prescription of systemic antibiotics. A possible need for surgery should be kept in mind; the prognosis is good if an operation is performed in a timely manner.
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