녹내장섬모체염발증으로 오인된 접촉성 폐쇄각녹내장에서 발생한 비동맥염 앞허혈시신경병증
Nonarteritic Anterior Ischemic Optic Neuropathy Accompanying Appositional Angle-closure Glaucoma Mimicking Glaucomatocyclitic Crisis
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목적: 녹내장섬모체염발증으로 오인된 고도원시를 동반한 폐쇄각녹내장 환자에서 발생한 비동맥염 앞허혈시신경병증 1예를 보고하고자 한다. 증례요약: 57세 남자 환자가 3일 전부터 발생한 두통, 우안의 통증 및 시력저하를 주소로 내원하였다. 과거력상 특이 소견은 없었고 우안 교정시력은 0.02, 안압은 30 mmHg, +7.25디옵터였고, 각막부종과 +1의 전방염증, 6 mm로 산동된 동공, 1/4 각막두께보다 약간 깊은 주변전방, 시신경유두부종과 하측 수평시야결손이 관찰되었다. 녹내장섬모체염발증과 비동맥염 앞허혈시신경병증으로 생각하여 안압하강제와 스테로이드 치료를 시행하였으나 안압이 조절되지 않아 우안 전방각경검사를 하였고, 360°에서 B10s의 Shaffer 분류상grade 1의 접촉성 폐쇄가 관찰되어 레이저홍채절개술을 하였다. 안압상승과 통증, 두통은 사라졌으며 초진 1개월 후 시신경유두부종은 호전되었고, 0.4의 시신경유두함몰비가 관찰되었다. 3개월 후에도 우안 시력은 호전되지 않았다. 결론: 전신위험인자 혹은 작은 유두함몰비가 없는 경우에도 고도원시 환자에서 접촉성 폐쇄각녹내장을 동반한 비동맥염 앞허혈시신경병증이 발생할 수 있음을 염두에 두어야 하겠다.
Abstract
Purpose: We report a case of nonarteritic anterior ischemic optic neuropathy (NAION) in a high hyperopia and appositional angle closure glaucoma (AACG) patient mimicking glaucomatocyclitic crisis. Case summary: A 57-year-old man presented with headache, ocular pain, and visual disturbance in the right eye for 3 days. There was no past medical history. The best corrected visual acuity was 0.02 and the intraocular pressure (IOP) was 30 mmHg in the right eye. Refractive errors were +7.25 diopters in the right eye. Slit-lamp examination revealed corneal edema, anterior chamber (AC) inflammation (+1), 6 mm-dilated fixed pupil, and >1/4 peripheral AC depth in the right eye. Fundus examination revealed optic disc swelling, and visual fields test demonstrated inferior altitudinal field defects in the right eye. Glaucomatocyclitic crisis and NAION in the right eye were diagnosed. Topical anti-glaucoma eyedrops and intravenous steroid were administered. IOP was not controlled and then, gonioscopy revealed a grade 1 360° B10s appositional angle closure on Shaffer classification in the right eye. Laser iridotomy was performed. IOP increasement, ocular pain of the right eye, and headache disappeared. After 1 month later, fundus examination revealed an improved optic disc swelling and 0.4 cup-to-disc ratio in the right eye. The visual acuity in the right eye didn’t improve after 3 months. Conclusions: NAION may occur in AACG patient with high hyperopia even if there is no underlying systmemic disease or small cup-to-disc ratio.
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