망막전막환자에서 혈관주위 내망막층 결손과 동반된 비녹내장망막신경섬유층 결손
Non-glaucomatous Retinal Nerve Fiber Layer Defect Associated with Paravascular Inner Retinal Defect
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목적: 특발망막전막환자에서 혈관주위 내망막층 결손과 동반되어 생긴 비녹내장망막신경섬유층 손상 증례를 문헌 고찰과 함께 보고하고자 한다. 증례요약: 만 70세 남자 환자가 개인 안과에서 우안 망막전막 및 좌안 거짓비늘녹내장을 진단받고 의뢰되었다. 비접촉안압계로 측정한 안압은 양안 14 mmHg였으며, 우안의 시신경유두에서는 녹내장성 손상이 보이지 않았고 우안의 표준자동시야검사에서도 녹내장성 시야결손은 발견되지 않았다. 망막신경섬유층 촬영과 파장가변 빛간섭단층촬영에서 혈관주위 내망막층 결손과 이로부터 시작하는 망막신경섬유층 결손이 관찰되었다. 저자들은 그를 우안의 비녹내장망막신경섬유층 결손으로 진단하고 우안의 녹내장 안약을 중단할 것을 권하였다. 안약 중단 2년 후까지 망막신경섬유층 결손은 진행하지 않았으며, 녹내장성 시야결손도 발생하지 않았다. 결론: 특발망막전막환자에서 혈관주위 내망막층 결손과 동반하여 비녹내장망막신경섬유층 결손이 발생할 수 있다. 망막전막과 망막신경섬유층 결손이 동반된 환자의 경우, 비녹내장성 손상일 가능성을 염두에 두고 시신경유두에 대한 평가뿐만 아니라 혈관주위 내망막층 결손에 대한 검사도 시행하는 것이 필요하다.
Abstract
Purpose: To report a case of non-glaucomatous retinal nerve fiber layer (RNFL) defect associated with paravascular inner retinal defect (PIRD) in a patient with idiopathic epiretinal membrane (ERM). Case summary: A 70-year-old male who was diagnosed with ERM in his right eye and pseudoexfoliative glaucoma in his left eye visited our clinic. His intraocular pressure was 14 mmHg in both eyes while using topical hypotensive medications in both eyes. His right eye showed no glaucomatous change of the optic disc head, and also no glaucomatous visual field defect on standard automated perimetry. Red-free fundus photography and swept-source optical coherence tomography showed an ERM and wedge-shaped RNFL defect starting from the PIRD, not the optic disc head. He was diagnosed with non-glaucomatous RNFL defect in the right eye and was told to stop using topical hypotensive medication for the right eye. After 2 years of discontinuing the medication, the IOP was within the normal range, the RNFL defect showed no progression, and the visual field remained stationary. Conclusions: A non-glaucomatous RNFL defect can develop in association with PIRD in patients with idiopathic ERM. Examinations for PIRD as well as evaluation of the optic disc head are therefore necessary in patients with ERM and RNFL defect.
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