특발혈소판감소자반증 환자에서 발생한 나쁜 예후의 망막병증
Poor Prognosis in Idiopathic Thrombocytopenic Purpura-associated Retinopathy
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목적: 만성 저항성 특발혈소판감소자반증 환자에서 발생한 나쁜 예후의 망막병증을 경험하였기에 이를 보고하고자 한다. 증례요약: 53세의 여자 환자가 시력저하를 주소로 내원하였다. 시력은 양안 각각 0.63으로 측정되었다. 환자는 만성 특발혈소판감소자반증으로 비장절제술과 전신치료를 받고 있었으며, 당뇨, 고혈압의 병력이 있었다. 안저검사에서 다발성의 망막 및 망막하출혈과 Roth 반점이 관찰되었고, 형광안저혈관조영술에서 망막 4 사분면의 미세동맥류와 출혈이 있었다. 혈액학적 검사에서 혈소판수치가 38,000/μL로 확인되었다. 환자는 비증식 당뇨망막병증, 특발혈소판감소자반증과 관련된 망막병증으로 진단받고 범망막레이저광응고술을 시행받았다. 치료 4개월째 갑작스러운 시력저하로 내원하였다. 시력은 양안 각각 0.1로 측정되었고 혈소판수치는 7,000/μL로 확인되었다. 2년간의 경과관찰 중 적극적인 내과적 치료에도 혈소판수치는 12,000-19,000/μL로 조절되지 않았다. 유리체강내 트리암시놀론, 덱사메타손, 베바시주맙 주사에도 망막 부종이 지속되고 출혈이 흡수되지 않아 치료 2년 이후 우안 시력 광각인지, 좌안 시력안전수지로 악화되었다. 결론: 특발혈소판감소자반증과 관련된 망막병증에서 전신질환이 조절되지 않은 경우 나쁜 예후를 보였다.
Abstract
Purpose: To report a case of retinopathy in a patient with chronically resistant idiopathic thrombocytopenic purpura (ITP) associated with a poor prognosis. Case summary: A 52-year-old female presented with a complaint of decreased visual acuity, which was 0.63 in both eyes. The patient had received a splenectomy, was receiving systemic treatment for chronic ITP, and had a history of diabetes mellitus and hypertension. Multiple retinal and subretinal hemorrhages and Roth spots were found on fundus examination. Fluorescein angiography revealed microaneurysms and hemorrhages in all four quadrants of the retina. The patient’s platelet count was 38,000/μL. The patient was diagnosed with non-proliferative diabetic retinopathy and ITP-associated retinopathy, and underwent panretinal photocoagulation. Sudden visual loss was noted 4 months later, at which time the patient’s visual acuity was 0.1 in both eyes, and her platelet count was 7,000/μL. For 2 years, the patient’s platelet count was not controlled, and remained between 12,000–19,000/μL despite active medical treatment. Macular edema did not improve with intravitreal triamcinolone, dexamethasone, and bevacizumab. Retinal hemorrhages were not absorbed and visual acuity decreased to light perception in the right eye and counting fingers in the left eye. Conclusions: ITP-associated retinopathy was associated with a poor prognosis when the systemic disease was not controlled.
참고문헌 (17)
- Sodhi PK, "Subconjunctival hemorrhage: the first presenting clinical feature of idiopathic thrombocytopenic purpura", Jpn J Ophthalmol, 47, pp.316~318 (2003)[DOI]
- Goel N, "Massive subretinal and vitreous hemorrhages at presentation in idiopathic thrombocytopenic purpura: report of a case and review of literature", Clin Exp Optom, 97, pp.270~273 (2014)[DOI]
- Gruson B, "Immune Thrombocytopenia;The Autoimmune Diseases, 5th ed." (2013), Elsevier Academic Press
- Rubenstein RA, "Thrombocytopenia, anemia and retinal hemorrhage", Am J Ophthalmol, 65, pp.435~439 (1968)[DOI]
- Meyer CH, "Complete resorption of retinal hemorrhages in idiopathic thrombocytopenic purpura", Eur J Ophthalmol, 17, pp.128~129 (2007)[DOI]
- Okuda A, "Massive bilateral vitreoretinal hemorrhage in patient with chronic refractory idiopathic thrombocytopenic purpura", Graefes Arch Clin Exp Ophthalmol, 243, pp.1190~1193 (2005)[DOI]
- Majji AB, "Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura", Indian J Ophthalmol, 58, pp.234~236 (2010)[DOI]
- Ling R, "White-centred retinal haemorrhages (Roth spots)", Postgrad Med J, 74, pp.581~582 (1998)[DOI]
- Ciardella AP, "Intravitreal triamcinolone for the treatment of refractory diabetic macular oedema with hard exudates: an optical coherence tomography study", Br J Ophthalmol, 88, pp.1131~1136 (2004)[DOI]
- Larsson J, "Rapid reduction of hard exudates in eyes with diabetic retinopathy after intravitreal triamcinolone: data from a randomized, placebo-controlled, clinical trial", Acta Ophthalmol, 87, pp.275~280 (2009)[DOI]
- Cakir M, "Optical coherence tomography evaluation of macular edema after intravitreal triamcinolone acetonide in patients with parafoveal telangiectasis", Eur J Ophthalmol, 16, pp.711~717 (2006)[DOI]
- Jarin RR, "Resolution of severe macular oedema in adult Coat’s syndrome with high-dose intravitreal triamcinolone acetonide", Eye (Lond), 20, pp.163~165 (2006)[DOI]
- Kocak N, "Combination of photodynamic therapy, intravitreal triamcinolone injection, and standard laser photocoagulation in radiation retinopathy: a case report", Ann Ophthalmol (Skokie), 38, pp.243~247 (2006)[DOI]
- Saatci AO, "Intravitreal dexamethasone implant (ozurdex) in coats' disease", Case Rep Ophthalmol, 4, pp.122~128 (2013)[DOI]
- Mehta H, "Efficacy of dexamethasone versus bevacizumab on regression of hard exudates in diabetic maculopathy: data from the BEVORDEX randomized clinical trial", Br J Ophthalmol, 100, pp.1000~1004 (2016)[DOI]
- Stringa F, "Long-term follow-up of anatomical and functional macular changes after a single intravitreal implant of dexamethasone 0.7 mg for radiation macular edema secondary to proton beam therapy for choroidal melanoma", Int Med Case Rep J, 9, pp.377~383 (2016)[DOI]
- Dior M, "A rare hematological adverse event induced by bevacizumab: severe thrombocytopenia", Am J Med, 125, pp.828~830 (2012)[DOI]