한국 성인의 시신경염
Optic Neuritis of Korean Adult
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목적: 한국 성인의 시신경염 임상양상과 특성을 Optic Neuritis Treatment Trial (ONTT) 연구와 비교하여 밝히고자 하였다. 대상과 방법: 2006년부터 2015년까지 단안 시신경염으로 진단된 18세에서 46세 사이의 환자를 대상으로 의무기록을 후향적으로 검토하였다. 포함기준은 ONTT와 같이 단안에서 급성 또는 아급성의 시력저하와 상대구심동공운동장애 양성이면서, 증상 발생 8일 이내에 내원하여 자동시야검사에서 시야결손을 보이는 환자를 대상으로 하였다. 결과: 총 41명이 포함되었고, 평균 연령은 32.7세, 남자의 비율이 65.9%였다. 시신경유두부종이 있었던 환자의 비율은 58.5%로 ONTT 의 보고보다 높았고(p=0.004), 안구운동 시 통증이 있었던 환자는 75.6%로 ONTT 보고보다 낮았다(p=0.002). 고용량 정맥 스테로이드 치료 6개월 후 최종적으로 1.0 이상의 시력을 보인 환자는 90.6%였고, 0.5 이하의 나쁜 시력을 보인 환자는 3.1%였다. 34명에서 안와 자기공명영상을 촬영하였고 91.2%에서 시신경의 조영 증강을 보였다. 조영 증강이 되지 않은 3명은 모두 통증을 호소하지 않았다. 결론: 한국 성인의 시신경염은 ONTT 연구와 임상양상이 다르다. 시신경염은 대부분 자기공명영상에서 시신경의 조영 증강을 보이므로 조영 증강이 없으면 다른 질환을 의심해 볼 필요가 있다.
Abstract
Purpose: The aim of the study was to describe the clinical features and characteristics of optic neuritis patients compared with those of patients enrolled in the Optic Neuritis Treatment Trial (ONTT). Methods: We retrospectively included consecutive patients diagnosed with optic neuritis between 2006 and 2015. The inclusion criteria were the same as those of the ONTT; an acute or subacute unilateral visual symptom ≤8 days in duration, a relative afferent pupillary defect, and a visual field defect in the affected eye. Results: The 41 patients (14 females, 27 males) were of mean age 32.7 years. The incidence of papilledema was 58.5%, thus higher than that of ONTT patients (p = 0.004), and the incidence of ocular pain was 75.6%, lower than that of ONTT patients (p = 0.002). Six months after intravenous methylprednisolone therapy, 29 of 32 eyes (90.6%) recovered visual acuity of ≥1.0 or better, and only one eye exhibited poor visual acuity (≤0.5). Orbital magnetic resonance imaging (MRI) was performed on 34 patients, and most (91.2%) exhibited optic nerve enhancement. The three patients who did not exhibit enhancement reported no pain. Conclusions: The clinical features of Korean optic neuritis patients differed from those of patients of the ONTT. Most patients exhibited optic nerve MRI enhancement associated with ocular pain. If enhancement of the optic nerve is lacking, diseases other than optic neuritis should be suspected because most optic nerves with neuritis exhibit enhancement on MRI.
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