자발적 맥락막상강출혈에 의한 급성폐쇄각녹내장 1예
A Case of Acute Angle-closure Glaucoma Secondary to Spontaneous Suprachoroidal Hemorrhage
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목적: 당뇨신장병증으로 헤파린을 투여하며 투석하는 환자에서 맥락막상강출혈에 의한 급성폐쇄각녹내장을 경험하여 이를 보고하고자 한다. 증례요약: 71세 남자 환자로 당뇨에 의한 만성신장병증으로 헤파린을 투여하며 투석하고 있는 상태로 내원 3일 전부터 발생한 우안시력저하, 통증을 주소로 내원하였다. 내원 당시 우안 최대교정시력 안전수동, 좌안 최대교정 시력 0.2로 측정되었고 우안 안압 58 mmHg, 좌안 안압 15 mmHg로 측정되었다. 우안의 전방각경 검사상 폐쇄각 소견이 관찰되었고, 안저 검사상 거대한 출혈성 망막박리를 보였으며, 안초음파 검사상 맥락막상강출혈을 동반한 망막박리소견을 보였다. 우안에 방수생성억제제 및 조절마비제를 점안하기 시작하였고 경과 관찰 2주째, 우안 최대교정시력 안전수동, 안압 8 mmHg로 측정되었으며 전방각경 검사상 개방각 소견을 보였다. 2개월간의 경과 관찰 기간 동안 우안 시력 회복은 보이지 않았으나, 안압 상승 소견이나 이와 관련한 통증 등의 증상은 보이지 않았다. 결론: 항응고제를 복용하지 않지만 헤파린을 이용하여 투석하는 환자에게서 자발적 맥락막상강출혈이 발생할 수 있으며, 이로 인해 이차적으로 급성폐쇄각녹내장이 동반될 수 있다. 방수생성억제제 및 조절마비제 점안 치료를 통해 자연스러운 맥락막상강출혈의 감소, 폐쇄각의 소실, 이로 인한 안압 감소를 기대할 수 있다.
Abstract
Purpose: To report a case of acute angle-closure glaucoma secondary to spontaneous suprachoroidal hemorrhage in a hemodialysis patient. Case summary: A 71-year-old man visited our clinic after 3 days of vision loss and ocular pain in the right eye. He had been treated with hemodialysis using heparin due to diabetic nephropathy. Visual acuity (VA) was hand motion in the right eye and 0.2 in the left eye. The intraocular pressure (IOP) was 58 mmHg in the right eye and 15 mmHg in the left eye. Gonioscopic examination revealed a closed angle in the right eye. Fundus examination of the right eye showed a massive hemorrhagic retinal detachment and ultrasound sonography revealed a dome-shaped retinal detachment with suprachoroidal hemorrhage in the right eye. The patient was treated with topical aqueous suppressants and cycloplegics. After two weeks of medical treatment, VA in the right eye was still hand motion and IOP was 8 mmHg. Gonioscopic examination showed a wide-open angle in the right eye. During the two-month observation period, VA in the right eye did not recover, however there was no sign of IOP elevation or symptoms of ocular pain. Conclusions: Spontaneous suprachoroidal hemorrhage can occur in patients who receive hemodialysis with heparin. This spontaneous suprachoroidal hemorrhage can be subsequently accompanied by acute angle-closure glaucoma. Spontaneous decrease of suprachoroidal hemorrhage, loss of angle-closure, and decline of IOP can be expected by treating with topical aqueous suppressants and cycloplegics.
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