당뇨망막병증 수술 중 과도한 레이저술 후 발생한 장액망막박리에서 전신 스테로이드 치료 2예
Systemic Steroid Therapy for Serous Retinal Detachment Caused by Excessive Endolaser during Diabetic Retinopathy Surgery
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목적: 당뇨병성 유리체출혈 환자에서 수술 중 과도한 안내레이저술 후 발생한 황반부 장액망막박리를 경험하였고, 전신 스테로이드치료로 호전을 보였기에 이를 보고하고자 한다. 증례요약: 당뇨병성 유리체출혈로 유리체절제술 및 안내레이저술(증례1 3,184회, 증례2 1,734회)을 시행 받은 64세 남자 환자(증례1)와 67세 여자 환자(증례2)가 수술 후 시력저하를 주소로 내원하였다. 당시 증례1의 교정시력은 안전수동, 증례2의 교정시력은 0.03이었으며, 안저검사 및 빛간섭단층촬영에서 후극부의 광범위한 망막하액이 관찰되었다. 수술 시 시행한 과도한 안내레이저술로 인한 황반부장액망막박리로 판단하여 증례1에서는 경구 스테로이드(40 mg/qd, 5 days) 투여 후 감량하였고, 증례2에서는 정맥내 고용량 스테로이드 요법(250 mg/qid, 3 days)을 시행하였다. 치료 후 교정시력은 증례1은 20/30, 증례2는 20/40으로 호전되었으며, 빛간섭단층촬영에서 망막하액은 모두 소실되었다. 결론: 당뇨망막병증 수술 중 과도한 안내레이저술은 황반부 장액망막박리를 유발하여 당뇨환자에게서 전신 스테로이드 치료가 필요할 수 있으므로 이를 유의하여야 한다.
Abstract
Purpose: To report cases of macular serous retinal detachment caused by excessive intraoperative endolaser in patients with diabetic vitreous hemorrhage. Macular serous retinal detachment was improved by systemic steroid therapy. Case summary: A 64-year-old male (case 1) and a 67-year-old female (case 2) treated with vitrectomy and endolaser (case 1, 3,184 shots; case 2, 1,734 shots) because of diabetic vitreous hemorrhage visited our out-patient clinic with blurred vision. Best corrected visual acuity (BCVA) in case 1 was hand motion and 0.03 in case 2. Fundus examination and optical coherence tomography (OCT) revealed extensive subretinal fluid accumulation of the posterior pole. With the diagnosis of macular serous retinal detachment caused by excessive intraoperative endoaser, oral steroid (40 mg/qd, 5 days) was administered and then later reduced in case 1. In case 2, we administered intravenous high-dose steroid (250 mg/qid, 3 days). After systemic steroid therapy, BCVA was improved to 20/30 in case 1 and 20/40 in case 2 and OCT showed the subretinal fluid was resolved. Conclusions: During diabetic retinopathy surgery, excessive endolaser induced macular serous retinal detachment and systemic steroid therapy was necessary in diabetic patients. Thus, physicians should be well acquainted with this complication.
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