급성대상잠재성외망막병증의 임상양상
Clinical Characteristics of Acute Zonal Occult Outer Retinopathy
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목적: 급성대상잠재성외망막병증의 임상양상을 보고하고자 한다. 대상과 방법: 2003년 5월부터 2015년 5월까지 분당서울대학교병원에서 급성대상잠재성외망막병증으로 진단된 13명의 의무기록을 후향적으로 분석해 임상양상을 살펴보았다. 결과: 초진 시 평균 연령은 28.5세이고, 여성이 11명(84.6%)이었다. 초진 시 4명이 양안이었고, 경과 관찰 중 7명에서 양안이 침범되었다. 추적관찰 기간은 평균 42.8 ± 30.3개월이었고, 증상 발생 후 진단까지 평균 62.1 ± 93.1주가 소요되었다. 시야결손, 광시증 등이 흔한 주소였고, 병변안의 평균 최대교정시력(logarithm of the minimum angle of resolution, logMAR)은 0.28 ± 0.56이었으며, 최대교정시력이 0.5 이상인 경우가 85.0%였다. 구면대응치는 평균 -4.59 ± 3.23디옵터(diopter, D)이고 75.0%에서 -2.00D 이상의 근시가 있었다. 초진 시 6명 8안(30.8%), 경과 관찰 중 7명 9안(34.6%)에서 안저 이상을 보였다. 13명 모두 망막전위도검사와 시야검사에서 이상이 나타났다. 13명 20안에서 시야결손이 발생했고 10안(50.0%)에서 호전, 4안(20.0%)에서 악화, 6안(30.0%)은 비슷하게 유지되었다. 상기도감염 증상(4명, 30.8%), 피로감(4명, 30.8%), 구역감(2명, 15.4%), 두통(2명, 15.4%) 등이 동반되었다. 결론: 근시안의 젊은 여성이 갑자기 시야결손과 광시증을 호소할 경우 급성대상잠재성외망막병증을 의심하고 망막전위도와 시야검사를 시행해야 한다. 대부분 중심시력은 양호하며, 일부에서 시야장애는 호전된다.
Abstract
Purpose: To investigate the clinical characteristics of patients with acute zonal occult outer retinopathy (AZOOR). Methods: Medical records of 13 patients who visited Seoul National University Bundang Hospital from May, 2003 to May, 2015 and diagnosed with AZOOR were retrospectively reviewed. Results: Thirteen patients (11 women and 2 men), with a mean age of 28.5 ± 11.4 years were followed for 42.8 ± 30.3 months. Visual field loss, photopsia, and blurred vision were common complaints. Initially, four patients had bilateral disease and seven patients showed bilateral involvement at the last visit. Mean best corrected visual acuity of involved eyes (BCVA) was 0.75 ± 0.32 (log MAR). Among 20 eyes with AZOOR, BCVA was 20/40 or better in 17 eyes (85.0%). The mean spherical equivalent was -4.59 ± 3.23 diopters (D), and 15 eyes (75.0%) had myopia less than -2.00 D. Nine eyes of seven patients (34.6%) had abnormal fundus findings. All patients underwent full field electroretinogram (ERG) or multifocal ERG and a visual field test. Thirteen patients (100.0%) showed a decreased response in ERG and visual field defects presented in every patient. With respect to the visual field test, 10 eyes (50.0%) showed improvement, 6 eyes (30.0%) had stationary status, and the progression of the visual field defect was observed in 4 eyes (20.0%). Among 13 patients, 4 (30.8%) patients showed flu-like symptom, 4 (30.8%) patients had fatigue, 2 (15.4%) patients had nausea, and 2 (15.4%) patients showed headache. Conclusions: AZOOR should be considered as one of the differential diagnoses, especially in female patients with myopia who show photopsia or visual field defects. ERG and visual field tests are necessary to confirm a decrease in retinal function and visual field loss. Central vision is preserved in most cases and recovery of visual field defect occurs often.
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