중심망막정맥폐쇄 환자에서 유리체강내 트리암시놀론 주입술 후 발생한 황반허혈 1예
Macular Infarction Following Intravitreal Triamcinolone Injection for Treatment of Central Retinal Vein Occlusion
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목적: 중심망막정맥폐쇄에 합병된 황반부종으로 유리체강내 트리암시놀론 주입술 후에 발생한 황반허혈을 경험하여 보고하고자 한다. 증례요약: 우안의 중심망막정맥폐쇄 및 황반허혈 진단하에 정기적인 안저검사를 시행 중이던 75세 남자가 최근 발생한 좌안의 시력저하를 주소로 내원하였다. 기저 질환으로는 당뇨병, 간경화증, 간암이 있었다. 안저검사상 좌안의 망막중심정맥폐쇄 소견 및 빛간섭단층촬영상 중등도의 황반부종이 관찰되어 유리체강내 트리암시놀론 주입술을 시행하였다. 주입술 1주일 후, 급격한 좌안 시력 저하를호소하였으며 빛간섭단층촬영상 황반부종은 호전되었으나 형광안저혈관조영에서 좌안의 황반허혈이 발생되었다. 주입술 시행 후 2달간 경과 관찰하였으며 빛간섭단층촬영상 황반 두께는 정상화되고, 형광안저혈관조영상 누출은 보이지 않았으나 여전히 시력은 호전되지 않았다. 결론: 중심망막정맥폐쇄에 의한 황반부종이 있는 환자에서 항혈관내피성장인자뿐만 아니라 유리체강내 트리암시놀론 주입술 후에도황반허혈이 발생할 수 있으므로 특히 망막에 허혈을 일으킬 수 있는 위험 요인이 있는 환자는 주의할 필요가 있다.
Abstract
Purpose: To report a case of macular infarction following intravitreal triamcinolone injection for treatment of central retinal vein occlusion. Case summary: A 75-year-old male visited our clinic for visual disturbance in his left eye and was diagnosed with macular infarction in his right eye. His medical history included type 2 diabetes, alcoholic liver cirrhosis, and hepatocellular carcinoma. After fundus examination, the patient was diagnosed with central vein occlusion with macular edema and intravitreal triamcinolone was administered to reduce edema. Within 1 week of treatment with the intravitreal injection, the patient experienced a significant decrease in visual acuity. Fluorescein angiogram showed an enlargement of the foveal avasacular zone, although optical coherence tomography (OCT) showed a decreased macular edema. Despite normalization of macular thickness on OCT and cessation of leakage on angiography, visual acuity remained at the same level during 2 months of follow-up. Conclusions: Intravitreal anti-vascular endothelial growth factor injection as well as intravitreal triamcinolone injection can cause macular ischemia which should be considered with the adopted treatment regimen for patients with ischemic risk factors.
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