유리체절제술과 내경계막제거술 후 9개월에 지연 폐쇄된 특발성 황반원공 1예
Delayed Closure of Idiopathic Macular Hole after Vitrectomy, Internal Limiting Membrane Peeling, and Gas Tamponade
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목적: 수술 후 9개월에 걸쳐 서서히 폐쇄된 특발성 전층황반원공 1예를 경험하였기에 보고하고자 한다. 증례요약: 69세 여자환자가 좌안 시력저하를 주소로 내원하였다. 최대교정시력은 좌안 20/100이었으며, 안저검사 및 빛간섭단층촬영에서 크기가 489 μm인 전층황반원공과 뒤유리체박리가 관찰되었다. 백내장수술과 함께 유리체절제술, 내경계막제거술, 가스충전술을 시행 후 1개월에 촬영한 빛간섭단층영상에서 원공이 폐쇄되지 않았으나 크기가 378 μm로 약간 작아진 상태였다. 추적관찰에서술후 2개월에는 새로운 낭포황반부종이 관찰되었으며, 2, 3, 5개월에 원공의 크기가 311 μm, 252 μm, 156 μm로 점차 줄어들었다. 술후 9개월에 원공이 폐쇄되며 황반부종도 소실되었으나 시력은 20/100으로 개선되지 않았다. 결론: 특발성 황반원공에서 수술 후 오랜시간에 걸쳐 원공이 폐쇄될 수 있으며, 낭포부종의 발생과 소실이 원공의 지연폐쇄와 관련이있는 것 같다.
Abstract
Purpose: To report a case of delayed idiopathic macular hole closure after vitrectomy, internal limiting membrane peeling, andgas tamponade. Case summary: A 69-year-old female complained of visual disturbance in her left eye. At presentation, her visual acuity was20/100 in the left eye. Fundus examination and optical coherence tomography revealed a full-thickness macular hole 489 μm indiameter as well as posterior vitreous detachment. Hence, vitrectomy, concurrent cataract surgery, internal limiting membranepeeling and gas tamponade were performed. One month postoperatively, the hole remained unclosed, although decreased insize to 378 μm. At 2 months, cystoid macular edema developed and postoperatively the hole diameter decreased gradually to311 μm, 252 μm and 156 μm at 2, 3, and 5 months, respectively. Finally, the hole was closed upon the resolution of macular edemaat 9 months. However, the visual acuity of 20/100 remained unchanged. Conclusions: Delayed closure of holes which may be related to cystoid macular edema, can develop after macular hole surgery.
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