시신경유두소와에 황반부 망막층간분리가 선행된 황반부 장액망막박리 1예
A Case of Serous Macular Detachment Preceding Macular Retinoschisis in an Optic Pit
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목적: 시신경유두소와에 동반된 황반부 망막층간분리가 있던 환자에서 황반부 장액망막박리가 발생하여 유리체절제술로 치료하였으나, 수술 후 황반원공이 발생하여 내경계막박리를 동반한 유리체절제술로 추가 치료한 증례를 보고하고자 한다. 증례요약: 74세 여자 환자가 우안이 흐려 보이는 증상을 주소로 내원하였다. 본원에서 시행한 안저 검사 상에서 시신경유두소와가관찰되었고, 빛간섭단층촬영상 황반부에 망막 층간 분리가 관찰되었다. 본원에서 경과관찰 중 황반부 장액망막박리 소견이 관찰되었으며, 당시 우안 나안시력은 0.05였다. 시신경유두소와에 동반된 황반부 장액망막박리로 진단하고 유리체 절제술을 시행하였다. 유리체절제술 도중 시신경유두소와를 덮고 있는 투명한 막의 결함을 발견하여 막의 결함을 통해 망막하액을 배액하였으며 액체-가스 교환술을 시행하였다. 수술 후 16일째 빛간섭단층촬영에서 망막층간분리는 부분적으로 호전되었으나, 황반원공이 발견되어 내경계막 박리를 동반한 유리체절제술을 시행하였고, 수술 뒤 1개월 후 황반박리는 관찰되지 않았으며, 6개월 후에는 최대 교정 시력이 0.63으로측정되었고 황반유착이 유지되었다. 결론: 시신경유두소와 황반병증이 고령의 환자에서도 갑자기 진행할 수 있고, 유리체절제술로 치료할 수 있으나 합병증으로 황반원공이 발행할 수 있다. 시신경유두소와 황반병증 환자에서 후유리체의 견인력과 내경계막의 역할에 대한 연구가 필요하다고 생각한다.
Abstract
Purpose: To report a case of serous macular detachment preceding macular retinoschisis in an optic pit patient successfullytreated by vitrectomy with internal limiting membrane peeling. Case summary: A 76 year old female visited our clinic for visual disturbance in her right eye. Fundus photograph revealedoptic pit and OCT showed macular retinoschisis in her right eye. She was followed up in our clinic. The patient revisited ourclinic because of sudden decrease of visual acuity in her right eye 3 days before. At that time, the patient’s best-correctedvisual acuity was 0.05. Macular retinoschisis, subretinal fluid and serous retinal detachment were observed in her right eyeon OCT. She was diagnosed with serous retinal detachment associated with optic pit and pars plana vitrectomy wasperformed. During vitrectomy, we found adhesion and defect of posterior hyaloid membrane which covered the optic pit. Therefore, subretinal fluid was drained via membrane defect and posterior vitreous detachment and fluid-gas exchangewere induced. Sixteen days after surgery, we found a macular hole in her right eye on OCT. Pars plana vitrectomy was performedwith internal limiting membrane peeling. One month after surgery, macular detachment was not observed. Sixmonths after surgery, the patient’s best corrected visual acuity was 0.63 and the macula was reattached completely. Conclusions: Optic pit maculopathy can be progressed rapidly in aged patients and macular hole would be ocurred as acomplication. Additional study will be needed to figure out the role of internal limiting membrane and tractional force of posteriorvitreous in these patients.
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