혈액 투석 환자에서 발생한 비동맥염성앞허혈시신경병증 1예
A Case of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in Patient on Hemodialysis
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목적: 혈액투석환자에서 발생한 비동맥염성 앞허혈신경병증(non-arteritic anterior ischemic optic neuropathy, NAION) 1예를 보고하고자 한다. 증례요약: 29년간 혈액투석 과거력이 있는 59세 여자 환자가 내원 3일전 투석을 하고 다음날 등산 후 좌안의 갑작스런 시력저하 및시야장애를 주소로 내원하였다. 내원 6개월 전 본원 초진할 때부터 현재까지의 검사에서 저혈압 및 빈혈을 보였으며 본원에서 5개월전 양안 백내장수술을 받은 과거력이 있었다. 내원당시 양안 교정시력은 0.7이었고 시야검사에서 좌안 상측부의 수평시야결손이 있었으며 안저검사에서 좌안 하비측 시신경부종이 관찰되었고 형광안저혈관조영에서 좌안 시신경유두의 후기 과형광을 보여 비동맥염성앞허혈시신경병증으로 진단하였다. 3주 후 경과관찰 당시 좌안 교정시력은 0.7이었고 안저검사에서 시신경유두부종은 다소 감소된소견을 보였다. 결론: 장기간 혈액투석을 할 때 발생가능한 갑작스런 혈압강하 및 빈혈을 예방하는 것이 투석환자에게 드물게 발생하는 앞허혈시신경병증의 발생가능성을 감소시킬 수 있을 것으로 생각한다.
Abstract
Purpose: To report a case of non-arteritic anterior ischemic optic neuropathy (NAION) in a patient on hemodialysis. Case summary: A 59-year-old female undergoing intravenous hemodialysis developed sudden blurred vision for 2 days. Chronic hypotension and anemia may have been persisted for approximately 6 months before the onset of symptoms. Her corrected visual acuity in both eyes was 0.7 and visual field test showed superior arcuate defect in the left eye. Fundus photography showed inferonasal optic disc swelling and fluorescein angiography revealed hyperfluorescence of the disc in the late phase which was probably attributable to NAION. After 3 weeks, corrected visual acuity was 0.7 in the left eye and fundoscopic finding of the left eye was improved. Conclusions: Hemodialysis can cause a hypotensive event and anemia which may be associated with NAION. Avoiding acute hypotension and anemia should be advised to prevent development of NAION in dialysis patients.
참고문헌 (34)
- Beri M, "Anterior ischemic optic neuropathy. VII. Incidence of bilaterality and various influencing factors", Ophthalmology, 94, pp.1020~1028 (1987)
- Hayreh SS, "Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy", Am J Ophthalmol, 118, pp.766~780 (1994)
- Doro S, "Cup-disc ratio and ischemic optic neuropathy", Arch Ophthalmol, 103, pp.1143~1144 (1985)
- Ellenberger C Jr, "Ischemic optic neuropathy as a possible early complication of vascular hypertension", Am J Ophthalmol, 88, pp.1045~1051 (1979)
- Tomsak RL, "Anterior ischemic optic neuropathy and increased intraocular pressure", J Neuroophthalmol, 9, pp.116~118 (1989)
- Jun BK, "Clinical features in anterior ischemic optic neuropathy", J Korean Ophthalmol Soc, 40, pp.3460~3467 (1999)
- Sabeel A, "The dialysed patient who turned blind during a haemodialysis session", Nephrol Dial Transplant, 13, pp.2957~2958 (1998)
- Haider S, "Optic neuropathy in uraemic patients on dialysis", Eye (Lond), 7, pp.148~151 (1993)
- Henderson LW, "Symptomatic hypotension during hemodialysis", Kidney Int, 17, pp.571~576 (1980)
- Nieto J, "Bilateral anterior ischemic optic neuropathy in patients on dialysis: A report of two cases", Indian J Nephrol, 20, pp.48~50 (2010)
- Servilla KS, "Anterior ischemic optic neuropathy as a complication of hemodialysis", Am J Kidney Dis, 8, pp.61~63 (1986)
- Hamed LM, "Optic neuropathyin uremia", Am J Ophthalmol, 108, pp.30~35 (1989)
- Connolly SE, "Salvage of vision after hypotension- induced ischemic optic neuropathy", Am J Ophthalmol, 117, pp.235~242 (1994)
- Korzets A, "Ischemic optic neuropathy in dialyzed patients: a previously unrecognized manifestation of calcific uremic arteriolopathy", Am J Kidney Dis, 44, pp.e93~e97 (2004)
- 김대현, "한국인 앞허혈시신경병증의 위험인자", 대한안과학회지, 48(11), pp.1527~1531 (2007), 대한안과학회
- Basile C, "Anterior ischemic optic neuropathy and dialysis: role of hypotension and anemia", J Nephrol, 14, pp.420~423 (2001)
- Kersh ES, "Autonomic insufficiency in uremia as a cause of hemodialysis-induced hypotension", N Engl J Med, 290, pp.650~653 (1974)
- Collins AJ, "CKD surveillance using administrative data: impact on the health care system", Am J Kidney Dis, 53(3 Suppl 3), pp.S27~S36 (2009)
- Kaderli B, "Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy", J Neuroophthalmol, 27, pp.164~168 (2007)
- 손병재, "The Effect of an Intravitreal Triamcinolone Acetonide Injection for Acute Nonarteritic Anterior Ischemic Optic Neuropathy", Korean Journal of Ophthalmology, 23(1), pp.59~61 (2009), 대한안과학회
- Winkelmayer WC, "Optic neuropathy in uremia: an interdisciplinary emergency", J Natl Kidney Dis, 37, pp.E23~ (2001)
- Beck RW, "Aspirin therapy in nonarteritic anterior ischemic optic neuropathy", Am J Ophthalmol, 123, pp.212~217 (1997)
- McFadzean R, "Ischemic optic neuropathy and giant cell arteritis", Curr Opin Ophthalmol, 9, pp.10~17 (1998)
- Rizzo JF 3rd, "Optic neuritis and ischemic optic neuropathy: Overlapping clinical profiles", Arch Ophthalmol, 109, pp.1668~1672 (1991)
- Hayreh SS, "Anterior ischemic optic neuropathy. IV. Occurrence after cataract extraction", Arch Ophthalmol, 98, pp.1410~1416 (1980)
- Serrano LA, "Postcataract extraction ischemic optic neuropathy", Arch Ophthalmol, 100, pp.1177~1178 (1982)
- Michaels DD, "Optic neuropathy following cataract extraction", Ann Ophthalmol, 5, pp.303~306 (1973)
- REESE AB, "Optic neuritis following cataract extraction", Am J Ophthalmol, 45, pp.659~662 (1958)
- Townes CD, "Complications of cataract surgery", Trans Am Ophthalmol Soc, 49, pp.91~107 (1951)
- Borchert M, "Progressive and recurrent nonarteritic anterior ischemic optic neuropathy", Am J Ophthalmol, 106, pp.443~449 (1988)
- McCulley TJ, "Incidence of nonarteritic anterior ischemic optic neuropathy associated with cataract extraction", Ophthalmology, 108, pp.1275~1278 (2001)
- Michaelson C, "Bilateral anterior ischaemic optic neuropathy associated with optic disc drusen and systemic hypotension", Br J Ophthalmol, 73, pp.762~764 (1989)
- Jackson TL, "Hypotensive ischemic optic neuropathy and peritoneal dialysis", Am J Ophthalmol, 128, pp.109~111 (1999)
- Chutorian AM, "Anterior ischemic optic neuropathy in children: case reports and review of the literature", Pediatr Neurol, 26, pp.358~364 (2002)