양안에 발생한 급성 황반 신경망막병증 1예
A Case of Bilateral Acute Macular Neuroretinopathy after URI
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목적: 감기몸살 후 양안에 발생한 급성 황반 신경망막병증 환자 1예를 보고하고자 한다. 증례요약: 42세 여자환자가 2주일 전 감기몸살을 앓고 난 후 발생한 양안의 중심부근 암점을 주소로 내원하였다. 안저검사상 황반부에군데군데 적갈색의 쐐기모양 병변이 관찰되었으며, 무적색광 안저사진에서 적갈색의 병변은 더 분명하게 관찰되었다. 형광안저혈관조영과 인도시아닌 형광안저혈관조영은 정상이었다. 암슬러격자 검사상 중심부근 암점소견을 나타내었으며, 다초점 망막전위도 검사상황반부의 진폭감소가 있었으며, 빛간섭단층촬영에서 광수용체의 손상이 있었다. 급성 황반 신경망막병증 진단하에 치료 없이 경과관찰 후 스펙트럼 영역 빛간섭단층촬영상 광수용체의 손상은 부분 회복되었고 중심부근 암점은 지속되었다. 결론: 다초점 망막전위도 및 스펙트럼 영역 빛간섭단층촬영 검사는 급성 황반 신경망막병증의 진단에 유용하게 사용될 수 있으며, 스펙트럼 영역 빛간섭단층촬영 검사상의 호전에도 불구하고 중심부근 암점은 오랫동안 지속될 수 있다.
Abstract
Purpose: To report a case of bilateral acute macular neuroretinopathy (AMN) following flu-like illness. Case summary: A 42-year-old woman complained of paracentral scotoma in both eyes 2 weeks after an episode of flu. Fundus examination showed several dark, brown-reddish, wedge- shaped lesions in both maculae, and red-free fundus photography confirmed the lesions. Fluorescein and indocyanine green angiography was normal. Amsler grid test demonstrated paracentral scotoma. The multifocal electroretinogram (ERG) response was subnormal, and ocular coherence tomography (OCT) confirmed an impaired photoreceptor layer in both eyes. Under the diagnosis of AMN, the patient was followed-up without treatment. No subjective changes were observed during follow-up, although the damage to the photoreceptor was partially recovered based on spectral-domain OCT (SD-OCT). Conclusions: Multifocal ERG and SD-OCT may be helpful to diagnose AMN. Despite partial recovery of clinical signs on SD-OCT, paracentral scotoma could be sustained for a long period of time.
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