모야모야병 환자에서 안허혈증후군으로 인해 발생한 신생혈관 녹내장 1예
A Case of Neovascular Glaucoma Secondary to Ocular Ischemic Syndrome in a Patient with Moyamoya Disease
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목적: 모야모야병 환자에서 안허혈증후군으로 인한 신생혈관녹내장이 발생하여 섬유주절제술로 성공적으로 치료하였기에 이를 보고하고자 한다. 증례요약: 45세 여자 환자가 3개월 전부터 우안의 점진적인 시력저하가 발생하고, 2개월 전 우안의 결막충혈, 안구통증, 두통이 발생하여 신경외과에서 모야모야병으로 진단받고, 뇌경질막동맥간접문합술을 시행 받았다. 수술 후, 우안의 결막충혈과 시력저하가 지속되어시행한 안과 검사에서 우안 교정시력 0.1, 안압 42 mmHg이었고, 홍채신생혈관, 주변 홍채앞유착이 관찰되었다. 형광안저혈관조영검사에서 동정맥 통과시간이 연장되어 있었고, 망막전위도 검사에서 a파와 b파 모두 감소하였다. 자기공명혈관촬영술에서 우측 속목동맥이 좁아져 있어 모야모야병에서 안허혈증후군으로 인한 신생혈관녹내장으로 진단하고, 우안의 범망막광응고술, 유리체강내 베바시주맙 주입술 후 섬유주절제술을 시행하였다. 수술 후 8개월에 안압은 17 mmHg, 교정시력은 0.1로 측정되었고, 여과포의 형성이 잘 이루어져 있었다. 결론: 본 증례를 통하여 모야모야병 환자에서 신생혈관녹내장이 안허혈증후군으로 인하여 발생할 수 있음을 알 수 있었다.
Abstract
Purpose: To report a case of neovascular glaucoma secondary to ocular ischemic syndrome in a patient with moyamoya disease, who was successfully treated with trabeculectomy. Case summary: A 45-year-old woman suffered from slowly decreased vision in the right eye 3 months previously. Ocular pain with conjunctival injection of the right eye and headache developed 2 months earlier. She was diagnosed with moyamoya disease and had an encephaloduroarteriosynangiosis at the neurosurgery. The patient complained of persistent conjunctival injection and decreased vision of the right eye after surgery. At the initial visit, best corrected visual acuity (BCVA) of the right eye was 0.1 and intraocular pressure (IOP) was 42 mm Hg. Slit lamp examination revealed neovascularization of the iris and gonioscopy showed a 360° peripheral anterior synechiae. Fluorescein angiography demonstrated prolonged arteriovenous transit time in the right eye. On the electroretinogram, the amplitude of both a and b waves decreased in the right eye more than in the left eye. On the magnetic resonance angiography, narrowing of the right internal carotid artery was observed. The patient was diagnosed with neovascular glaucoma due to ocular ischemic syndrome caused by moyamoya disease. Panretinal photocoaguration, intravitreal bevacizumab injection and trabeculectomy with mitomycin-C soaking was performed in the right eye. At 8 months after surgery, BCVA of the right eye was 0.1,IOP was 17 mm Hg without antiglaucoma medication and bleb was maintained in good condition. Conclusions: The patient’s results indicate that neovascular glaucoma can occur secondary to ocular ischemic syndrome caused by moyamoya disease.
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