유리체 절제술을 시행한 안에서 백내장 수술 후 발생한 황반원공 1예
A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye
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목적: 당뇨병성 망막병증으로 인해 유리체절제술을 시행한 안에서 백내장 수술 후 발생한 황반원공을 황반원공 수술로 치료한 1예를보고하고자 한다. 증례요약: 53세 환자가 양안 유리체 절제술 후 경과 관찰하던 중 좌안에 백내장이 발생하여 초음파 수정체유화술 및 인공수정체 후낭삽입술을 시행 받았다. 환자는 백내장 수술 3개월 후 좌안의 변형시를 주소로 내원하여 시행한 안저 검사 및 빛간섭단층촬영에서 낭포황반부종과 전층 황반원공이 관찰되어 내경계막 제거술, 가스 주입술을 시행하였으며, 수술 3개월 후에는 황반 원공이 폐쇄되었다. 결론: 유리체 절제술이 시행된 눈이라도 백내장 수술 후 낭포황반부종의 발생 가능성이 있는 경우에는 수술 전 후 안저검사 및 빛간섭단층촬영을 통하여 낭포황반부종과 동반하여 발생 가능한 황반원공 유무를 확인하고 이를 조기에 치료하는 것이 필요하다.
Abstract
Purpose: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. Case summary: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. Conclusions: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.
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