고혈압과 습성 나이관련 황반변성이 연관된 자발적인 맥락막상강 출혈 2예
Spontaneous Suprachoroidal Hemorrhage Associated with Wet Type of Age-Related Macular Degeneration and Hypertension: Two Cases
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목적: 습성 나이관련 황반변성 및 고혈압 치료를 받고 있는 환자에서 자발적 맥락막상강 출혈이 있었던 2예에 대해 알아보고자 한다. 증례요약: 76세, 73세 여자 환자는 과거력상 고혈압을 전신적인 질환으로 10년 이상 치료를 받고 있었으며 습성 나이관련 황반변성으로안과 진료를 받고 있었다. 그중 76세 환자는 습성 나이관련 황반변성의 치료로 유리체내 루센티스 주입술 계획 중 갑자기 발생한 시력감소와 안구 통증을 호소하였으며 73세 환자는 습성 나이관련 황반변성에 대한 특별한 치료 없이 그냥 지내다 갑자기 시력감소 및안구 통증으로 내원하였다. 두 경우에서 안저검사 또는 초음파 검사를 통해 맥락막상강 출혈로 진단할 수 있었다. 두 환자는 모두유리체 절제술 및 맥락막상강 출혈 배액술을 시행 받은 후 통증 경감 및 증상 호전을 보였다. 결론: 출혈성 경향의 약을 복용하지는 않지만 맥락막상강 출혈의 위험인자인 고령, 고혈압을 가진 습성 나이관련 황반변성 환자에서는맥락막상강 출혈을 예방하기 위해 주기적인 관찰과 적극적인 치료가 필요할 것으로 생각한다.
Abstract
Purpose: To report two cases of spontaneous suprachoroidal hemorrhage associated with wet type of age-related macular degeneration (ARMD) and systemic hypertension. Case summary: Two women, aged 76 and 73 years, with a history of systemic hypertension for more than ten years had been treated in an eye clinic for wet type of ARMD. The 76-year-old woman was scheduled to receive an injection of intravitreal Lucentis® but experienced sudden onset loss of vision and ocular pain in her left eye. The 73-year-old woman had received no specific treatment for wet type of ARMD. She also complained of visual disturbance and ocular pain. In these two cases, slit lamp or B-scan examination disclosed suprachoroidal hemorrhage. Surgical intervention relieved the ocular pain and symptoms in both cases. Conclusions: Even if a patient has not received systemic anticoagulation/thrombolytic therapy, if wet-type ARMD patients are elderly and have systemic hypertension, they should receive regular follow-ups because old age and systemic hypertension are risk factors of spontaneous suprachoroidal hemorrhage.
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