지연성으로 증상이 발현된 수정체 내 덱사메타손 삽입물
Delayed Symptoms after Intralenticular Dexamethasone Implant
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목적: 지연성으로 증상이 발현된 수정체 내 덱사메타손 삽입물(Ozurdex®; Allergan, Irvine, CA, USA) 1예를 경험하여 이를 보고하고자 한다. 증례요약: 65세 남자 환자가 우안 비문증과 시력저하를 주소로 내원하였다. 세극등현미경검사상 경도의 수정체핵 혼탁과 수정체 내덱사메타손 삽입물이 관찰되었다. 환자는 당뇨황반부종으로 수차례 유리체강내 혈관내피성장인자억제제 주사를 받았으며, 증상 발생 약 7주 전 덱사메타손 삽입물주입술을 받았다. 환자가 증상에 따른 불편감을 지속적으로 호소하여 수정체유화술과 후방인공수정체삽입술을 시행하였다. 수술 후 증상은 호전되었다. 수술 1개월 후 낭포황반부종이 악화되어 유리체강내 트리암시놀론 아세토나이드(MaQaid®; Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) 주사를 시행하였다. 유리체강내 주사 후 낭포황반부종은 점차 호전되는 양상을 보였다. 결론: 수정체 내로 덱사메타손 삽입물을 주입하게 되는 경우는 매우 드물지만 시술 중 주의하여야 하며, 지연성으로도 수정체 내 덱사메타손 삽입물로 인한 증상이 발현될 수 있음을 인지할 필요가 있다. 따라서 면밀한 경과 관찰이 필요하며, 시력과 합병증에 따라 수술을 시행할 수 있다.
Abstract
Purpose: To report a case of delayed symptoms after intralenticular dexamethasone implant (Ozurdex®; Allergan, Irvine, CA, USA). Case summary: A 65-year-old male was referred for myodesopsia and decreased visual acuity. A dexamethasone implant was located in the crystalline lens, and the lens showed mild nucleus opacity. The patient had been treated with multiple intravitreal injections of anti-vascular endothelial growth factor and had received an injection of dexamethasone implant about seven weeks before symptom onset. Based on the symptoms, phacoemulsification was performed and an intraocular lens was placed within the capsular bag. After surgery, symptoms improved. One month after surgery, as cystoid macular edema worsened, the patient was treated with an intravitreal injection of triamcinolone acetonide (MaQaid®; Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan). After intravitreal injection, cystoid macular edema improved. Conclusions: Intralenticular injection of the dexamethasone implant is very rare; however, great care should be taken during the procedure. It should be noted that the onset of symptoms by intralenticular dexamethasone implant may not occur immediately following the procedure. Thus, close follow-up is necessary, with the possibility of surgical intervention depending on visual acuity and underlying complications.
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