망막비허혈 신생혈관녹내장환자에서 안압하강치료만으로 신생혈관 소실
Regression of Neovascularization after Using Only Intraocular Pressure-lowering Medications in Neovascular Glaucoma
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목적: 인공수정체홍채고정술 후 발생한 신생혈관녹내장환자에서 원인 질환에 대한 치료 없이 안압하강 치료만으로 홍채 및 전방각의 신생혈관이 호전된 1예를 보고하고자 한다. 증례요약: 양안 백내장수술을 받은 74세 여자 환자가 3일 전부터 시작된 좌안 통증 및 편두통을 주소로 내원하였다. 초진 시 좌안최대교정시력은 0.9, 안압은 38 mmHg였다. 세극등현미경검사 시 좌안 홍채 전반에 분포된 신생혈관과 홍채 위아래 부분에 polypropylene 실매듭이 관찰되었다. 전방각경검사 시 좌안 모든 사분면의 신생혈관 및 아래 사분면의 국소적 주변홍채앞유착이 관찰되었다. 안저검사에서 시신경 하측 시신경유두테의 얇아진 소견 및 망막신경섬유층 손상이 관찰되었고, 형광안저혈관조영술에서는 망막미세동맥류 이외 특이 소견은 없었다. 좌안 신생혈관녹내장 진단하에 안압하강제만을 점안하며 경과 관찰하였고, 치료 시작 6개월 후 안압은 10 mmHg였고, 홍채 및 전방각 신생혈관은 소실되었다. 결론: 망막의 허혈성 병변이 원인이 아닌 신생혈관녹내장환자에서 완전 폐쇄각 상태가 아니며 즉각적인 원인 제거 치료가 어려운 경우, 안압하강치료를 우선적으로 시행하며 경과 관찰할 수 있겠다.
Abstract
Purpose: To report a case of neovascular glaucoma after intraocular lens iris fixation, in which the neovascularization of the iris and the anterior chamber improved with only intraocular pressure (IOP) lowering agents, without treatment of the underlying cause. Case summary: A 74-year-old woman who had undergone bilateral cataract surgery presented with left ocular pain and headache that started 3 days previously. At the initial examination, the best-corrected visual acuity was 0.9, and the IOP was 38 mmHg in the left eye. Slit-lamp examination of the left eye revealed diffuse iris neovascularization and several polypropylene suture knots fixated in the superior and inferior iris. Gonioscopic examination revealed angle neovascularization in all quadrants, with focal peripheral anterior synechia in the inferior quadrant. Fundus examination presented inferior neuroretinal rim thinning and an inferior retinal nerve fiber layer defect in the left eye. Fluorescent angiography showed no ischemic retinal lesions, with the exception of several retinal microaneurysms. Six months after topical IOP-lowering treatment in the left eye, the IOP was 10 mmHg, and neovascularization of the iris and angle had regressed completely. Conclusions: In the case of early-stage neovascular glaucoma with partial angle closure not associated with retinal ischemia, IOP-lowering treatment can be effective without other invasive procedures.
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