비전형적 시야 이상으로 발현된 비동맥염 앞허혈시신경병증
Nonarteritic Anterior Ischemic Optic Neuropathy with an Atypical Visual Field Defect
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목적: 안내 수술 후 비전형적 시야 이상으로 발현된 비동맥염 앞허혈시신경병증 증례를 경험하여 보고하고자 한다. 증례요약: 61세 남자 환자가 우안 백내장 및 망막앞막수술 1일 후 발생한 시야장애로 내원하였다. 최대교정시력은 우안 20/400, 좌안20/32이었으며 색각검사에서 우안 전색맹 좌안 정상, 우안의 상대구심동공운동장애가 관찰되었다. 시신경 및 망막 이상은 없었고시야검사에서 우안에 수직경선을 따르는 코쪽 반맹 소견을 보였다. 안와 및 뇌자기공명영상에서 이상 소견은 없었다. 술 후 2주경우안의 시신경유두부종과 선상 출혈이 관찰되고, 형광안저혈관조영에서 시신경유두 이측과 하이측 유두주위 맥락막에 충만지연을보여 비동맥염 앞허혈시신경병증으로 진단하였다. 경구 스테로이드 및 아스피린 투여 후 부종이 감소하고 술 후 17일째 최대교정시력이 20/100으로 호전되었으나 술 후 3개월째 최대교정시력은 20/125, 시야결손의 호전 없이 상측 및 하측 시신경유두의 부분적 창백이관찰되었다. 결론: 비동맥염 앞허혈시신경병증에서 드물게 수직 반맹이 발생할 수 있으므로 관련된 위험인자가 있는 환자에서, 특히 안내 수술후 비전형적인 시야 이상 발생 시 감별 진단으로 고려해야 한다.
Abstract
Purpose: To report a case of nonarteritic anterior ischemic optic neuropathy (NA-AION) with an atypical visual field defect after intraocular surgery. Case summary: A 61-year-old male presented with a visual field defect in his right eye 1 day after uneventful cataract surgery with pars plana vitrectomy for epiretinal membrane. His best-corrected visual acuity (BCVA) in the right eye was 20/400 with a relative afferent pupillary defect. A color vision test revealed failure only in the right eye. A slit-lamp examination revealed no abnormality in the anterior part of the eyes. A fundoscopic examination also revealed no abnormality in the posterior part of the eyes, including the optic disc. The Humphrey visual field test revealed a nasal vertical defect in the right eye. Orbital and brain magnetic resonance imaging were normal. After 14 days from the initial symptom, fundus photography and optical coherence tomography revealed an optic disc swelling and splinter hemorrhage. Fluorescein angiography revealed a delayed filling on the temporal half of the optic disc and inferotemporal peripapillary choroid. A diagnosis of NA-AION was made. The patient was treated with oral steroids and aspirin. After 3 months, the BCVA was 20/125. The visual field defect was maintained and segmental atrophy developed on the superior and inferior sides of the right optic disc. Conclusions: AION may present as vertical hemianopsia. With the risk factors of ischemic optic neuropathy, the possibility of AION should be considered in the differential diagnoses of postoperative visual impairments or field defects after intraocular surgery.
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