유리체강 내 애플리버셉트 주사 후 급격히 진행한 망막앞막
Rapid Progression of the Epiretinal Membrane after Intravitreal Aflibercept Injecti
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목적: 삼출성 황반변성에서 유리체강 내 애플리버셉트 주사 후 망막앞막이 급격히 진행한 증례를 경험하였기에 이를 보고하고자 한다. 증례요약: 82세 여자가 1개월 전부터 발생한 좌안 시력저하를 주소로 내원하였다. 초진 시 좌안 시력은 0.2로 측정되었다. 안저검사및 빛간섭단층촬영에서 좌안 황반부의 연성 드루젠과 출혈 및 투명한 망막앞막이 관찰되었다. 형광안저혈관조영술 및 인도시아닌그린혈관조영술 결과 좌안의 망막혈관종성증식 retinal angiomatous proliferation으로 진단하였고, 좌안 유리체강 내 애플리버셉트 주사를 시행하였다. 첫 주사 1개월 후 좌안 오목부위의 망막 내 낭포황반부종은 감소했으나, 안저검사에서 망막앞막의 투명도가 감소하였고 빛간섭단층촬영에서 앞막의 반사도와 두께가 증가하였다. 이후 애플리버셉트 주사를 2회 더 시행하였고, 망막혈관종성증식은 호전 소견을 보였으나 좌안 시력이 0.1로 감소하여 망막앞막에 대한 유리체절제술을 시행하였다. 결론: 망막앞막이 동반된 삼출성 황반변성의 치료로 유리체강 내 애플리버셉트 주사 후 망막앞막의 급격한 진행에 대한 주의 깊은 관찰이 필요하다.
Abstract
Purpose: To report a case of rapid progression of the epiretinal membrane following intravitreal aflibercept injection in a patient with exudative age-related macular degeneration. Case summary: An 82-year-old female presented with a complaint of decreased visual acuity in her left eye for 1 month. The initial best-corrected visual acuity was 0.2 in the left eye. Fundus examination and optical coherence tomography revealed soft drusen with retinal hemorrhage of the macula and a transparent epiretinal membrane in the left eye. Fluorescein angiography and indocyanine green angiography showed retinal angiomatous proliferation (RAP) of the left eye, so intravitreal aflibercept injection was performed. One month after the first injection, intraretinal cystic macular edema decreased, while transparency of the epiretinal membrane decreased and reflectivity and thickness of the membrane increased. After two additional injections of aflibercept, RAP showed improvement, whereas the epiretinal membrane progressed. Visual acuity of the left eye decreased to 0.1 and vitrectomy of the membrane was performed. Conclusions: Careful observation for potentially rapid progression of epiretinal membrane is needed after intravitreal aflibercept injection in the management of exudate age-related macular degeneration accompanied by epiretinal membrane.
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