유리체 내 베바시주맙 및 애플리버셉트 주사를 통해 호전된 망막하출혈을 동반한 맥락막골종 1예
A Case of Choroidal Osteoma with Subretinal Hemorrhage Improved by Intravitreal Bevacizumab and Aflibercept Injections
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목적: 광범위한 망막하출혈을 동반한 맥락막골종 환자에서 유리체 내 베바시주맙 및 애플리버셉트 주사를 시행한 후 시력과 망막의 해부학적 구조가 개선된 환자 1예를 보고하고자 한다. 증례요약: 42세 여자 환자가 내원 1개월 전부터 시작된 좌안의 시력저하 및 이측의 시야가림을 주소로 내원하였다. 환자는 3년 전에도 좌안에 망막출혈이 있었으나 특별한 치료 없이 증상 및 망막출혈이 호전되었다고 하였다. 내원 당시 환자의 시력은 0.6이었고, 안저검사에서 좌안에 황반부를 침범하는 거대 망막하출혈을 동반한 오렌지색의 융기된 종괴가 시신경 위쪽에서 관찰되었다. 빛간섭단층촬영과 형광안저혈관조영술, B-scan 초음파검사를 이용하여 맥락막신생혈관이 합병된 맥락막골종을 진단하였다. 맥락막신생혈관의 치료를 위해 유리체 내 베바시주맙과 애플리버셉트 주사를 각각 한 차례와 두 차례 시행하였으며, 치료 후 환자의 시력 및 망막의 해부학적 구조가 개선되었고 이후 1년간 안정적으로 유지되었다. 결론: 맥락막신생혈관이 합병된 맥락막골종 환자에서 시력 호전 및 망막의 해부학적 구조 개선을 위해 유리체 내 베바시주맙 및 애플리버셉트 주사를 시도해 볼 수 있다.
Abstract
Purpose: To report a case of choroidal osteoma (CO) complicated by extensive subretinal hemorrhage treated with intravitreal bevacizumab and aflibercept injections. Case summary: A 42-year-old female patient presented with decreased visual acuity and a temporal visual field defect in the left eye. The patient had a history of retinal hemorrhage in the left eye 3 years prior, which improved without any treatment. The patient’s visual acuity had decreased to 0.6 at the initial visit. On fundus examination, orange-colored elevated lesions involving the superior peripapillary area with massive subretinal hemorrhage extending to the macular area were revealed. Optical coherence tomography, fluorescein angiography, and B-scan ultrasonography results indicated CO complicated by choroidal neovascularization (CNV). With multiple intravitreal injections of bevacizumab and aflibercept (bevacizumab ×1, aflibercept ×2), the patient’s visual acuity improved and the CNV lesion was kept stable without recurrence as of the 1-year follow-up visit. Conclusions: Intravitreal bevacizumab and aflibercept injections can be helpful in the treatment of CO complicated by CNV, by improving visual acuity and the retinal anatomy.
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