점모양내측맥락막병증 환자에서 병발한 소실다발흰점증후군 1예
A Case of Punctate Inner Choroidopathy Followed by Multiple Evanescent White Dot Syndrome
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목적: 점모양내측맥락막병증으로 진단된 환자에서 소실다발흰점증후군이 병발한 1예를 경험하여 보고하고자 한다. 증례요약: 특이병력이 없는 23세 여자 환자가 1주 전부터 시작된 우안의 시력 저하로 내원하였다. 최대교정시력은 우안 20/100, 좌안20/20이었다. 안저검사와 빛간섭단층촬영 영상에서 양안 후극부에 다발성의 탈색소성 병변과 우안 맥락막신생혈관과 황반하 출혈이 관찰되었다. 점모양내측맥락막병증에서 병발한 우안의 맥락막신생혈관을 진단하였고 우안은 유리체강 내로 베바시주맙(Avastin®, Roche, Basel, Switzerland; 1.25 mg/0.05 mL)을 총 3회 주사하였다. 맥락막신생혈관은 퇴행하였고, 후극부에 색소성 반흔을 남긴 채 우안 시력은 20/20까지 회복되었다. 2년 뒤 좌안의 시력 저하로 내원하였고 최대교정시력은 20/40이었다. 안저검사에서 다수의 백색반점이 좌안의 후극부와 시신경유두 주변에서 관찰되었다. 빛간섭단층촬영에서 광수용체 신호가 감소되어 있었다. 형광안저혈관조영에서 다수의 과형광의 반점이 관찰되었으며, 인도사이아닌그린혈관조영에서는 이보다 많은 수의 저형광 반점이 관찰되었다. 시야검사에서는 암점의 확대가 있었다. 소실다발흰점증후군으로 진단하고, 경구 스테로이드 치료 1개월 후 병변은 소실되었으며 시력은 20/20으로 호전되었다. 결론: 흰점증후군에 속하는 질환인 점모양내측맥락막병증과 소실다발흰점소실증후군이 시간을 두고 함께 발생할 수 있음을 경험하여 보고하는 바이다.
Abstract
Case summary: A 23-year-old female complained about sudden visual loss in the right eye. Best-corrected visual acuity (BCVA) was 20/100 in the right eye and 20/20 in the left eye. In fundus examination and optical coherence tomographic images, subfoveal choroidal neovascularization (CNV) with hemorrhage was observed in the right eye, accompanied by multiple lesions of atrophic pigmentation on the posterior pole in both eyes. We diagnosed the patient as punctate inner choroidopathy (PIC) and CNV in the right eye, and treated her using three monthly intravitreal injections of bevacizumab (Avastin®, Roche, Basel, Switzerland; 1.25 mg/0.05 mL). The CNV regressed and the BCVA improved to 20/20. Two years later, she complained of visual impairment in her left eye. The BCVA was 20/40. Fundus photography revealed numerous small white dots around the posterior pole and optic disc. Disruption of the photoreceptor layer was seen in optical coherence tomography images. Small white dots were observed as multiple hyperfluorescent dots in fluorescein angiography and hypofluorescent spots in indocyanine green angiography. An enlarged blind spot was observed in the visual field. We diagnosed her as multiple evanescent white dot syndrome (MEWDS). One month after systemic steroid treatment, the multiple white dots disappeared and the BCVA improved to 20/20. Conclusions: We determined that PIC and MEWDS, which belong to the white dot syndrome, could occur in a patient at different times.
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