원발항인지질항체 증후군에서 발생한 양안 황반부 경색 1예
Bilateral Macular Infarction in Primary Antiphospholipid Syndrome
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목적: 원발항인지질항체 증후군 환자에서 발생한 양안의 황반부 경색을 경험하였기에 보고하고자 한다. 증례요약: 융모양막염으로 응급 제왕절개술을 시행받은 29세 산모가 양안 시력저하를 주소로 본과에 협진의뢰되었다. 내원 당시 교정시력은 우안 안전수지, 좌안 0.05였고, 안저검사에서 양안의 황반부 경색 소견을 보였다. 혈액응고 이상을 포함한 전반적인 혈액학적검사를 시행하였고, 12주 간격으로 시행한 항인지질항체 검사에서 루푸스항응고 수치가 증가되어 있었다. 원발항인지질항체 증후군에 의한 양안 황반경색으로 진단하고, 테논낭하 트리암시놀론 아세토나이드 주사를 시행하였으나, 큰 호전을 보이지 않았다. 결론: 원발항인지질항체 증후군은 혈전 및 색전을 유발하여 망막의 동정맥폐쇄가 발생할 수 있으며, 심한 경우 황반부 경색을 초래할수도 있다. 기저질환이 없는 건강한 젊은 사람에서 양안의 황반부 경색이 발생한 경우 항인지질항체 검사를 시행해 보는 것이 필요하다.
Abstract
Purpose: We report a rare case of bilateral macular infarction as an ocular presenting sign of primary antiphospholipid syndrome. Case summary: A 29-year-old woman who had undergone a cesarean section for chorioamnionitis in the department of Obsterics was referred to the department of ophthalmology for bilateral visual loss. At examination, best-corrected visual acuity (BCVA) of the right eye was counting fingers, and for the left was 0.05. Fundus examination revealed extensive macular edema and cotton- wool spots in both eyes. We performed hematologic tests including thrombophilia examination. Antinuclear antibody and rheumatoid factor were negative but lupus anticoagulant presented high titers on two occasions 12 weeks apart. She was administered sub-Tenon’s injections of triamcinolone acetonide 50 mg/week in both eyes under the diagnosis of bilateral macular arteriolar occlusion in primary antiphospholipid syndrome. Her BCVA remained 0.025 in her right eye and improved to 0.125 in her left eye. Conclusions: Macular infarction is an uncommon but severe complication of antiphospholipid syndrome. Early and regular fundus exam in patients with antiphospholipid syndrome is necessary to avoid progression of severe ocular complications.
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