증식당뇨망막병증 환자에서 유리체절제술 후 발생한 황반부 장액망막박리 2예
Two Cases of Serous Retinal Detachment Following Vitrectomy in Patients with Proliferative Diabetic Retinopathy
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목적: 유리체절제술을 시행한 증식당뇨망막병증 환자에서 발생한 장액망막박리 2예를 보고하고자 한다. 증례요약: (증례 1) 고위험 증식당뇨망막병증 진단하에 본원에서 경과관찰 중이던 38세 여성이 좌안의 유리체출혈을 진단 받고, 좌안유리체절제술 및 초음파 수정체 유화술 및 인공수정체 삽입술, 안내레이저응고술을 시행 받았다. 수술 후 1일째 안저검사에서 황반주변부의 장액망막박리 소견이 관찰되었고, 빛간섭단층촬영에서 후극부의 망막하액 소견이 관찰되었다. 안저검사를 통해 후극부의망막열공이 없음을 확인하고, 장액망막박리 진단하에 점안 항생제 및 스테로이드 점안액을 사용하며 경과관찰하였다. 수술 1주 후 시행한 검사상 망막하액은 소실되었다. (증례 2) 증식당뇨망막병증으로 경과관찰 중이던 63세 남자 환자가 우안의 유리체출혈로 유리체절제술 및 안내레이저응고술을 시행 받은 후 1일째 황반부에 국한된 장액망막박리가 관찰되었다. 환자는 수술 중 유리체강 내 트리암시놀론 주사술을 시행하였으며, 스테로이드 및 항생제 점안액을 사용하였고 5일 후 시행한 경과관찰에서 망막하액의 흡수 소견을 보였다. 결론: 증식당뇨망막병증 환자에서 유리체절제술 후 갑작스러운 장액망막박리가 동반될 수 있다. 후극부의 망막열공이 없음을 확인하고, 특별한 치료 없이 경과관찰하였을 경우 장액망막박리가 호전되는 것을 경험하였다. 이에 저자들은 가능한 기전을 설명함과 동시에 보고하는 바이다.
Abstract
Purpose: In the present study, 2 cases of serous retinal detachment in patients diagnosed with proliferative diabetic retinopathy after pars plana vitrectomy are reported. Case summary: (Case 1) A 38-year-old female diagnosed with high-risk proliferative diabetic retinopathy underwent pars plana vitrectomy and cataract surgery due to intravitreal hemorrhage. One day after the operation, fundus photograph and optical coherence tomography (OCT) revealed serous retinal detachment. After ensuring that no retinal hole was present based on fundus examination, the patient was diagnosed with serous retinal detachment and antimicrobial and steroid eye drops were applied. After 1 week, subretinal fluid disappeared. (Case 2) A 63-year-old male diagnosed with proliferative diabetic retinopathy underwent pars plana vitrectomy due to right vitreous hemorrhage. On postoperative day 1, focal subretinal fluid under the macula was observed using OCT. Intravitreal triamcinolone injection was performed during surgery and steroid eye drops were applied. Subretinal fluid collection was absorbed 5 days postoperatively. Conclusions: Two cases of serous retinal detachment that occurred postoperatively in patients with diabetic retinopathy are reported. Serous retinal detachment was resolved after several days without specific management.
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