광각안저촬영으로 관찰한 비정형 급성망막괴사
A Case of Atypical Acute Retinal Necrosis Observed Using Ultra-Wide-Field Imaging
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목적: 광각안저촬영으로 관찰한 비정형 급성망막괴사 1예를 보고하고자 한다. 증례요약: 연 3회의 구강궤양 재발 과거력이 있는 건강한 50세 남자가 내원 2주 전부터 발생한 우안의 시력 저하를 호소하며 내원하였다. 우안 전방과 유리체내 염증세포가 관찰되고 안저검사 및 광각안저사진상 심한 혈관주위 망막출혈을 동반한 폐쇄성 혈관염이관찰되었으나 주변부 망막괴사는 관찰되지 않아 베세트병을 먼저 의심하였다. 치료를 위해 전신 스테로이드, cyclophosphamide와infliximab 정맥주사, triamcinolone 안내주입술을 시행하였으나 호전이 없었다. 이후 안저검사와 광각안저사진상 망막주변부에 괴사병변이 관찰되어 급성망막괴사를 의심하고, 시행한 중합연쇄효소반응검사에서 수두-대상포진바이러스가 검출되어, acyclovir 정맥주사 치료 후 병변의 진행이 중지되었다. 이후 우안 망막박리가 발생하여 유리체절제술 및 실리콘기름주입술을 시행하였고, 좌안 망막주변에도 백색의 병변이 광각안저사진상 관찰되었나 ganciclovir 안내주입술 3차례 시행 한달 후 모두 소실되었다. 결론: 비정형 급성망막괴사 환자의 경과를 관찰하는 데 광각안저촬영이 유용하게 이용될 수 있다.
Abstract
Purpose: To report a case of atypical acute retinal necrosis (ARN) observed using ultra-wide-field imaging. Case summary: A 50-year-old male with recurrent oral ulcer presented with visual loss in his right eye. On the initial visit,slit-lamp examination showed inflammatory cells (3+) in the anterior chamber and vitreous of the right eye. Funduscopic examinationand ultra-wide-field fundus images showed severe occlusive vasculitis with perivascular hemorrhage. No necrotic lesionwas observed at the peripheral retina in the left eye. Under the impression of Behçet's uveitis, immunosuppressive therapies includingoral steroid, intravenous cyclophosphamide, anti-tumor necrosis factor (TNF) alpha agent and intravitreal triamcinolonewere administered, but without improvement. Subsequently, a necrotic lesion appeared at the far peripheral retina in the righteye and varicella-zoster virus was identified using the polymerase chain reaction test. After the patient was diagnosed with atypicalARN, intravenous acyclovir was administered, resulting in eventual suppression of the necrotic lesion progression. Due toretinal detachment, pars plana vitrectomy with silicone oil infusion was performed in the right eye. At that time, a whitish lesion atthe far peripheral retina in the ultra-wide-field photography of the fellow eye was found and 3 intravitreal ganciclovir injectionswere administered. Finally, the whitish lesion regressed after 1 month. Conclusions: Ultra-wide-field imaging might be useful for diagnosis and follow-up of atypical ARN patients.
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