베바시주맙에 반응 않는 당뇨황반부종 환자에서 덱사메타존 삽입물의 수정체 내 주입 1예
Inadvertent Intralenticular Dexamethasone Implant for Diabetic Macular Edema Unresponsive to Bevacizumab
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목적: 베바시주맙에 반응하지 않는 당뇨황반부종이 있었던 환자에서 덱사메타존 삽입물(Ozurdex®, Allergan, Irvine, CA, USA)이 수정체 내에 주입된 1예를 보고하고자 한다. 증례요약: 증식당뇨망막병증이 있는 71세 여자가 레이저범망막광응고술을 시행 받고 경과관찰하던 중에 양안에 당뇨황반부종이 발생하였다. 양안에 유리체내 베바시주맙 주사를 시행하였으나 호전이 없어 좌안에 유리체내 덱사메타존 삽입물을 주사하였다. 시술 도중예기치 않게 덱사메타존 삽입물이 수정체 내로 주입되었고 10개월간 그대로 경과관찰하였다. 좌안의 황반부종은 시술 1개월에 호전되어 경과관찰 기간 동안 재발하지 않았으며 경도의 백내장 발생 외에 다른 합병증은 없었다. 좌안의 최대교정시력은 0.1에서 0.2로상승하였다. 10개월 동안 덱사메타존 삽입물의 크기는 약간 감소하였으나 여전히 수정체 내에서 관찰되었다. 결론: 당뇨황반부종 환자에서 덱사메타존 삽입물의 수정체 내 삽입은 드문 합병증이지만 황반부종 호전에 효과적이었다.
Abstract
Purpose: To report a case of inadvertent intralenticular slow-release dexamthasone implant (Ozurdex®, Allergan Inc., Irvine, CA,USA) for diabetic macular edema unresponsive to bevacizumab. Case summary: A 71-year-old woman presented with proliferative diabetic retinopathy. During follow-up, diabetic macular edemadeveloped in both eyes and did not improve with intravitreal bevacizumab injections. For refractory diabetic macular edema,slow-release dexamthasone implant (Ozurdex®) was to be injected at the vitreous cavity of her left eye, but it was inadvertentlyinjected into the crystalline lens. The patient was followed closely for 10 months. Diabetic macular edema completely resolved 1month after the injection and did not recur during follow-up. There were no severe complications except mild cataract formation. Best-corrected visual acuity for the left eye improved from 0.1 to 0.2. The Ozurdex® implant slightly decreased after 10 months,but was still observed in the crystalline lens. Conclusions: The inadvertent intralenticular dexamthasone implant was a rare complication but effective for diabetic macular edema.
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