유리체절제술과 동시에 시행한 베바시주맙 주사 후 발생한 유리체 그물망
Vitreous Web after Pars Plana Vitrectomy and Bevacizumab Injection
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목적: 당뇨병성 유리체출혈로 유리체절제술 및 유리체강 내 베바시주맙 주사 시행 후 유리체내에 발생한 유리체 그물망(vitreous web)염증 1예를 보고하고자 한다. 증례요약: 양안 당뇨망막병증으로 범망막레이저광응고술 후 안과외래에 경과관찰 중인 41세 여자 환자가 우안 시력저하를 주소로 병원에 내원하였다. 세극등 검사상 우안에 유리체출혈 보여 당뇨병성 유리체출혈 진단하에, 유리체강 내 베바시주맙 주사를 동반한 유리체절제술을 시행하였다. 수술 후 1일째 전안부에 염증소견 없이 유리체출혈은 모두 제거되었다. 그러나 전안부염증 없이, 유리체내에다발성의 흰색의 유리체 그물망 염증이 관찰되었다. 비감염성 유리체 염증 진단하에 통상적인 점안 스테로이드제 이외에 소량의 경구스테로이드 투약을 시작하였다. 수술 후 4일째 유리체 그물망은 모두 사라졌다. 1달 뒤 좌안에도 당뇨병성 유리체출혈 발생하였으며,베바시주맙 주사 없이 유리체절제술 시행하였고, 유리체 그물망은 발생하지 않았다. 결론: 당뇨병성 유리체출혈로 유리체절제술 및 유리체강 내 베바시주맙 주사 시행 직후에 일시적 합병증으로, 유리체 그물망모양 염증이 생길 수 있다. 통증, 결막충혈, 전방축농 및 전방내 염증세포 등의 유무를 확인하여 감염에 의한 유리체 염증을 배제할 수 있으면유리체 그물망 염증은 침습적인 유리체강 내 항생제 주사 없이도 호전될 수 있다.
Abstract
Purpose: To report a case of vitreous inflammation (vitreous web) after intravitreal bevacizumab injection accompanying parsplana vitrectomy (PPV) for the treatment of proliferative diabetic retinopathy with vitreous hemorrhage. Case summary: A 41-year-old female who underwent panretinal photocoagulation for diabetes mellitus (DM) retinopathy presentedwith decreased visual acuity in her right eye which was caused by vitreous hemorrhage. The patient underwent PPV withintravitreal bevacizumab injection. One day after surgery, the vitreous hemorrhage cleared and there was no inflammation in theanterior segment; however, multiple inflammatory white strands (vitreous web) were found in the vitreous cavity. She was diagnosedwith non-infectious endophthalmitis and treated with topical steroid and additional oral steroids, resulting in clearance ofthe vitreous web on postoperative day 4. One month later, vitreous hemorrhage occurred in the other eye. PPV without bevacizumabinjection cleared the vitreous hemorrhage with no evidence of vitreous web. Conclusions: Vitreous web-like inflammation can occur after intravitreal bevacizumab injection accompanying PPV for the treatmentof DM vitreous hemorrhage. After eliminating infectious endophthalmitis based on lack of pain, conjunctival injection, anteriorchamber hypopyon, and inflammatory cells, the web can be cleared without invasive intravitreal antibiotics injections.
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