망막분지정맥폐쇄에 합병된 황반부종에서 유리체강내베바시주맙 주입 후 발생한 혈소판감소 1예
Thrombocytopenia after Intravitreal Bevacizumab Injection for Macular Edema in Branch Retinal Vein Occlusion
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목적: 망막분지정맥폐쇄에 합병된 황반부종 환자에게 유리체강내 베바시주맙 주입 후 발생한 가역적 혈소판감소 1예를 경험하였기에이를 보고하고자 한다. 증례요약: 52세 여자 환자가 2개월 전부터 시작된 우안 시력저하를 주소로 내원하였다. 4년 전부터 만성 신부전으로 주 3회 혈액투석을 받고 있었다. 안저검사 및 빛간섭단층촬영검사에서 우안의 망막분지정맥폐쇄에 합병된 황반부종 소견이 관찰되어 유리체강내 베바시주맙(1.25 mg/0.05 ml)을 주입하였다. 4주 간격으로 유리체강내 베바시주맙을 2회 주입하고 4주 후 혈액검사에서 혈소판감소가 확인되었고, 그 이후로 8주간 유리체강내 베바시주맙 주입을 하지 않고 경과 관찰하였을 때 혈소판 수가 증가하였다. 이후 다시 4주간격으로 2회 주입 후 혈소판감소가 확인되었다. 8주간 주입하지 않고 특별한 치료 없이 경과 관찰하면서 다시 혈소판 숫자의 증가를확인할 수 있었다. 결론: 망막분지정맥폐쇄에 합병된 황반부종 환자에서 유리체강내 베바시주맙 주입 후 혈소판감소 발생 시 유리체강내 베바시주맙 주입이 원인이 될 수 있음을 고려해야 한다.
Abstract
Purpose: To report a rare case of thrombocytopenia after intravitreal bevacizumab injection (IVBI) in a patient with macular edema secondary to branch retinal vein occlusion (BRVO). Case summary: A 52-year-old female presented to our clinic with complaints of visual disturbance in her right eye for 2months. She was receiving hemodialysis therapy 3 times a week for 4 years due to chronic renal failure. Unilateral macular edema secondary to BRVO was observed on fundus examination and was confirmed with optical coherence tomography (OCT). The first IVBI was performed, and an additional injection was given 4 weeks later. Four weeks after the second injection,thrombocytopenia was present. The patient was followed up in our clinic without IVBI for 8 weeks and the platelet count recovered. Thrombocytopenia was reconfirmed after 2 additional monthly injections. After she revisited our clinic without IVBI for 8 weeks, the platelet count recovered without any treatment. Conclusions: When a patient presents with thrombocytopenia after IVBI with macular edema in BRVO, thrombocytopenia due to IVBI should be considered as a possible diagnosis.
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