유리체강내 트리암시놀론 주입술로 호전된 임신 중발생한 보그트-고야나기-하라다 병 1예
Vogt-Koyanagi-Harada Disease in a Pregnant Patient Successfully Treated with Intravitreal Triamcinolone Injection
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목적: 유리체강내 트리암시놀론 주입술로 호전된 임신 중 발생한 보그트-고야나기-하라다(Vogt-Koyanagi-Harada , VKH) 병 1예를보고하고자 한다. 증례요약: 양안의 시력감소, 두통, 이명을 주소로 내원한 임신 19주의 21세 여자로, 초진 시 최대교정시력은 우안 0.15, 좌안 0.3이었다. 양안의 전안부 염증과 안저 검사상 다발성의 장액망막박리가 관찰되었다. VKH 병으로 진단하고 전신적 스테로이드 사용을 고려하였으나, 유산 등 스테로이드에 대한 합병증에 대한 우려로 우안의 유리체강내 트리암시놀론 주입술을 시행하였으며 좌안은 스테로이드점안제를 사용하였다. 주입술 시행 1일째 우안의 장액망막박리는 감소하였고, 전안부 염증 반응은 소실되었다. 10일 후 양안의 장액망막박리는 소실되었으나 좌안의 전안부 염증은 지속되었다. 1달 뒤 양안의 최대교정시력은 1.0 이었으며 장액망막박리는 재발하지 않았다. 정상 분만한 신생아에도 문제는 없었다. 결론: 유리체강내 트리암시놀론 주입술 역시 임신 중 발생한 VKH 병의 치료 방법 중 하나로 고려해 볼 수 있을 것으로 생각한다.
Abstract
Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease in a pregnant patient treated with intravitreal triamcinolone injection. Case summary: A 21-year-old female in the 19th week of gestation presented with bilateral blurring of vision associated with mild headache and tinnitus. Her initial best corrected visual acuity was 0.15 in the right eye and 0.3 in the left eye. Multiple serous retinal detachment and anterior chamber inflammation were observed, and VKH disease was diagnosed. Because of her pregnancy, the patient did not want high-dose systemic prednisolone therapy which may cause an abortion or low birth weight infant when used in a pregnant patient. Therefore, an intravitreal triamcinolone (4 mg/0.1 ml) injection was given in the right eye and topical steroid eye drops were used in the left eye. After 1 day, serous retinal detachment was significantly decreased and anterior chamber inflammation disappeared in the right eye. After 1 week, no serous retinal detachment was observed. In the left eye, serous retinal detachment was decreased after using steroid eye drops. After 10 days, serous retinal detachment disappeared but anterior chamber inflammation was still observed. After 1 month, best corrected visual acuity was 1.0 in both eyes and serous retinal detachment had not recurred. On follow-up, VKH disease had not recurred and a healthy normal weight infant was delivered. Conclusions: Intravitreal triamcinolone injection is an effective and safe treatment for VKH disease in pregnant women.
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