신생혈관성 나이관련황반변성 환자에서 1차 루센티스 안내주사 후 발생한 전층황반원공 1예
Macular Hole after Single Intravitreal Injection of Ranibizumab in a Patient with Age-Related Macular Degeneration
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목적: 후유리체가 부분적으로 박리된 신생혈관성 나이관련황반변성환자에서 1차 루센티스 안내주사후 발생한 황반원공 1예를 보고하고자 한다. 증례요약: 63세 여자환자가 서서히 진행되는 우안 시력저하를 주소로 내원하였다. 고혈압을 제외한 전신질환은 없었으며 안수술의 과거력도 없었다. 최대교정시력은 우안이 0.7, 좌안이 1.0 이었다. 우안에 나이관련황반변성 및 맥락막 신생혈관과 황반하출혈이 있었다. 안저검사 및 빛간섭단층촬영검사에서 불완전한 후유리체박리, 망막하출혈 및 장액망막박리가 있었다. 우안에 1차 루센티스 안내주사를 시행하였다. 1개월 후 최대교정시력은 0.4로 저하되었으며 전층황반원공으로 진행하여 우안 유리체 절제술, 내경계막제거술, 액체공기교환술, SF6 가스 주입술, 초음파수정체유화술 및 인공수정체삽입술을 시행하였다. 수술 후 3개월째 최대교정시력은 1.0 이었고,황반원공은 소실되었다. 결론: 유리체내 루센티스주사는 드물지만 황반원공을 발생시킬 수 있어 이를 유의하여야겠다.
Abstract
Purpose: To report a case of a full-thickness macular hole after a single intravitreal injection of ranibizumab in a patient with choroidal neovascularization associated with age-related macular degeneration. Case summary: A 63-year-old woman presented to our department with gradually decreasing vision in her right eye. Best corrected visual acuity (BCVA) was measured as 0.7 in the right eye and 1.0 in the left eye. Examination of the macula showed a choroidal neovascularization associated with subretinal hemorrhage in the right eye. Optical coherence tomography (OCT) confirmed incomplete posterior vitreous detachment, subretinal hemorrhage and serous elevation. The patient subsequently received an intravitreal ranibizumab injection. After 1 month, the best corrected visual acuity in the right eye was decreased to 0.4, and fundus examination revealed posterior vitreous detachment and a macular hole. The patient underwent pars plana vitrectomy with internal limiting membrane peeling and fluid-air exchange, SF6 gas injection,phacoemulsification and posterior chamber intraocular lens implantation. Three months later, the macular hole had closed completely and best visual acuity was 1.0. Conclusions: Although the occurrence of a full-thickness macular hole after intravitreal ranibizumab injection is uncommon,physicians should be well acquainted with this complication.
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