유리체강내 ganciclovir 주입술을 이용한 거대세포바이러스망막염 치료 2예
Two Cases of Intravitreal Ganciclovir Injection for Cytomegalovirus Retinitis
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목적: 유리체강내로 ganciclovir를 주입하여 거대세포바이러스망막염을 치료한 2예를 보고하고자 한다. 증례요약: (증례 1) 3개월 전 췌장이식 받은 후 면역억제제를 복용 중이던 29세 여자가 양안 중심망막정맥폐쇄로 양안 유리체강내Bevacizumab 주입술 치료 후 경과관찰하던 중 좌안에서 불투명한 흰색 병소와 다수의 눈뭉치가 관찰되었다. 거대세포바이러스망막염의심 하에 유리체강내 ganciclovir 주입술을 시행하였으며 이후 흰색병변의 크기가 감소하고 교정시력 또한 호전되는 양상을 보였다. (증례 2) 전신쇠약과 만성 심부전으로 치료 중인 66세 남자가 1년 전부터 시작된 양안 시력저하를 주소로 내원하였다. 우안 하부망막에다수의 눈뭉치, 망막출혈, 황반부종 보여 진단적 유리체절제술을 시행하였다. 술 후 황반부종, 망막하액 지속되고 혈액검사에서 거대세포바이러스 면역글로불린G 양성을 보여 거대세포바이러스망막염 의심 하에 유리체강내 ganciclovir 주입술을 시행하였으며 이후 황반부종과 망막하액은 호전되었고 교정시력 또한 호전되는 소견을 보였다. 결론: 유리체강내 ganciclovir 주입술은 거대세포바이러스망막염에서 효과적인 치료법이 될 수 있다.
Abstract
Purpose: To report 2 cases of cytomegalovirus retinitis treated with intravitreal ganciclovir. Case summary: A 29-year-old female (Case 1) who received immunosuppressive therapy with tacrolimus and mycophenolate mofetil for 3 months after pancreatic transplantation, was given an intravitreal Bevacizumab injection 4 times in each eye under the suspicion of bilateral central retinal vein occlusion. During follow-up, a new lesion with white opacification and multiple snowballs appeared in the left eye. Suspecting cytomegalovirus retinitis, we administered an intravitreal ganciclovir injection resulting in a decrease of white opacification and improvement of visual acuity. A 66-year-old male (Case 2) who was receiving treatment for general weakness and heart failure, presented with visual disturbance in both eyes. Fundoscopic examination revealed white opacification, multiple snowballs and retinal hemorrhage in the left eye; diagnostic vitrectomy was performed. Macular edema and subretinal fluid continued after the vitrectomy and the serologic testing revealed an IgG titer positive for cytomegalovirus, therefore, an intravitreal injection of ganciclovir was given. Macular edema and subretinal fluid decreased and visual acuity improved. Conclusions: Intravitreal ganciclovir can be an effective treatment option for the management of CMV retinitis.
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