광범위한 장액성 황반부박리를 동반한 푸르처망막병증 1예
A Case of Purtscher’s Retinopathy with Diffuse Serous Macular Detachment
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목적: 광범위한 장액성 황반부박리를 동반한 푸르처망막병증 1예를 경험하였기에 이를 보고한다. 증례요약: 63세 남자 환자가 3일 전 발생한 양안의 시력저하를 주소로 내원하였다. 내원 3일 전 철제빔에 가슴을 맞은 과거력이 있었으며, 교정시력은 우안 20/50, 좌안 20/160 이었다. 전안부 검사상 특이소견 없었고, 안저검사에서는 좌안 후극부의 망막출혈 및 면화반점이 관찰되었으며 우안은 특이소견 관찰되지 않았다. 형광안저촬영에서 좌안 후극부의 심한 비관류가 관찰되었으며, 빛간섭단층촬영에서는 좌안 후극부 및 하부 망막에 광범위한 장액망막박리 및 우안 후극부의 경도의 망막하액이 관찰되었다. 좌안 푸르처망막병증,우안 푸르처망막병증의증 진단하에 경구 Prednisolone 40 mg을 처방 후 점차 감량하였다. 치료 6주 후 교정시력 우안 20/20, 좌안20/30으로 호전되었으며 빛간섭단층촬영에서 양안의 망막하액은 소실된 모습을 보였다. 결론: 푸르처망막병증은 전신외상 후 발생하는 안저의 질환으로 망막하액의 관찰은 매우 드문 것으로 알려졌다. 저자들은 광범위한장액성 황반부박리를 동반한 푸르처망막병증을 경험하고 경구 스테로이드에 반응하였기에 이를 보고하는 바이다.
Abstract
Purpose: To report a case of Purtscher’s retinopathy with diffuse serous macular detachment. Case summary: A 63-year-old male patient presented to the hospital with decreased visual acuity. Three days prior to visiting the hospital, he had an blunt injury to the thoracic region caused by a steel beam, and his best corrected visual acuity was 20/50 in the right eye and 20/160 in the left eye. On slit lamp examination nothing unusual was observed in either eye,but fundus examinations showed retinal hemorrhages and a cotton wool spots on the posterior pole of the left eye and nothing unusual in the right eye. On fluorescein angiography, severe nonperfusion was observed at the posterior pole of the left eye. On optical coherence tomography, there was diffuse serous retinal detachment at the posterior pole and inferior retina of the left eye while mild subretinal fluid was observed at the posterior pole of the right eye. Under the suspicion of Purtscher’s retinopathy in both eyes, oral prednisolone (40 mg) was prescribed and the dosage was gradually reduced. Six weeks after the treatment, best corrected visual acuity improved to 20/20 in the right eye, and 20/30 in the left eye. Additionally, subretinal fluid in the right eye completely disappeared. Conclusions: Purtscher’s retinopathy is known as an ocular disease occurring after traumatic events. However, serous detachment of the macula has rarely been observed in Purtscher’s retinopathy, and herein we report a case with diffuse serous macular detachment which responded to oral steroid treatment.
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