하라다병 환자에서 섬모체맥락막 삼출로 인해 발생한 양안의 급성 근시와 전방각 폐쇄 1예
Bilateral Acute Myopia and Angle-Closure Due to Ciliochoroidal Effusion in Vogt-Koyanagi-Harada Syndrome
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목적: 하라다병 환자에서 섬모체맥락막 삼출로 인해 양안에서 발생한 급성 근시와 전방각 폐쇄를 경험하였기에 이를 보고하고자 한다. 증례요약: 43세 여자환자가 보크트-고야나기-하라다 증후군으로 진단되어 정맥내 고용량 부신 피질 호르몬 치료를 시행 받았다. 치료3일 후 시력은 호전되고, 망막하액은 감소되어 스테로이드 경구투여로 전환하였다. 경구투여 전환 2일 후 양안의 전방이 얕아지고안압은 증가하였다. 근시이동을 동반한 시력 악화가 발생하고 망막하액은 증가하였다. 안압 하강제 치료에도 반응이 없었고, 초음파생체현미경 검사에서 섬모체맥락막 삼출과 이로 인한 전방각 폐쇄를 확인하여, 조절마비제를 점안하고 정맥내 고용량 부신 피질호르몬요법을 재시행하였다. 재시행 2일 후 양안의 전방은 깊어졌고 안압은 감소하였다. 굴절력 및 최대교정시력은 호전되었고 초음파 생체현미경 검사에서 섬모체맥락막 삼출은 흡수되었다.
Abstract
Purpose: To report a case of bilateral acute myopia and angle-closure with ciliochoroidal detachment in Vogt-Koyanagi-Harada (VKH) syndrome. Case summary: A 43-year-old Korean woman diagnosed with VKH syndrome underwent intravenous methylprednisolone steroid pulse treatment. After oral medication was given for 2 days, the anterior chambers became shallow in both eyes. Intraocular pressure (IOP) increased to 25 mm Hg in the right eye and 23 mm Hg in the left eye. Subretinal fluid increased and visual acuity decreased with myopic shift in both eyes. IOP did not decrease despite maximum tolerated medical therapy. Ultrasound biomicroscopy (UBM) revealed that ciliochoroidal effusion caused forward displacement of the lens-iris diaphragm, which resulted in anterior chamber shallowing and angle closure in both eyes. The patient was treated with cycloplegic eyedrops and intravenous steroid pulse therapy. After intravenous steroid pulse treatment was given for 2days, the anterior chambers became deep in both eyes. IOP reduced to 13 mm Hg and 14 mm Hg in the right and left eye respectively. Visual acuity increased with normalization of myopic shift. UBM revealed that the ciliochoroidal effusion had resolved in both eyes.
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