테논낭하 트리암시놀론 주입술 후 발생한 난치성 녹내장에서 침적물의 조직병리학적 소견
Histopathologic Features of Triamcinolone Deposits in Refractory Steroid-Induced Glaucoma after Subtenon Triamcinolone Injection
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목적: 테논낭하 트리암시놀론 주입술 후 발생한 난치성 스테로이드녹내장 2예를 침적물 제거를 통하여 성공적으로 치료하였기에 이를조직병리학적인 소견과 함께 보고하고자 한다. 증례요약: 72세 남자 환자가 정상안압 녹내장으로 travoprost 점안치료 중이었으며 당뇨망막병증 치료 중 우안의 난치성 황반부종으로후테논낭하 트리암시놀론 주입술을 시행받았다. 3개월 후 우안 안압상승으로 최대 약물 치료에도 안압이 조절되지 않아 침적물 제거술을 시행하였다. 시술 전 24 mmHg였던 안압은 제거 후 1개월에 18 mmHg로 감소하였고, 술 후 7개월까지 14 mmHg로 조절되었다. 42세 남자 환자가 앞포도막염으로 전 테논낭하 트리암시놀론 주입술을 시행 받고 한 달 후 우안 안압 상승으로 주입술 7개월 후 침적물 제거술을 시행받았다. 시술 전 35 mmHg였던 안압은 제거 후 2주일에 12 mmHg로 감소하였고, 4개월까지 12 mmHg로 조절되었다. 침적물을 분석한 결과 육안적으로 섬유성 막에 둘러싸인 무정형의 물질이 관찰되었고, 편광현미경에서 트리암시놀론 결정이 관찰되었다. 결론: 테논낭하 트리암시놀론 침적물의 제거는 약물 치료에 반응이 없는 스테로이드녹내장의 치료에 효과적일 수 있고, 여과수술의전 단계 치료로서 고려될 수 있음을 알 수 있었다.
Abstract
Purpose: To report the removal of subtenon triamcinolone precipitates in patients with refractory steroid-induced glaucoma following subtenon triamcinolone injection. Case summary: A 72-year-old male patient with diabetic retinopathy had cystoid macular edema in the right eye. The patient received a posterior subtenon injection of triamcinolone acetonide and developed intractable glaucoma one month after the injection in the right eye. Corticosteroid-deposit was excised three month after the injection. The intraocular pressure decreased to normal within one month after surgery and remained normal for seven months after surgery. A 42-year-old man with bilateral chronic recurrent anterior uveitis received a posterior subtenon triamcinolone acetonide injection in both eyes. The patient developed refractory steroid-induced glaucoma one month after the injection in the right eye. Corticosteroid-deposit was excised six months after the injection in the right eye. The patient’s intraocular pressure decreased to normal within two weeks after surgery and remained normal. Light microscopy showed a fibrous capsule encapsulating an amorphous whitish material. The excised specimen with polarized light showed birefringence of triamcinolone crystals within an encapsulated cyst. Conclusions: Removal of subtenon triamcinolone acetonide precipitate may facilitate the management of patients developing increased intraocular pressure unresponsive to maximum tolerable medical therapy and should be considered before performing glaucoma filtration surgery.
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