급성 특발성 맹점확대증후군 소견을 나타내는 급성 대상잠재성 외망막병증
A Case Report of Acute Zonal Occult Outer Retinopathy Showing Acute Idiopathic Blind Spot Enlargement
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목적: 급성 특발성 맹점확대 소견을 나타내는 급성 대상잠재성 외망막병증 환자를 대상으로 인도사이아닌그린 혈관조영술, 다초점 망 막전위도 검사, spectral domain-OCT (SD-OCT) 소견에 대해 알아보았다. 증례요약: 좌안에 5일간의 광시증과 시야장애를 나타낸 31세 여성을 대상으로한 검사에서 안저, 형광안저혈관조영술, 전체망막전위도 검사 및 전신검사, 신경학적 검사상 정상소견을 나타내었으나, 후기 인도사이아닌그린 혈관조영술상 다수의 저형광 점들이 나타나고, 자동시야검사상 맹점의 확대 및 다양한 암점소견이 나타나며, 시야장애에 부합되는 망막영역에 다초점 망막전위도 검사상 진폭감소 및 SD-OCT상 시세포의 inner, outer segment 경계부의 손상을 확인할 수 있었다. 급성 대상잠재성 외망막병증 진단하에 치료없이 경과관찰 후 맹점확대 증상을 포함하여 모든 검사에서 3개월 후에 정상소견으로의 회복을 보였으나, 다초점 망막전위도상 진폭감소는 일부 지속되었다. 결론: 인도사이아닌그린 혈관조형술, 다초점 망막전위도 및 SD-OCT 검사는 맹점확대 증상을 나타내는 급성 대상잠재성 외망막병증의 진단에 도움이 될 수 있을 것이다.
Abstract
Purpose: To present a case of acute zonal occult outer retinopathy (AZOOR) with acute idiopathic blind spot enlargement (AIBSE) investigated using indocyanine green angiography (ICGA), multifocal electroretinography (multifocal ERG) and spectral domain-OCT (SD-OCT). Case summary: A healthy 31-year-old female with photopsia and a five-day visual field defect in her left eye showed no abnormal findings in ocular examinations such as slit lamp and fundus examination, fluorescein angiography (FAG), or full field ERG as well as in the systemic neurologic examination. In the late phase of ICGA, there were multiple hypofluorescent spots around the optic disc and scattered through the posterior pole. The patient showed an amplitude decrease of multifocal ERG and the destruction of the boundary between the inner and outer segments of the photoreceptors in the SD-OCT examined in the retinal area corresponding to the visual field defect. The patient was diagnosed with AZOOR and was followed-up without treatment. After three months, no abnormal SD-OCT or visual field test findings were observed and no symptoms remained; however, a slightly depressed response on multifocal ERG was present. Conclusions: ICGA, multifocal ERG and SD-OCT could be useful methods to detect AZOOR with EBS.
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