황반부 망막박리를 동반한 소아의 시신경유두소와에서 수술 후 발생한 황반원공 1예
Case of Macular Hole after Surgery in Macular Detachment with Optic Disc Pit in a Child
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목적: 시신경유두소와에 의한 황반부 장액망막박리가 발생한 소아환자에서 유리체절제술 후 발생한 황반원공을 실리콘 기름을 안내충전물로 이용해 치료한 증례를 보고하고자 한다. 증례요약: 12세 남자 환자가 내원 1주전 발생한 좌안 시력 저하를 주소로 내원하였다. 내원 당시 좌안 교정시력은 0.08, 안과적 검사상 좌측 전안부에는 특이소견 없었으며, 황반부 장액망막박리를 동반한 시신경유두소와로 진단되어 유리체절제술, 내경계막 제거술및 가스주입술을 시행하였다. 수술 1주 후 좌안 중심부 시력저하 호소하였으며 전층 황반원공이 발생하였다. 내경계막 확장제거술 및실리콘 기름 주입술 시행하였으며, 2개월 후 실리콘 기름 제거술 시행 후 황반원공 소실 및 좌안 교정시력 0.2로 향상되었고, 술 후20개월까지도 재발되지 않았다. 결론: 소아에서 동반된 시신경유두소와에 의한 황반부 망막박리에서 수술적 치료 후 황반원공이 발생할 수 있으므로 주의하여야 하고,이에 대한 치료로 실리콘 기름 주입과 빠른 제거술이 유용한 치료법이 될 수 있을 것으로 생각한다.
Abstract
Purpose: To report a case of macular hole after surgery in macular serous detachment associated with optic disc pit in a child, which was treated with silicone oil as an intraocular substitute. Case summary: A 12-year-old boy was referred for examination due to visual disturbance in his left eye for the last 1 week. Corrected visual acuity at presentation was 0.08 in the left eye. The anterior part of the left eye was normal on slit lamp examination. Funduscopic examination revealed optic disc pit associated with macular detachment. The patient was treated with vitrectomy, internal limiting membrane (ILM) peeling and gas tamponade. One week after treatment, the patient presented with central visual disturbance and showed a full thickness macular hole in the left eye. Extensive ILM peeling and silicone oil instillation were performed and after 2 months, silicone oil removal was performed. The macular hole appeared to be closed and visual acuity improved to 0.2. Recurrence was not observed until 20 months after treatment. Conclusions: After surgical treatment due to macular detachment associated with optic disc pit in a child, occurrence of a macular hole is possible. Regarding macular hole treatment, silicone oil instillation and fast removal could be a beneficial option.
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