후천면역결핍증환자에게 발생한 양안 급성폐쇄각녹내장과 삼출맥락막박리
Bilateral Acute Angle Closure Attack and Choroidal Detachment in Patient with Acquired Immune Deficiency Syndrome
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목적: 후천면역결핍증환자에게 발생한 양안 급성폐쇄각녹내장과 삼출성맥락박리 증례를 경험하였기에 이를 보고하고자 한다. 증례요약: 63세 남자환자가 갑자기 발생한 두통, 시력저하로 응급실에 내원하였다. 양안 시력 안전수지, 안압은 49/44 mmHg (우안/ 좌안)였다. 앞방깊이는 각막두께의 3배(중심부), 1/4배(주변)로 측정되었으며, 앞방각경검사에서 양안 모두 폐쇄각이 관찰되었다. 안압하강제 치료에 효과가 없어 응급 우안 백내장수술 및 유리체절제술을 시행하였다. 수술 중에 심한 맥락막박리가 발견되었다. 다음날 맥락막박리는 반대안에서도 관찰되었고 응급 백내장수술과 함께 맥락막상강액 배출술을 시행하였다. 한 달 후 다른 전신 치료 없이 맥락막박리는 호전되었고, 안압은 14/7 mmHg (우안/좌안), 시력은 0.32/0.4 (우안/좌안)였다. 응급실 혈액검사에서 후천면역결핍증후군 양성이 검출되었고 약물치료를 시작하였다. 결론: 후천면역결핍증환자에서 양안 급성폐쇄각녹내장이 삼출맥락막박리와 함께 드물게 발생할 수 있다. 맥락막삼출은 자연적으로 호전될 수 있으나 수술 치료가 필요한 경우 맥락막상강액 배출을 함께 시행하는 것이 추천된다.
Abstract
Purpose: To report a case of simultaneous bilateral acute angle closure attack combined with bilateral choroidal detachment in a patient with acquired immune deficiency syndrome (AIDS). Case Summary: A 63-year-old male who had a history of several months of diarrhea, abdominal pain, and weight loss visited the emergency room with sudden bilateral blurred vision accompanied with headache, periocular pain, nausea, and vomiting. His visual acuity was finger counting in both eyes and the intraocular pressure (IOP) was 49/44 mmHg (right/left). The anterior chamber depth was three times the corneal thickness in the center and less than 1/4 of the corneal thickness in the periphery in both eyes. Maximum medical therapy had no effect and emergency cataract surgery combined with vitrectomy was performed on the right eye. During surgery, severe choroidal detachment was noted. One day after surgery, choroidal detachment was also found in the left eye and emergency cataract surgery with suprachoroidal fluid drainage was performed. Approximately 1 month after surgery, choroidal detachment of both eyes regressed without systemic therapy. The IOP was 14/7 mmHg (right/left) with a visual acuity of 0.32/0.4 (right/left). The blood test performed in the emergency room showed a positive result for AIDS and the patient started medical therapy. Conclusions: In patients with AIDS, bilateral simultaneous acute angle closure attack combined with choroidal detachment may rarely develop. Although choroidal effusion can regress spontaneously, combined suprachoroidal fluid drainage is recommended when a surgical intervention is required.
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