거대세포바이러스망막염에서 10회 이상 시행한 유리체강내 간시클로버 주입술의 효과와 안전성 = Safety and Efficacy of Intravitreal Ganciclovir Injections More than 10 Times for Cytomegalovirus Retinitis

국문 초록 (Abstract)

목적: 거대세포바이러스망막염에서 전신 항바이러스제 치료 없이 시행한 10회 이상의 유리체강내 ganciclovir 주입술의 안전성과 치료 효과에 대해 알아보고자 한다.
증례요약: 침습성 흉선종, 진성 적혈구계무형성증으로 스테로이드와 cyclosporine을 복용 중인 64세 남자 환자, 미만성 큰B세포 림프종 진단하에 항암치료를 진행하던 60세 여자 환자, 급성골수성백혈병으로 골수이식 시행 후 경구 스테로이드를 복용 중이던 49세남자 환자, 피부근염으로 장기간 경구 스테로이드와 cyclosporine 복용 중이던 29세 여자 환자, 베체트병과 양안 전포도막염으로 유리체강내 덱사메타존 임플란트, 유리체강내 및 테논낭하 트리암시놀론 주입술을 시행하던 47세 여자 환자, 총 5명의 환자에게서 발생한 거대세포바이러스망막염의 치료를 위해 유리체강내 ganciclovir 주입술을 시행하였다. 환자들은 범혈구감소증 등의 합병증으로 전신 항바이러스 제제를 사용하기 어려운 상태였으며 이에 유리체강내 ganciclovir 주입술 단독 요법으로 치료를 진행하였다. 황반부가 침범된 한 예를 제외하고는 모든 환자에게서 시력 호전과 함께 망막 병변의 호전 소견을 관찰할 수 있었다. 주입술 시행 중과 시행 후 경과 관찰 기간 동안 합병증은 발견되지 않았다.
결론: 유리체강내 ganciclovir 주입술은 전신 항바이러스제 치료가 불가능한 거대세포바이러스 망막염 환자에게서 10회 이상 반복시행하여도 효과적이고 안전한 치료가 될 수 있다.

다국어 초록 (Multilingual Abstract)

Purpose: To study the treatment outcomes in patients who were administered multiple intravitreal ganciclovir injections more than 10 times alone without systemic anti-cytomegalovirus therapy for cytomegalovirus retinitis.
Case summary: A 64-year-old man who underwent immunosuppressive therapy after thymectomy due to an invasive thymoma and pure red-cell aplasia, a 60-year-old woman who underwent chemotherapy after diagnosis of diffuse large B-cell lymphoma, a 49-year-old man with a history of bone marrow transplantation due to acute myeloid leukemia, a 29-year-old woman with dermatomyositis treated with oral steroids and cyclosporine, and a 47-year-old woman who received intravitreal dexamethasone implant injections, intravitreal and subtenon steroid injections due to Behcet's disease were diagnosed with cytomegalovirus retinitis. All patients showed systemic complications such as pancytopenia after systemic anti-cytomegalovirus therapy, and therefore, they were administered multiple intravitreal ganciclovir injections alone. Best-corrected visual acuities improved in all patients, except in one case, where viral lesions were observed in the fovea. Retinal hemorrhaging and infiltrative lesions decreased
in all patients. No severe complication was observed during the injection and in the follow-up period.
Conclusions: Multiple intravitreal ganciclovir injections alone can be used as a treatment modality for cytomegalovirus retinitis to avoid the systemic side effects of systemic anti-cytomegalovirus therapy.

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