양측 돔모양황반에서 발생한 단안의 결절맥락막혈관병증 및 반대안의 장액망막박리 1예 = Case of Polypoidal Choroidal Vasculopathy and Serous Retinal Detachment in a Bilateral Dome-shaped Macula

국문 초록 (Abstract)

목적: 양안에 경사유두와 하비측 후포도종이 동반된 돔모양황반이 있는 환자에서 우안의 결절맥락막혈관병증과 좌안의 장액망막박리가 발생하여 우안에 항혈관내피성장인자의 유리체내주입술을 시행한 후 병변이 호전되고 좌안은 자발적으로 호전된 증례를 경험하였기에 이를 보고하고자 한다.
증례요약: 50세 여자가 5일 전부터 발생한 우안의 시력저하로 내원하였다. 안저검사와 빛간섭단층촬영에서 양안에 경사유두와 하비측 후포도종이 동반된 돔모양황반이 관찰되었고, 좌안은 특이 소견이 없었으나 우안은 황반하출혈을 동반한 색소상피박리가 관찰되었다. 인도사이아닌그린혈관조영술에서 우안에 결절로 의심되는 병변과 분지혈관망이 관찰되었다. 우안에 애플리버셉트와 C3F8 가스 유리체내주입술을 시행하고 경과관찰 3달 후 빛간섭단층촬영에서 우안의 망막하출혈은 사라졌고 색소상피박리의 높이는 감소하였다. 이때 시행한 빛간섭단층촬영에서 좌안에 장액망막박리가 관찰되었으나, 1개월 후 장액망막박리는 사라졌으며 이후 재발은 없었다.
결론: 경사유두와 하비측 후포도종을 동반한 돔모양황반에서 결절맥락막혈관병증과 장액망막박리 등이 발생할 수 있으며 이에 대해 적절한 치료가 필요하다.

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of polypoidal choroidal vasculopathy in the right eye which improved after intravitreal injection of anti- vascular endothelial growth factor, and serous retinal detachment (SRD) in the left eye which improved spontaneously in a patient with a bilateral dome-shaped macula (DSM) with a tilted optic disc and inferonasal posterior staphyloma.
Case summary: A 50-year-old female visited our clinic with visual disturbance of the right eye for 5 days. A tilted optic disc with inferonasal posterior staphyloma and DSM were observed in both eyes by fundus examination and spectral domain optical coherence tomography (SD-OCT), and there was no specific finding in the left eye, but pigment epithelial detachment (PED) with subretinal hemorrhage was observed in the right eye. Polyps and branching vascular networks were found using indocyanine green angiography. We performed intravitreal C3F8 gas and aflibercept injection. After 3 months, SD-OCT of the right eye showed no subretinal hemorrhage and diminished PED. SD-OCT of the left eye showed SRD but the SRD disappeared after 1 month. SD-OCT of the left eye showed no recurrence of the SRD.
Conclusions: In a patient with a tilted optic disc and dome-shaped macula, polypoidal choroidal vasculopathy and SRD may occur, so appropriate treatment will be necessary.

참고문헌 (Reference)

• 1 Witmer MT, "Tilted optic disks" 55 : 403-428, 2010
• 2 Ellabban AA, "Three dimensional tomographic features of dome-shaped macula by swept-source optical coherence tomography" 155 : 320-328, 2013
• 3 Errera MH, "The extended clinical phenotype of dome-shaped macula" 252 : 499-508, 2014
• 4 Furuta M, "Submacular choroidal neovascularization at the margin of staphyloma in tilted disk syndrome" 33 : 71-76, 2013
• 5 Cohen SY, "Spectral domain optical coherence tomography analysis of macular changes in tilted disk syndrome" 33 : 1338-1345, 2013
• 6 Pardo-Lopez D, "Serous macular detachment associated with dome-shaped macula and tilted disc" 2 : 111-115, 2011
• 7 Mauget-Faysse M, "Polypoidal choroidal vasculopathy in tilted disk syndrome and high myopia with staphyloma" 142 : 970-975, 2006
• 8 Maruko I, "Morphologic choroidal and scleral changes at the macula in tilted disc syndrome with staphyloma using optical coherence tomography" 52 : 8763-8768, 2011
• 9 Ohsugi H, "Morphologic characteristics of macular complications of a dome-shaped macula determined by swept-source optical coherence tomography" 158 : 162-170, 2014
• 10 Nakanishi H, "Macular complications on the border of an inferior staphyloma associated with tilted disc syndrome" 28 : 1493-1501, 2008
• 11 Kang HM, "Lack of polypoidal lesions in patients with myopic choroidal neovascularization as evaluated by indocyanine green angiography" 157 : 378-383, 2014
• 12 Imamura Y, "Enhanced depth imaging optical coherence tomography of the sclera in dome-shaped macula" 151 : 297-302, 2011
• 13 Gaucher D, "Dome-shaped macula in eyes with myopic posterior staphyloma" 145 : 909-914, 2008
• 14 Mehdizadeh M, "Dome-shaped macula in eyes with myopic posterior staphyloma" 146 : 478-, 2008
• 15 Byeon SH, "Dome-shaped macula" 151 : 1101-, 2011