소아 환자에서 녹색광 레이저 포인터로 인해 발생한 비전형적 절박황반원공을 유리체절제술로 치료한 1예 = A Case of Green Laser Pointer-induced Atypical Impending Macular Hole Treated with Vitrectomy in a Pediatric Patient

국문 초록 (Abstract)

목적: 소아 환자에서 녹색광 레이저 포인터가 눈에 조사된 후 발생한 비전형적 절박황반원공을 유리체절제술로 치료한 증례를 경험하여 이를 보고하고자 한다.
증례요약: 13세 여자 환자가 녹색광 레이저 포인터를 눈에 조사한 후 발생한 우안의 시력저하 및 상측 시야결손을 주소로 내원하였다. 수상 당일 우안의 교정시력은 0.1이었고 광각안저촬영 및 빛간섭단층촬영에서 중심와를 침범한 망막앞출혈과 내경계막하출혈이 확인되었다. 특별한 치료 없이 경과관찰 하던 중 수상 후 4개월째 빛간섭단층촬영에서 망막앞출혈과 내경계막하출혈은 소실되었으나 새롭게 발생한 비전형적 절박황반원공이 관찰되었다. 내경계막이 원공을 덮은 채로 보존되어 원공의 자연폐쇄를 기대하고 경과관찰을시행하였으나 수상 후 8개월째 빛간섭단층촬영에서 황반원공의 기저직경이 증가된 소견을 보였다. 이에 우안 유리체절제술, 내경계막제거술 및 유리체강 내 과불화프로판가스 주입술을 시행하였으며, 수술 후 1개월째 빛간섭단층촬영에서 황반원공은 해부학적으로 폐쇄된 소견이 관찰되었고 교정시력은 0.8로 회복되었다.
결론: 소아 환자에서 녹색광 레이저 포인터가 눈에 조사된 후 발생한 망막의 출혈은 자연적으로 흡수될 수 있으나 이후 황반원공이발생할 수 있다. 이러한 절박황반원공에 대해 유리체절제술을 이용한 수술적 치료로 효과적인 해부학적 폐쇄 및 시력의 호전을 이룰수 있다.

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of atypical impending macular hole induced by green laser pointer in a pediatric patient treated with vitrectomy.
Case summary: A 13-year-old patient visited our clinic complaining of decreased visual acuity and upper visual field defect in the right eye after exposure to a green laser pointer. Her best corrected visual acuity was 20/200 in the right eye. Ultra-widefield fundus photography and optical coherence tomography showed pre-retinal hemorrhage and sub-internal limiting membrane hemorrhage involving the fovea. After 4 months of follow-up, the retinal hemorrhage was spontaneously resolved, however, atypical impending macular hole with intact overlying internal limiting membrane was observed on optical coherence tomography in the right eye. Regular follow-up was performed for spontaneous macular hole closure. After 8 months of follow-up, the base diameter of the macular hole increased on optical coherence tomography, accordingly, pars plana vitrectomy, internal limiting membrane peeling, and intravitreal perfluoropropane gas injection were performed in the right eye. After 1 month of the surgery, the macular hole was successfully closed and the best corrected visual acuity was 20/25 in the right eye.
Conclusions: In pediatric patient, retinal hemorrhage can be caused by green laser pointer, which may be spontaneously resolved. However, delayed macular hole can occur, and surgical intervention might be helpful for successful anatomical closure and recovery of visual acuity.

참고문헌 (Reference)

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