초광범위안저촬영술을 이용한 제주도 지역에서의 눈개회충증의 임상양상 분석

The Clinical Characteristics of Ocular Toxocariasis in Jeju Island Using Ultra-wide-field Fundus Photography

목적: 제주도 지역에서의 눈개회충증 환자들을 초광범위안저촬영술을 이용하여 그 임상양상을 분석하고, 치료 후 결과를 보고하고자 한다. 대상과 방법: 임상양상과 혈청학적 검사를 통해 눈개회충증으로 진단된 환자 37명 40안을 후향적으로 분석하였다. 병력 청취와 말초 혈액 검사를 진행하였고, 초광범위안저촬영술과 빛간섭단층촬영을 이용하여 진단 당시 안저소견, 치료 후 시력 및 안저소견의 변화를 평가하였다. 결과: 환자의 평균연령은 57.9세였으며 Toxocara canis IgG의 평균 역가는 1.979 ± 0.486이었다. 안저소견으로 유리체혼탁(63.6%) 과 육아종(60%)의 빈도가 높았으며, 기존의 안저촬영기를 통해 관찰할 수 없는 부위에서 육아종이 관찰된 경우가 15안(62.5%)이었다. 초광범위형광안저혈관조영술 검사상 주변부 혈관누출이 16안(69.6%)에서 동반되었다. 경구 prednisolone과 albendazole 복합 치료를 한 경우, 평균 0.19 ± 0.07 logMAR의 시력 개선을 보였고(p=0.031), 전방내 염증 및 유리체혼탁이 유의하게 호전되었으며, prednisolone 단독 치료에 비해 유의하게 재발률이 낮았다(p=0.049). 결론: 제주도 지역의 눈개회충증 환자들은 혈청 Toxocara canis IgG의 평균 역가가 높았고, 육아종뿐 아니라 유리체혼탁의 빈도가 높았다. 초광범위안저촬영술을 통해 기존의 안저촬영기로 확인할 수 없었던 주변부 병변 및 혈관누출을 확인할 수 있었고, 눈개회충 증의 진단과 치료 후 경과 관찰의 평가에 유용한 검사임을 알 수 있었다. 경구 prednisolone과 albendazole 복합 치료는 염증의 호전과 시력 개선 및 재발률 감소에 효과적이었다. <대한안과학회지 2017;58(5):554-562>

Purpose: To investigate the clinical features and treatment outcomes of ocular toxocariasis in Jeju Island using ultra-wide-field fundus photography. Methods: We retrospectively reviewed the medical records of 40 eyes of 37 patients who were diagnosed with ocular toxocariasis based on clinical aspects and serologic tests. The quality of history-taking was assessed and peripheral blood samples were analyzed. Ocular characteristics were evaluated using ultra-wide-field fundus photography and optical coherence tomography. Changes in visual acuity and funduscopic findings after treatment were also analyzed. Results: The average age of the patients was 57.9 years and the mean Toxocara canis IgG titer was 1.979 ± 0.486. The most common fundus findings were vitreous opacity (63.6%) and granuloma (60%). Granulomas that were not initially observed within the field of view of conventional fundus photography were found using ultra-wide-field imaging in 15 eyes (62.5%). Ultra-wide-field fluorescein angiography showed peripheral vascular leakage in 16 eyes (69.6%). Treatment with oral prednisolone and albendazole resulted in average vision improvements of 0.19 ± 0.07 logMAR (p = 0.031) as well as significant improvements in anterior chamber inflammation and vitreous opacity. Combination therapy led to a significantly lower recurrence rate than prednisolone monotherapy (p = 0.049). Conclusions: In Jeju Island, the mean Toxocara canis IgG titer of ocular toxocariasis was high. The incidences of vitreous opacity and granulomas were also high. Ultra-wide-field fundus imaging was useful for finding peripheral retinal lesions and peripheral vascular leakage that were not observed within the field of view of conventional fundus photography. Ultra-wide-field fundus imaging was valuable not only during clinical diagnosis, but also on follow-up evaluations of ocular toxocariasis. Treatment with oral prednisolone and albendazole effectively improved ocular inflammation and visual acuity and helped reduce the recurrence rate. J Korean Ophthalmol Soc 2017;58(5):554-562