습성연령관련황반변성 환자에서 애플리버셉트 유리체내주사 후 발생한 전층황반원공 1예

Full-thickness Macular Hole after Intravitreal Aflibercept Injection in a Patient with Wet Age-related Macular Degeneration

목적: 습성연령관련황반변성 환자에서 애플리버셉트 유리체내주사 후 발생한 황반원공 1예를 보고하고자 한다. 증례요약: 70세 남자 환자가 서서히 진행되는 좌안 시력저하를 주소로 내원하였다. 최대교정시력은 우안 0.8, 좌안 0.2였다. 안저검사, 형광안저혈관조영술 및 빛간섭단층촬영에서 잠복맥락막신생혈관과 망막하액이 관찰되었다. 좌안에 수차례 라니비주맙과 베바시주맙 유리체내주사를 시행받고 반응이 없어서 애플리버셉트 유리체내주사를 시행하였다. 애플리버셉트 유리체내주사 1개월 후 최대교정시력은 0.05로 저하되었으며 안저검사에서는 명확하지는 않으나 빛간섭단층촬영에서 전층황반원공이 발견되었다. 좌안 평면부 유리체절제술, 내경계막벗김술, 액체공기교환술, 20% SF6 가스 주입술, 수정체초음파유화술 및 인공수정체삽입술을 시행하였다. 수술 후 1개월째 좌안최대교정시력은 0.2였고, 빛간섭단층촬영에서 황반원공이 폐쇄된 것을 확인하였다. 결론: 습성연령관련황반변성에 동반된 맥락막신생혈관에 대하여 애플리버셉트 유리체내주사는 드물지만 황반원공을 발생시킬 수 있어 이를 유의해야 하겠다. <대한안과학회지 2017;58(7):875-878>

Purpose: To report a case of full-thickness macular hole following intravitreal aflibercept injection in a patient with wet age-related macular degeneration (AMD). Case summary: A 70-year-old man presented to our department with gradually decreasing vision in his left eye. Best-corrected visual acuity was measured as 0.8 in the right eye and 0.2 in the left eye. Fundus examination, fluorescein angiography, and optical coherence tomography (OCT) showed occult choroidal neovascularization associated with subretinal fluid in the left eye. The patient received several intravitreal ranibizumab and bevacizumab injections in his left eye but responded poorly to the treatment. The patient was switched to intravitreal aflibercept injection. After 1 month, the best corrected visual acuity in the left eye was decreased to 0.05. Although the fundus examination was indistinct, OCT confirmed the presence of a full-thickness macular hole. The patient underwent pars plana vitrectomy with internal limiting membrane peeling and fluid-gas exchange, 20% SF6 gas injection, phacoemulsification, and posterior chamber intraocular lens implantation. One month after the operation, the best corrected visual acuity was 0.2. The macular hole was closed completely, as confirmed by OCT. Conclusions: Although the occurrence of a full-thickness macular hole after intravitreal aflibercept injection in the treatment of choroidal neovascularization with wet AMD is uncommon, physicians should pay attention for this complication. J Korean Ophthalmol Soc 2017;58(7):875-878