목적: 급성망막괴사 환자에서 Ganciclovir 유리체강내 주입 후 발생한 망막독성 1예를 보고하고자 한다. 증례요약: 56세 남자가 우안 시력저하 및 통증으로 내원하였다. 최대교정시력 0.8, 전방 염증과 다수의 주변부 망막염, 혈관폐쇄, 유리체 혼탁이 관찰되었다. 급성망막괴사로 추정하여 전방수 중합효소 연쇄반응 검사와 aciclovir 2,400 mg/일 정맥주사, ganciclovir 2.0 mg 유리체강내 주입술을 시행하였다. 치료 4일째 병변 악화와 전방수에서 Varicella zoster virus가 확인되었다. Ganciclovir 유리체강내 주입을 주 2회로 증량하였다. 치료 16일째 우안 망막박리 소견으로 두르기공막돌융술, 유리체절제술, 눈속레이저, 실리콘기름 충전술과 ganciclovir 1.0 mg을 유리체강 내에 주입하였다. 수술 다음날 우안 최대교정시력 안전수동이었고, 황반부의 크리스탈 결정 형태 침착물과 다발성 출혈이 관찰되었다. 이후 시력은 회복되지 않았고 황반의 얇아짐이 관찰되었다. 결론: 시력소실은 ganciclovir 망막독성에 의한 것으로 추정되며, 실리콘기름 충전으로 ganciclovir의 국소적 농도가 높아진 것이 원인으로 생각된다.
Purpose: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil. Case summary: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient’s visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned. Conclusions: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.
증례보고
고 찰