삼출성 황반변성에서 이중 망막색소상피파열 및 출혈성 망막박리 후 발생한 급성폐쇄각발작

Angle-closure Attack after Retinal Pigment Epithelium Double-tear and Hemorrhagic Retinal Detachment in Exudative Macular Degeneration

목적: 거대망막색소상피박리가 동반된 삼출성 황반변성에서 유리체강내 주사 후 이중 망막색소상피파열이 발생하였고 출혈성 망막박리와 급성폐쇄각발작을 치료하였기에 이를 보고하고자 한다. 증례요약: 66세 여자가 1달 전부터 시작된 좌안의 시력저하를 주소로 내원하였다. 빛간섭단층촬영과 인도시아닌그린혈관조영술에서 거대망막색소상피박리를 동반한 삼출성 황반변성으로 진단하고 유리체강내 애플리버셉트주입술을 1차 시행하였다. 주사 2주 후 망막색소상피파열이 발생, 이후 2차 주사 4주 후 망막색소상피파열의 범위가 황반부를 포함하여 확대되었다. 3차 주입술 3개월 후 대량의 황반하출혈이 발생하여 4차 주사 시행, 3일 후 안압 60 mmHg 상승과 전방각 폐쇄, 수정체 후면에 접촉되는 출혈성 장액망막박리가 발생하였다. 공막절개술을 이용한 망막하출혈과 망막하액의 배액을 시행하였고, 이후 안압하강과 망막박리의 감소 소견이 보여 경과 관찰 중이다. 결론: 삼출성 황반변성에서 유리체강내 주사 후 이중 망막색소상피파열로 진행되는 경우는 매우 드물다. 이중 망막색소상피파열에서 출혈성 망막박리로 발생한 급성폐쇄각발작으로 안압상승을 경험하고 이를 치료하였기에 보고하고자 한다.

Purpose: To report a case of acute angle-closure attack resulting from hemorrhagic retinal detachment after a double retinal pigment epithelium (RPE) tear in exudative age-related macular degeneration (AMD) with large pigment epithelial detachment (PED). Case summary: A 66-year-old female visited with a complaint of poor vision in left eye, which began 1 month prior. She was diagnosed with exudative AMD with a large PED using optical coherence tomography and indocyanine green angiography. Intravitreal aflibercept injection was performed. The RPE tear occurred at 2 weeks after the intravitreal anti-vascular endothelial growth factor injection for AMD, after which the range of the RPE tear expanded and included the macular area at 4 weeks after the second injection. At 3 months after the third injection, massive submacular hemorrhage occurred; aflibercept injection was repeated. At 3 days after the fourth injection, the patient’s intraocular pressure (IOP) was 60 mmHg, and massive hemorrhagic serous retinal detachment and anterior movement of the lens with total angle closure were observed. Therefore, we performed a sclerotomy; a large amount of dark blood and subretinal fluid was drained. The IOP decreased, and the retinal detachment improved somewhat. The patient was kept under observation for careful monitoring of her condition. Conclusions: It is very rare to experience a double RPE rupture after intravitreal anti-vascular endothelial growth factor injection in AMD. We report on our experience and treatment of acute angle-closure attack. The IOP increased due to hemorrhagic retinal detachment after a double RPE tear over the treatment course.