경추수술 후 발생한 뒤허혈시신경병증 1예

Posterior Ischemic Optic Neuropathy after Cervical Spine Surgery

목적: 경추수술 후 발생한 뒤허혈시신경병증에서 치료 후 호전된 증례를 보고하고자 한다. 증례요약: 51세 여자가 복와위로 경추수술을 시행하고 8시간 뒤부터 시작된 좌안 통증과 좌안 시력저하로 의뢰되었다. 최대교정시력은 우안 1.0, 좌안 안전수동이었고, 좌안에 상대구심동공운동장애가 관찰되었다. 눈운동장애는 없었으나 좌안 통증을 호소하였다. 양안 모두 세극등검사, 안저검사, 형광안저조영술과 빛간섭단층촬영에서 특이 소견은 관찰되지 않았다. 뇌와 안와 자기공명영상검사에서 시각 경로에 뇌경색이나 뇌혈관 협착 등의 소견은 관찰되지 않았다. 혈액검사에서 헤모글로빈 9.9 g/dL로 수술 전 14.7 g/dL보다 현저히 감소한 소견을 보여 농축적혈구를 수혈하고, 경정맥 고용량스테로이드와 경피적 에포에틴알파(Epoetin alfa)를 투여하였다. 치료 3주 후 좌안 최대교정시력은 0.9로 호전되었다. 결론: 복와위로 시행한 경추수술 후 발생한 단안 뒤허혈시신경병증에서 적혈구 수혈, 경정맥 고용량 스테로이드 및 경피적 에포에틴알파 치료 후 호전되었다.

Purpose: To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment. Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye. Conclusions: Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection. J Korean Ophthalmol Soc 2021;62(10):1449-1454