Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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Bilateral Delayed Nonarteritic Anterior Ischemic Neuropathy Following Acute Primary Angle-closure Crisis

양안 급성 폐쇄각녹내장 환자에서 발생한 양안 지연 비동맥염 앞허혈시신경병증 1예

  • Park, Eun Jung (Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Chun, Yeoun Sook (Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Moon, Nam Ju (Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine)
  • 박은정 (중앙대학교 의과대학 중앙대학교병원 안과학교실) ;
  • 전연숙 (중앙대학교 의과대학 중앙대학교병원 안과학교실) ;
  • 문남주 (중앙대학교 의과대학 중앙대학교병원 안과학교실)
  • Received : 2018.07.05
  • Accepted : 2018.10.18
  • Published : 2018.11.15
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Abstract

Purpose: We report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) following acute angle-closure crisis (AACC). Case summary: A 76-year-old female visited our clinic because of a 1-day history of ocular pain and vision loss in both eyes. The visual acuity was 0.02 in both eyes and her intraocular pressure (IOP) was 52 mmHg in the right eye (RE) and 50 mmHg in the left eye (LE). She had corneal edema and a shallow anterior chamber in both eyes, with 4 mm fixed dilated pupils. After decreasing the IOP with intravenous mannitol, laser iridotomy was performed. However, 2 days later, visual acuity was further reduced to finger counting at 10 cm RE and at 50 cm LE, and her optic disc was swollen. Bilateral NAION following AACC was diagnosed. One month later, visual acuity slightly improved to 0.02 RE and 0.04 LE, and the optic disc edema resolved. A small cup-disc ratio, optic disc pallor, and atrophy were observed. Humphrey visual fields demonstrated superior and inferior altitudial visual field defects in the LE, and almost total scotoma in the RE. Conclusions: AACC can be a predisposing factor for NAION, so the relative afferent pupillary defect, papilledema, and presentation of other risk factors are important clues to a diagnosis of NAION.

목적: 양안 급성 폐쇄각녹내장 후 발생한 양안 비동맥염 앞허혈시신경병증 1예를 보고하고자 한다. 증례요약: 76세 여자 환자가 하루 전 시작된 양안 통증 및 시력저하로 방문하였다. 양안 시력 0.02, 안압은 우안 52 mmHg, 좌안 50 mmHg, 양안 각막부종과 얕은 전방이 관찰되었으며, 동공은 4 mm로 고정되어 있었다. 만니톨 주사로 안압하강 시킨 후 양안 레이저홍채절개술을 시행하였다. 그러나 2일 후 시력은 우안 안전수지 10 cm, 좌안 안전수지 50 cm로 더 감소되었고 양안 시신경 유두부종이 관찰되었다. 양안 급성 폐쇄각녹내장 후 발생한 비동맥염 앞허혈시신경병증으로 진단하고 경과관찰하였다. 한 달 뒤, 시력은 우안 0.02, 좌안 0.04로 약간 호전되었고, 양안 시신경 유두부종은 사라졌다. 매우 작은 유두함몰비와 시신경 창백과 위축이 관찰되었으며, 표준자동시야검사상 우안은 완전시야결손, 좌안에 상하 수평시야결손이 관찰되었다. 결론: 급성 폐쇄각녹내장이 비동맥염 앞허혈시신경병증의 선행 위험인자가 될 수 있으며, 구심동공운동장애와 유두부종, 다른 위험인자의 동반이 있는 경우 비동맥염 앞허혈시신경병증의 동반 가능성을 고려해야 한다.

Keywords

References

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