중심망막동맥폐쇄로 진단된 환자들의 장기 임상결과와 예후 인자

황재형,임수현,김철구,김종우,김재휘 한국망막학회 2021 Journal of Retina Vol.6 No.1

Purpose: To evaluate long-term clinical outcomes of patients with central retinal artery occlusion and to investigate factors associated with visual recovery. Methods: This retrospective study was performed on 31 patients with central retinal artery occlusion. The patients were divided into 3 groups according to degree of vascular occlusion: incomplete, subtotal, total. Visual acuity was classified as finger counting or worse, 0.02 or better and worse than 0.1, and 0.1 or better. The proportions of patients in these 3 groups at diagnosis were compared to those at the final follow-up. In addition, factors associated with visual recovery were investigated. Results: The mean follow-up period was 40.0 ± 22.0 months. According to degree of vascular occlusion, 10 patients were incomplete, 17 were subtotal, and 4 were total. During the follow-up period, visual acuity was recovered in 14 patients, maintained in 6, and deteriorated in 11. At diagnosis, visual acuity was finger counting or worse in 77.4% of patients, 0.02 or better and worse than 0.1 in 22.6%, and 0.1 or better in 0. At the final visit, these proportions changed to 58.1%, 22.6%, and 19.4% (p = 0.013), respectively. Visual recovery was limited with greater degree of occlusion (p = 0.004). Conclusions: During the follow-up period, visual recovery was noted in 45% of patients with central retinal artery occlusion. Degree of vascular occlusion was identified as a factor predictive of visual recovery. 목적: 중심망막동맥폐쇄 환자의 장기 임상 결과를 확인하고 시력회복과 연관된 인자들을 분석하고자 하였다. 대상과 방법: 중심망막동맥폐쇄로 진단받은 31안을 대상으로 후향적 연구를 시행하였다. 전체 환자를 혈관폐쇄 정도에 따라 불완전폐쇄, 부분폐쇄, 전체폐쇄의 세 군으로 구분하였다. 시력을 안전수지 이하, 0.02 이상/0.1 미만, 0.1 이상의 세 군으로 구분하여 진단 및최종추적 관찰 시 각 군의 비율 차이를 확인하였다. 추가적으로 시력회복과 관련된 인자들을 분석하였다. 결과: 평균 추적 관찰 기간은 40.0 ± 22.0개월이었으며, 불완전폐쇄 10명, 부분폐쇄 17명, 전체폐쇄 4명이었다. 추적 관찰 중 14명에서 시력이 회복되었다. 진단 당시의 시력은 안전수지 이하가 77.4%, 0.02 이상/0.1 미만이 22.6%, 0.1 이상은 없었으며, 최종추적 관찰 시에는 각각 58.1%, 22.6%, 19.4%였다(p = 0.013). 혈관폐쇄 정도가 심할수록 시력회복이 제한되는 결과를 보였다(p = 0.004). 결론: 중심망막동맥폐쇄를 추적 관찰한 결과 약 45%에서 시력회복이 나타났다. 혈관폐쇄의 정도는 장기 시력회복을 예측할 수 있는인자였다.

망막중심동맥폐쇄에 합병된 망막신생혈관의 유리체강 내 아바스틴 주입술에 의한 치험 1예

최현준(Hyun Joon Choi),최경섭(Kyoung Sub Choi) 대한검안학회 2008 Annals of optometry and contact lens Vol.7 No.1

목적: 중심망막동맥폐쇄에 합병된 망막혈관신생 소견을 보인 환자의 유리체강 내 아바스틴??(Bevacizumab) 주입술 시행 후 망막신생혈관의 퇴행을 경험하였기에 보고하고자 한다. 대상과 방법: 특이 과거력 없는 71세 남자 환자가 양안의 시력저하(안전수지)를 주소로 내원하였다. 안저검사상 양안 후극부에 황반부를 중심으로 망막의 혼탁 및 혈류장애 소견 보였으나, 전형적인 중심와 앵두반점은 보이지 않았다. 형광안저촬영상 양안 동정맥 통과 시간의 지연 및 우안 망막혈관신생 부위의 형광누출이 관찰되었다. 발병 2개월째 우안 안저검사상 유리체출혈 및 악화된 혈관신생 소견 보여, 유리체강 내 아바스틴?? 주입술을 시행하였다. 결과: 주입술 후 3주째, 우안의 유리체 출혈 감소되었고, 형광안저촬영상 혈관신생의 퇴행 소견 보였다. 결론: 유리체강 내 아바스틴?? 주입술은 중심망막동맥폐쇄에 합병된 망막 혈관신생에 있어서 고려할 수 있는 안전하고 효과적인 방법으로 생각한다. Purpose: To report a case of regression of retinal neovascularization following central retinal artery occlusion with a single intravitreal injection of avastin?? (bevacizumab). Methods: A 71-year-old man without significant past medical history visited our clinic because of diminished vision in his both eyes (count-finger vision). Fundus examination showed retinal opacification on the posterior pole around the center of the macula with significant reduction of the retinal circulation, but there is no cherry-red spot at the fovea. Fluorescein angiography revealed marked delay in arteriovenous transit time in both eyes, and leakage from retinal neovascularization in the right eye. Five months after the occlusion, fundus examination of the right eye showed vitreous hemorrhage and increased retinal neovascularization. We performed intravitreal avastin?? injection. Results: After three weeks, there was decreased vitreous hemorrhage and regression of neovascularization on fluorescein angiography in the right eye. Conclusions: Our experience suggests that intravitreal avastin?? injection may be a safe and effective alternative to conventional therapeutic procedures for retinal neovascularization with central retinal artery occlusion.

Intra-arterial Thrombolysis for Central Retinal Artery Occlusion after the Coil Embolization of Paraclinoid Aneurysm

Minwook Yoo,Sung-Chul Jin,Hae Yu Kim,최병삼 대한뇌혈관외과학회 2016 Journal of Cerebrovascular and Endovascular Neuros Vol.18 No.4

The most common complication of coil embolization for cerebral aneurysms is thrombo-embolic stroke; in rare cases, these strokes, can present with central retinal artery occlusion. At our institution, a 53-year-old woman underwent stent-assisted coiling of the aneurysm. The patient's vision was improved immediately after intra-arterial thrombolysis and had further improved 8 months later. This report describes our experience of a rare case of central retinal artery occlusion after coil embolization that was successfully treated by intra-arterial thrombolysis.

편측성 중심망막동맥폐쇄 환자에서 맥락막 두께의 시간에 따른 변화

김동익,황덕진 한국망막학회 2021 Journal of Retina Vol.6 No.2

Purpose: To investigate the changes in the choroidal thickness of patients with central retinal artery occlusion (CRAO) over time and compare it with the changes in the fellow eye. Methods: Medical records were retrospectively reviewed for patients diagnosed with CRAO from November 2014 to May 2020. The central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) were measured at the time of diagnosis and at 1, 3, 6, and 12 months after diagnosis using optical coherence tomography and compared with the values of the fellow eye. Results: This study included 32 patients, and the mean age was 76.3 ± 10.0 years. When classified according to the degree of obstruction, seven patients presented incomplete occlusion, 21 patients presented partial occlusion, and four patients presented total occlusion. At diagnosis, the CFT of the eye with CRAO was thicker than that of the fellow eye (p = 0.017). It decreased continuously from 1 month to 12 months after diagnosis. The SFCT at baseline and 12 months after diagnoses did not differ significantly. However, from the time of diagnosis to 12 months after diagnosis, the decrease in the SFCT was greater in the eye with CRAO than in the fellow eye (p = 0.018). Conclusions: The SFCT of the eye with CRAO significantly decreased 12 months after diagnosis, and this reduction was more than that in the fellow eye. 목적: 중심망막동맥폐쇄 환자의 맥락막 두께의 변화를 시간에 따라 분석하고 반대안과 비교하여 살펴보고자 하였다. 대상과 방법: 2014년 11월부터 2020년 5월까지 중심망막동맥폐쇄로 진단받은 환자들을 대상으로 의무기록을 후향적으로 분석하였다. 빛간섭단층촬영을 이용하여 진단 시와 진단 후 1, 3, 6, 12개월 추적 관찰 시의 중심황반 두께, 중심와 아래 맥락막 두께를 측정하였고, 반대안과 그 값을 비교하였다. 결과: 총 32명이 포함되었으며 평균 연령은 76.3 ± 10.0세였고 폐쇄 정도에 따라 분류하였을 때 불완전폐쇄 7명, 부분폐쇄 21명, 전체폐쇄 4명이었다. 진단 시 중심황반 두께는 반대안에 비하여 두꺼웠으며(p = 0.017) 진단 후 1개월부터 12개월까지 지속해서 감소하였다. 진단 시와 진단 후 12개월에 중심와 아래 맥락막 두께는 양안 간에 차이가 없었으나 12개월 동안 중심와 아래 맥락막 두께의 감소량은 중심망막동맥폐쇄가 발생하였던 눈에서 반대안에 비하여 컸다(p = 0.018). 결론: 중심망막동맥폐쇄가 발생한 눈의 중심와 아래 맥락막 두께는 12개월 경과 관찰하였을 때 유의하게 감소하였고, 반대안에 비하여더 많은 양이 감소하였다.

안와농양과 동반된 중심망막동맥 폐쇄 1예

김영승,백승국,하명숙,Young Seung Kim,MD,Seung Kook Baek,MD,Myung Sook Ha,MD 대한안과학회 2012 대한안과학회지 Vol.53 No.10

Purpose: To report a case of rapidly progressed orbital abscess after central retinal artery occlusion. Case summary: A 60-year-old man with right periorbital pain and edema starting 3 days earlier visited the hospital. His first visual acuity was 1.0 for the right eye with peripheral edema and tenderness; severe hemorrhagic chemosis, proptosis (approximately 3 mm) and extraocular motility limitation were also observed. According to the CT findings, a 2.5 × 1 cm-sized encapsulated cystic mass was found in the right orbital cavity, along the medial orbital wall; with a diagnosis of orbital abscess, he was hospitalized with systemic antibiotic treatment and abscess drainage. On the second day of hospitalization, the best corrected visual acuity was reduced to light perception, and relative afferent pupillary defect, pale retina and cherry red spot were found. Therefore, emergent incisional drainage, optic massage, and antibiotics were given to the patient. Immediately after the surgery, the peripheral edema and proptosis improved; nevertheless, central retinal artery occlusion did not resolve and vision did not improve. Two months later, best corrected visual acuity for the right eye was counting fingers and central retinal artery occlusion showed no further improvement. Conclusions: No case report on rapidly progressing orbital abscess has been proposed in Korea to date. In the case of rapidly progressed orbital abscess, incisional drainage and antibiotics should be administered promptly. J Korean Ophthalmol Soc 2012;53(10):1523-1527

Intra-arterial Thrombolysis for Central Retinal Artery Occlusion: Two Cases Report

황교준,우세준,박규형,황정민,권오기 대한의학회 2010 Journal of Korean medical science Vol.25 No.6

Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Retina is a part of the brain, thus basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Therefore, intra-arterial thrombolysis (IAT) has been considered as a treatment method in CRAO. Recently, we treated 2 patients diagnosed as CRAO and could achieve complete recanalization on fundus fluorescein angiogram with IAT. Of them, one recovered visual acuity to 20/25. We report our 2 CRAO cases treated with IAT and discuss technical aspects for IAT and management of patient. To the best of our knowledge, this is the first Korean report of IAT for CRAO.

증례보고 : 안와농양과 동반된 중심망막동맥 폐쇄 1예

김영승 ( Young Seung Kim ),백승국 ( Seung Kook Baek ),하명숙 ( Myung Sook Ha ) 한국안전학회(구 한국산업안전학회) 2003 International Journal of Safety Vol.2 No.1

목적: 급격히 진행된 안와농양과 동반된 중심망막동맥 폐쇄 1예를 보고하고자 한다. 증례요약: 60세 남환이 3일 전부터 발생한 우측 안와 주위 통증 및 부종을 주소로 내원하였다. 우안 나안시력은 1.0이었으며 우안안압은 37 mmHg로 증가되어 있었고 3 mm의 우측 안구 돌출소견과 안구운동 장애를 보였다. 안와 전산화 단층 촬영에서 우측 안와내측의 2.5×1 cm 크기의 격막이 있는 낭성 종괴가 관찰되어 안와 농양 진단하에 전신 항생제 및 배농치료 위해 입원하였다. 입원2일째 우안 안압은 18 mmHg로 감소되었으나 우측 안와 주위 종창 및 발적은 지속되었고 우안 교정시력은 광각으로 감소하였으며 상대적 구심성 동공장애 및 창백해진 망막과 앵두반점 소견 관찰되어 응급 절개 배농술 및 안구마사지를 시행 후 전신 항생제 치료 유지하였다. 술 후 안와 주위 부종 및 안구돌출은 개선되었으나 중심망막동맥은 개통되지 않았으며 시력은 호전되지 않았다. 결론: 급격한 진행을 보이는 안와농양과 동반된 중심망막동맥 폐쇄의 예가 국내에선 알려진 바 없어 보고하고자 하였으며 이러한 안와 농양의 경우 절개 배농 및 전신 항생제 치료 등의 즉각적인 대처가 필요할 것으로 생각한다. Purpose: To report a case of rapidly progressed orbital abscess after central retinal artery occlusion. Case summary: A 60-year-old man with right periorbital pain and edema starting 3 days earlier visited the hospital. His first visual acuity was 1.0 for the right eye with peripheral edema and tenderness; severe hemorrhagic chemosis, proptosis (approximately 3 mm) and extraocular motility limitation were also observed. According to the CT findings, a 2.5 × 1 cm-sized encapsulated cystic mass was found in the right orbital cavity, along the medial orbital wall; with a diagnosis of orbital abscess, he was hospitalized with systemic antibiotic treatment and abscess drainage. On the second day of hospitalization, the best corrected visual acuity was reduced to light perception, and relative afferent pupillary defect, pale retina and cherry red spot were found. Therefore, emergent incisional drainage, optic massage, and antibiotics were given to the patient. Immediately after the surgery, the peripheral edema and proptosis improved; nevertheless, central retinal artery occlusion did not resolve and vision did not improve. Two months later, best corrected visual acuity for the right eye was counting fingers and central retinal artery occlusion showed no further improvement. Conclusions: No case report on rapidly progressing orbital abscess has been proposed in Korea to date. In the case of rapidly progressed orbital abscess, incisional drainage and antibiotics should be administered promptly. J Korean Ophthalmol Soc 2012;53(10):1523-1527

심장 점액종에 의한 중심망막동맥폐쇄 1예

김준오(Jun o Kim),최인호(In Ho Choi),최경식(Kyung Seek Choi) 대한안과학회 2017 대한안과학회지 Vol.58 No.4

목적: 중심망막동맥폐쇄 진단 후에 심장점액종이 발견되어 흉부외과에서 수술적 제거 후 경과관찰 중인 1예를 보고하고자 한다. 증례요약: 47세 여자 환자가 갑작스럽게 발생한 좌안의 시력저하를 주소로 안과에 내원하였다. 내원 당시 좌안 시력 안전수동, 안압 15.4 mmHg 측정되었으며, 좌안에 상대적 구심동공운동 장애가 관찰되었다. 안저검사에서 앵두반점 및 창백안저가 관찰되었으며, 빛간섭단층촬영검사상 황반부의 부종이 관찰되었다. 형광안저혈관조영에서 초기 및 후기에 맥락막 및 망막 혈관의 혈류 충만 장애 소견이 관찰되었고, 이를 바탕으로 좌안의 중심망막동맥폐쇄로 진단하였다. 신경외과에서 시행한 뇌혈관조영술에서 안동맥은 정상적으로 조영되었고, 혈관폐쇄는 관찰되지 않았다. 동맥폐쇄의 원인을 찾기 위해 심장내과와 신경과에 의뢰하였고, 심장초음파검사에서 좌심방에 4.46 × 2.09 cm의 심장점액종이 발견되었으며, 뇌 자기공명영상검사 후 급성 뇌경색을 진단하였다. 보존적 치료를 시행하며, 급성기 뇌경색 치료로 전신적 혈전 용해제를 사용하였고 흉부외과에서 좌심방점액종 절제술을 시행하였다. 심장점액종 절제술 시행 후 1개월째 시행한 형광안저혈관조영술상 망막의 혈액순환이 호전되었으나 시력은 개선되지 않았고, 3개월째 시행한 빛간섭단층촬영에서 황반부 부종은 감소했으나 망막층의 위축과 망막전막이 관찰되었다. 결론: 중심망막동맥폐쇄는 눈뿐만 아니라 전신적 질환을 함께 고려해야 하는 질병이다. 고혈압이나 심장질환, 당뇨 및 경동맥협착 등의 다양한 기저질환이 중심망막동맥폐쇄의 원인으로 알려져 있으며, 저자들은 심장점액종에 의해 망막중심동맥이 폐쇄된 증례를 경험하였기에 이를 보고하고자 한다. Purpose: We report the case of a patient diagnosed with central retinal artery occlusion caused by cardiac myxoma who underwent surgery to remove the myxoma. Case summary: A 47-year-old woman came to our clinic presenting with a sudden decrease of visual acuity in the left eye. At the first visit, left eye visual acuity was hand motion, and intraocular pressure was 15.4 mmHg. A relative afferent pupillary defect was observed in the left eye. On fundus examination, a pale retina and cherry-red spot were observed at the posterior pole. On optical coherence tomography, macular edema was found. On fluorescein angiography and indocyanine green angiography, delayed blood circulation of the retina and choroid was found at early and late stages. Cerebral angiography was performed in the neurosurgery department and showed no occlusion of the ophthalmic artery. Cardiac ultrasonography and brain magnetic resonance imaging were performed. On cardiac ultrasonography, 4.46 × 2.09 cm cardiac myxoma was found. Resection of the cardiac myxoma was conducted in the thoracic and cardiovascular surgery department. Multiple cerebral infarcts were detected by brain imaging, and antithrombotic treatment was administered. After one month, blood circulation in the retina and choroid was observed in fluorescence angiography, but there was no improvement of visual acuity. At the 3-month follow-up visit, macular edema was decreased, but retinal atrophy and epiretinal membrane were observed on optical coherence tomography. Conclusions: Central retinal artery occlusion is a disease related to one’s general condition. We experienced this case of central retinal artery occlusion caused by cardiac myxoma.

안허혈 증후군을 동반한 급성 망막중심동맥폐쇄의 치료 1예

이종환,문호석,남동흔,이대영,Jong Hwan Lee,Ho Seok Moon,Dong Heun Nam,Dae Yeong Lee 대한안과학회 2014 대한안과학회지 Vol.55 No.8

Purpose: We report a case of treatment of acute central retinal artery occlusion (CRAO) with ocular ischemic syndrome (OIS). Case summary: A 72-year-old man presented with acute loss of vision in the right eye on that day. At initial examination, visual acuity tested positive for light sensitivity in the right eye. Fundus examination demonstrated a visible embolus at the central retinal artery overlying the optic disc head and a cherry-red spot in the fovea. Fluorescein angiography revealed that filling of the choroidal circulation was delayed, and the arteriovenous transit time was even further delayed. Carotid angiography showed marked stenosis within the right internal carotid artery. Laboratory tests included blood tests for hypercoagulability evaluation, for which the results were non-specific. To treat acute CRAO with OIS in the right eye, transluminal Nd:YAG laser embolectomy (TYE) was performed twice, and carotid angioplasty with stenting was conducted within the stenosed internal carotid artery. One month after the TYE procedure and carotid stenting, the patient’s visual acuity improved to 0.06 and the arteriovenous transit time was within normal limits on fluorescein angiography. Conclusions: The visual prognosis in eyes with CRAO plus an associated choroidal circulatory disturbance is extremely poor. However, we experienced and reported a case of CRAO with OIS treated successfully through a prompt TYE procedure and carotid angioplasty with stenting. J Korean Ophthalmol Soc 2014;55(8):1242-1247

항중성구세포질항체 연관 혈관염에서 망막중심동맥 폐쇄, 급속진행토리콩팥염이 동반된 말초 다발신경병증: 증례보고

박승완,류병주,문정보,곽호준,김윤희 대한근전도전기진단의학회 2018 대한근전도 전기진단의학회지 Vol.20 No.1

We report a case of asymmetric polyneuropathy with left central retinal artery occlusion, rapid progressive glomerulonephritis (RPGN) due to Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). A-64-year-old man started to have numbness and weakness in both legs. One month later, he suddenly lost a vision in his left eye and had swelling in both legs. Thereafter, weakness progressed to both upper extremities. Multiple eye retinal hemorrhages and cherry-red spots were observed on fundus examination and were diagnosed as central retinal artery occlusion. Pauci-immune crescentic glomerulonephritis were identified after renal biopsy. Nerve conduction study was performed and the patient was diagnosed by peripheral polyneuropathy involving both upper and lower extremities. Clinically, we diagnosed a vasculitis, especially microscopic polyangiitis (MPA).