외상에 의한 망막중심동맥폐쇄 2예 = Central Retinal Artery Occlusion after Trauma: Report of Two Cases

국문 초록 (Abstract)

목적: 외상에 의하여 발생한 망막중심동맥폐쇄 2예를 경험하였기에 이를 보고하고자 한다.
증례요약: 26세 남자 환자가 계단에서 넘어져 좌측 이마 주위를 계단에 부딪힌 후 발생한 좌안의 급격한 시력저하를 주소로 내원하였다. 좌안의 시력은 광각유였다. 망막은 창백하였으며 망막 부종 및 앵두반점이 관찰되었고 혈관조영술에서 좌안 안동맥 기시부 근처에 심한 협착 및 색전이 관찰되어 안동맥폐쇄가 동반된 망막중심동맥폐쇄로 진단하에 동맥내 혈전용해술을 시행하였다. 57세 여자환자가 넘어지면서 우측 하안검을 나뭇가지에 찔린 후 발생한 급격한 우안의 시력저하를 주소로 내원하였다. 우안의 시력은 안전수동이었다. 안저검사에서 망막은 창백하고 혼탁하였으며 앵두반점이 관찰되어 형광안저혈관조영술 및 빛간섭단층촬영 시행 후 망막중심동맥폐쇄로 진단하였다.
결론: 외상 후 발생한 시력저하에 대한 감별진단으로 망막중심동맥폐쇄를 고려해야 한다.

다국어 초록 (Multilingual Abstract)

Purpose: To report two patients who developed central retinal artery occlusion (CRAO) after trauma.
Case summary: A 26-year-old man complained of severe loss of vision in his left eye after falling and bumping his forehead on a staircase. His visual acuity was light perception in the left eye. Fundus examination revealed edematous white retina and a cherry red spot on the macula. Angiography showed severe stenosis in the initial segment of the ophthalmic artery with ophthalmic arterial embolus. He underwent intra-arterial thrombolysis with a clinical diagnosis of CRAO with ophthalmic artery stenosis. A 57-year-old woman presented with vision loss after falling and striking her face below her right lower eyelid on a wooden stick. Her visual acuity was hand motions in the right eye. Fundus examinations showed white retina with opacity and a cherry red spot on the macula. Fluorescein angiography and optical coherence tomography was performed, and a clinical diagnosis of CRAO was made.
Conclusions: CRAO must be considered when clinically differentiating visual loss after a trauma.

참고문헌 (Reference)

1 이종환, "안허혈 증후군을 동반한 급성 망막중심동맥폐쇄의 치료 1예" 대한안과학회 55 (55): 1242-1247, 2014

2 Schmidt D., "Systemic diseases in non-inflammatory branch and central retinal artery occlusion--an overview of 416 patients" 12 : 595-603, 2007

3 차동민, "Silent Giant Cell Arteritis in an Elderly Korean Woman" 대한안과학회 27 (27): 224-227, 2013

4 Dalma-Weiszhausz J., "Retinal vascular occlusion following ocular contusion" 243 : 406-409, 2005

5 Moshfeghi DM., "Retinal and choroidal vascular occlusion after posterior sub-tenon triamcinolone injection" 134 : 132-134, 2002

6 Ahn SJ., "Retinal and choroidal changes and visual outcome in central retinal artery occlusion : an optical coherence tomography study" 159 : 667-676, 2015

7 Sodhi KS., "Post-traumatic occlusion of subclavian artery with clavicle fracture" 33 : 419-420, 2007

8 Scheerlinck TA., "Post-traumatic intima dissection and thrombosis of the external iliac artery in sportsman" 8 : 645-647, 1994

9 Goldsmith MO, "Occlusion of the central retinal artery following retrobulbar hemorrhage" 153 : 191-196, 1967

10 Park SJ., "Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011" 121 : 1933-1938, 2014

11 Tabarki B., "Ischemic cerebral vascular accident caused by vertebral artery dissection" 4 : 763-766, 1997

12 Park SW., "Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections" 154 : 653.e1-662.e1, 2012

13 정은혜, "Iatrogenic Central Retinal Artery Occlusion Following Retrobulbar Anesthesia for Intraocular Surgery" 대한안과학회 29 (29): 233-240, 2015

14 Stein PD., "Fat embolism syndrome" 336 : 472-477, 2008

15 Singla AA., "External iliac artery occlusion in a paediatric patient following handlebar trauma" 2015 : 2015

16 Poon H., "Endovascular repair for left common iliac artery occlusion following blunt trauma without associated bony injury : image in vascular surgery" 46 : 179-180, 2012

17 Nakao Y., "Embolic brain infarction related to posttraumatic occlusion of vertebral artery resulting from cervical spine injury : a case report" 8 : 344-, 2014

18 Kim KE., "Central retinal artery occlusion caused by fat embolism following endoscopic sinus surgery" 33 : 149-150, 2013

19 Hayreh SS., "Central retinal artery occlusion : visual outcome" 140 : 376-391, 2005

20 Narang S., "Bilateral simultaneous central retinal artery occlusion following head injury" 27 : 387-390, 2007

21 Ghose S., "Bilateral central retinal arterial obstruction following head trauma : a very rare case report" 59 : 66-68, 2011

22 Varma DD., "A review of central retinal artery occlusion : clinical presentation and management" 27 : 688-697, 2013