Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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A Case of Posterior Ischemic Optic Neuropathy and Abducens Nerve Palsy

외향신경마비를 동반한 비동맥염성 뒤허혈시신경병증 1예

Song, Tae-Geun;Park, Hye-Young
송태근;박혜영

  • Published : 2009.02.15
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Abstract

Purpose: To report a case of a patient with posterior ischemic optic neuropathy and abducens nerve palsy who responded to steroid therapy. Case summary: A 47-year-old man visited our clinic with decreasing visual acuity and abduction limitation in his right eye, which suddenly started 4 days earlier. The best corrected visual acuity (BCVA) was 20/250 in the right eye and 20/20 in the left eye. Fundus examination showed normal in both eyes, and relative afferent pupillary defect was positive in the right eye. The visual field test showed a right central scotoma with inferior altitudinal field defect. In addition, the brain magnetic resonance imaging (MRI) was done. Orbit MRI, fluorescein angiography (FAG), and carotid ultrasonography results were normal. Therefore, the patient was diagnosed with non-arteritic posterior ischemic optic neuropathy. The systemic steroid therapy was started and tapered over a period of 5 weeks. At one month after treatment, the BCVA was 20/20 and abduction limitation in the right eye improved.

목적: 비동맥염성 뒤허혈시신경병증과 외향신경마비를 동반한 환자에서 스테로이드 치료로 시기능 향상 및 외향신경마비의 호전을 경험하였기에 이를 보고하고자 한다. 증례요약: 47세 남자 환자가 4일 전부터 발생한 우안 시력저하를 주소로 내원하였다. 최대교정시력은 우안) 20/250, 좌안) 20/20이었으며 우안의 구심성동공운동장애가 관찰되었다. 안저검사는 정상이었고, 눈 운동검사에서 우측 외향신경마비가 관찰되었다. 정확한 진단을 위하여 색각검사, 시야검사, 형광안저혈관조영술, 시각유발전위검사, 혈액검사, 뇌와 안와 자기공명영상, 경동맥초음파검사를 시행하였다. 우안의 심한 색각이상과 시야검사상 우안의 중심암점과 아래쪽의 시야결손이 관찰되었다. 시각유발전위검사에서 현저한 진폭의 감소가 관찰되었으며 혈액검사는 혈당과 콜레스테롤이 증가되어 있었고, 자기공명영상, 경동맥초음파, 형광안저혈관조영술은 정상이었다. 이에 비동맥염성 뒤허혈시신경병증으로 진단하고 스테로이드 정맥주사를 시행하였다. 치료 5일째 최대교정시력 20/20까지 회복되었고 외향신경마비도 호전되는 양상을 보였다. 1개월 후 시행한 검사에서 시력은 20/20으로 유지되었고, 안구운동장애는 관찰되지 않았다.

Keywords

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