백내장수술 후 발생한 외인성 진균안내염 6예
Six Cases of Fungal Exogenous Endophthalmitis after Cataract Surgery
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목적: 백내장수술 후 발생한 외인성 진균안내염 6예를 보고하고자 한다. 증례요약: 약 1개월의 기간 동안 8명의 환자가 백내장수술 후 발생한 진균안내염 의심하에 본원으로 의뢰되었다. 유리체절제술 및인공수정체 제거술을 시행하였으며 수술 중에 전방, 유리체강 혹은 인공수정체 표면에서 검체를 채취하여 염색검사 및 배양검사를실시하였다. 배양검사 결과가 나오기 전(임상 양상을 바탕으로) 진균안내염 의심하에 경험적 치료를 시작하였다. 남자는 5명, 여자는3명(환자 8명 각각의 8안)이었으며, 평균 나이는 64세였다. 모든 증례에서 환자들이 적절한 치료를 받기 시작하기까지 13-36일(평균약 28일)의 기간이 소요되었으며, 배양검사 결과 8명 중 6명에서 Fusarium속이 동정되었다. 진균이 검출된 6명의 수술 후 1개월 경과관찰 시 최대교정시력은 1.0 (1안), 0.5 (2안), 0.4 (1안), 0.2 (2안)로 측정되었다. 결론: 백내장수술 후 발생하는 진균안내염은 매우 드물지만 시력예후가 좋지 않으며 장기적인 치료가 필요한 질환이다. 따라서 진균안내염이 의심되는 경우 적절한 약제 선택과 함께 적극적인 치료가 중요할 것으로 생각된다.
Abstract
Purpose: To report six cases of exogenous fungal endophthalmitis developed after cataract surgery. Case summary: Over about 1 month, eight patients were referred to our hospital under suspicion of fungal endophthalmitis arose after cataract surgery. We performed vitrectomy and intraocular lens removal. We intraoperatively sampled the anterior chamber, vitreous cavity, or intraocular lens surface, and performed staining and culture tests. Before the culture test results were available, we commenced empirical treatment under suspicion of fungal endophthalmitis (based on the clinical features). Five eyes were male and three female (eight eyes of eight patients); the mean patient age was 64 years. The time from cataract surgery to the commencement of appropriate treatment ranged from 13 to 36 days (average 28 days). The culture tests revealed Fusarium species in six of the eight patients. At the 1-month postoperative follow-up of these six patients, the best-corrected visual acuities were 20/20 (one eye), 20/40 (two eyes), 20/50 (one eye), and 20/100 (two eyes). Conclusions: Fungal endophthalmitis is very rare after cataract surgery but is associated with poor visual prognosis and requires long-term treatment. If fungal endophthalmitis is suspected, aggressive treatment with an appropriate selection of medication is important.
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