양안에 발생한 데스메막박리의 육불화황 가스치료 증례
Therapeutic Efficacy of Sulfur Hexafluoride Gas in Bilateral Descemet Membrane Detachment: A Case Report
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목적: 백내장 수술 후 한 달 이상 지속된 양안 데스메막박리의 치료 증례를 보고하고자 한다. 증례요약: 67세 여성이 개인 의원에서 3일 간격으로 양안 백내장 수술을 받았다. 수술 후 1일째 양안 모두 중심 각막 부종을 동반한 데스메막박리가 발생하여, 1달간의 보존적 치료에도 불구하고 호전되지 않아, 본원에 전원되었다. 내원 당시 최대 교정 시력은 우안 0.25, 좌안 0.2였다. 우안은 10% SF6를 0.3 cc 주입하여 유착에 실패한 후, 20% SF6를 재주입하여 성공적으로 유착시켰다. 좌안도 20% SF6 가스를 주입한 후 전방 내로 높아진 고안압을 조절하기 위해, 가스 10-20% 일부를 제거하면서 부작용 없이 재유착에 성공하였다. 최종 시력은 우안은 0.8, 좌안은 1.0으로 개선되었다. 결론: 중심 각막을 침범하거나 4주 이상 지속되는 데스메막박리의 경우 보존적 치료에 반응하지 않는다면, 전방에 20% SF6 가스를 주입한 후 높아진 안압을 적절하게 조절하면서 심각한 합병증 없이 데스메막박리를 해결할 수 있었다.
Abstract
Purpose: To report a case of bilateral Descemet membrane detachment (DMD) persisting for over a month following phacoemulcification. Case summary: A 67-year-old female underwent bilateral phacoemulcification at a local clinic, with a 3-day interval between procedures on each eye. On the first postoperative day, both eyes developed DMD accompanied by central corneal edema. After 1 month of conservative treatment with no improvement, the patient was referred to our clinic. Upon presentation, corrected visual acuity was 0.25 in the right eye and 0.2 in the left eye. The right eye was initially treated with a 0.3-mL injection of 10% sulfur hexafluoride (SF6), which did not result in reattachment. However, reattachment was successfully achieved with a subsequent injection of 20% SF6. In the left eye, a 20% SF6 injection into the anterior chamber also achieved reattachment, but partial removal of 10-20% of the gas was necessary to manage elevated intraocular pressure. The procedure was completed without complications. Following treatment, visual acuity improved to 0.8 in the right eye and 1.0 in the left eye. Conclusions: For cases of DMD involving the central cornea or persisting for over 4 weeks without responding to conservative treatment, the injection of 20% SF6 gas into the anterior chamber represents a viable surgical option. Careful management of intraocular pressure is essential to ensure successful outcomes without complications.
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