교감안염 환자의 수상안에서 무세포 사람 보존각막을 이용한 구조적 각막이식술
Tectonic Keratoplasty Using Acellular Preserved Human Cornea for the Inciting Eye in Sympathetic Ophthalmia
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 교감안염의 수상안에서 무세포 사람 보존각막을 이용한 구조적 각막이식술을 통해 시력을 개선시킨 치료 경험을 공유하고자한다. 증례요약: 68세 남자 환자가 2개월 전, 못에 좌안을 수상한 뒤 최근 악화된 양안 시력저하를 주소로 내원하였다. 최대교정시력 우안0.32, 좌안 0.16이었다. 검진상 좌안 상측부 주변부 각막에 전방수 유출 없이 홍채마개를 동반한 각막천공이, 우안 각막내피에 굳기름침착물과 함께 전방 내 섬유소모양 띠가 관찰되었다. 빛간섭단층촬영상, 양안 모두 삼출성 망막박리와 맥락막주름들이 보였다. 익일, 전신 스테로이드와 함께 좌안의 괴사 홍채절제, 홍채유착 박리 및 천공 부위에 무세포 보존각막을 이용한 구조적 각막이식을 시행하였다. 삼출성 망막박리는 양안 모두 호전되었고, 수술 4개월째 수상안 백내장수술을 시행하였으며, 내원 21개월 후 좌안 나안시력1.0으로 개선되었고 양안 모두 시신경위축이나 맥락망막염의 재발 없이 저녁노을안저 소견을 보였다. 결론: 주변부 각막천공이 동반된 교감안염의 수상안에서, 내과적 항염증 치료와 더불어 무세포 보존각막을 이용한 구조적 각막이식술을 효과적으로 시도해볼 수 있겠다.
Abstract
Purpose: We report a case of sympathetic ophthalmia in which the inciting eye was treated with a tectonic keratoplasty using acellular preserved human cornea. Case summary: A 68-year-old man whose left eye was injured by a nail visited our institute complaining of a recent decrease in bilateral vision. The best corrected visual acuity was 0.32 for the right eye and 0.16 for the left. On slit-lamp examination, a superior peripheral corneal perforation with no wound leakage due to iris plugging was seen in the left eye (i.e., the inciting eye). The right eye (i.e., the sympathizing eye) had mutton-fat keratic precipitates and copious fibrinoid strands in the anterior chamber. Bilateral exudative retinal detachment with choroidal folds was prominent in both eyes. The next day, the necrotic iris lump was removed from the inciting eye and adhesiolysis of the iris and tectonic keratoplasty using acellular preserved human cornea were performed. Systemic steroid was started immediately postoperatively. The exudative retinal detachment improved in both eyes and cataract surgery was undertaken for the inciting eye 4 months later. Twenty-one months after the initial visit, the uncorrected visual acuity was 1.0 in the inciting eye, and both eyes had a sunset glow fundus appearance, without optic atrophy or recurrent chorioretinitis. Conclusions: Tectonic keratoplasty using acellular preserved human cornea with anti-inflammatory treatment may be a favorable therapeutic option for the inciting eye with peripheral corneal perforation in sympathetic ophthalmia.
참고문헌 (13)
- Castiblanco CP, "Sympathetic ophthalmia", Graefes Arch Clin Exp Ophthalmol, 247, pp.289~302 (2009)
- Savar A, "Enucleation for open globe injury", Am J Ophthalmol, 147, pp.595~600 (2009)
- Kilmartin DJ, "Prospective surveillance of sympathetic ophthalmia in the UK and Republic of Ireland", Br J Ophthalmol, 84, pp.259~263 (2000)
- Kumar K, "Sympathetic ophthalmia in pediatric age group : clinical features and challenges in management in a tertiary center in southern India", Ocul Immunol Inflamm, 22, pp.367~372 (2014)
- Chan CC, "Relationship between sympathetic ophthalmia, phacoanaphylatic endophthalmitis, and Vogt-Koyanagi-Harada disease", Ophthalmology, 95, pp.619~624 (1988)
- Parchand S, "Sympathetic ophthalmia : a comprehensive update", Indian J Ophthalmol, 70, pp.1931~1944 (2022)
- Ramamurthi S, "Penetrating keratoplasty for the exciting eye in sympathetic ophthalmia", Cornea, 27, pp.1080~1081 (2008)
- Ramamurthi S, "Management and clinical outcome of penetrating keratoplasty for long-term corneal changes in sympathetic ophthalmia", J Ophthalmol, 2011, pp.439025~ (2011)
- Dogra M, "Surgical intervention in inciting eyes of patients with sympathetic ophthalmia : a case series and review of literature", Ocul Immunol Inflamm, 27, pp.1154~1159 (2019)
- Chan CC, "Immunohistochemistry and electron microscopy of choroidal infiltrates and Dalen-Fuchs nodules in sympathetic ophthalmia", Ophthalmology, 92, pp.580~590 (1985)
- Jakobiec FA, "Human sympathetic ophthalmia. An analysis of the inflammatory infiltrate by hybridoma-monoclonal antibodies, immunochemistry, and correlative electron microscopy", Ophthalmology, 90, pp.76~95 (1983)
- Goto H, "Sympathetic ophthalmia and Vogt-Koyanagi-Harada syndrome", Int Ophthalmol Clin, 30, pp.279~285 (1990)
- Hamrah P, "The corneal stroma is endowed with a significant number of resident dendritic cells", Invest Ophthalmol Vis Sci, 44, pp.581~589 (2003)