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안구 이식편대숙주병 환자들에서 발생한 감염각막염의 임상 양상

Clinical Manifestation of Infectious Keratitis in Ocular Graft Versus Host Disease

김종화|윤현정|윤경철|진형남
대한안과학회 (The Korean Ophthalmological Society)|2022.07|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제63권 제7호|pp. 592-601|DOI 10.3341/jkos.2022.63.7.592

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키워드

Corneal neovascularizationInfectious keratitisCorneal epithelial defectsOcular graft-versus-host disease
주제분류안과학

초록

목적: 안구 이식편대숙주병 환자들에서 발생한 감염각막염의 임상 양상과 위험인자를 알아보고자 한다. 대상과 방법: 2015년 1월부터 2020년 12월까지 안구 이식편대숙주병으로 진단받은 후 감염각막염이 발생한 환자 11명과 감염각막염이발생하지 않은 36명의 의무기록을 후향적으로 조사하였다. 두 군의 성별, 연령, 기저 질환, 전신 이식편대숙주병에 의한 타 장기의침범 여부, 사용된 전신 면역억제제, 안구 이식편대숙주병의 이환기간 등의 전신 지표와 감염 전 이식편대숙주병의 임상 양상 및 중증도, 감염 발생 후 각막상피결손의 크기 및 각막침윤 깊이, 전방축농 여부, 미생물배양검사결과 등의 임상지표를 조사하였다. 감염 발생군과 미발생군의 전신 이식편대숙주병 상태를 포함한 전신지표 및 안구지표들을 카이제곱검정을 통해서 비교하였고, 감염 발생과관련 있는 위험인자들에 대해 이용하여 각각 회귀분석을 시행하였다. 결과: 안구 이식편대숙주병으로 인한 각막지표 중 각막 필라멘트, 각막 신생혈관, 각막상피결손이 감염 발생군에서 유의미하게 많았으며(p＜0.05), 이식편대숙주병의 중증도는 감염 발생군에서 유의하게 높았다(p＜0.001). 감염 발생은 감염 전 각막 필라멘트, 각막 신생혈관, 각막상피결손의 존재와 유의한 관계가 있었고(p＜0.05), 다변량 회귀분석에서 감염 발생의 위험인자는 각막상피결손의 존재(p=0.029)였다. 결론: 안구 이식편대숙주병에서 감염 발생 전 각막상피결손, 각막 신생혈관, 각막 필라멘트의 존재가 감염 발생과 관련이 있으며, 이중 각막상피결손의 존재가 안구 이식편대숙주병에서 감염각막염 발생의 위험인자였다.

Abstract

Purpose: We evaluated the clinical manifestations of, and risk factors for, infectious keratitis in patients with ocular graft-versus- host disease (GVHD). Methods: A total of 11 patients who developed infectious keratitis after a diagnosis of ocular GVHD between January 2015 and December 2020, and 36 who did not (the control group), were included in this retrospective study. We recorded sex, age, any underlying disease, any other organ affected by systemic GVHD, systemic immunosuppressant use, follow-up duration, clinical manifestations, the severity of ocular GVHD prior to infection, the size of the epithelial defect, the depth of infiltration, hypopyon status, and the results of microbiological tests. Systemic and ocular indices (including systemic GVHD status) were compared using the chi-squared test. Risk factors for infection were identified. Results: Of the corneal indices, the presence of corneal filaments, the extent of corneal neovascularization, and the number of corneal epithelial defects were significantly higher in the infected group (p = 0.023, p = 0.004, and p = 0.001, respectively). GVHD severity was also significantly higher in that group (p < 0.001). The presence of corneal filaments, corneal neovascularization, and corneal epithelial defects prior to infection correlated significantly with the risk of infection (p = 0.046, p = 0.010, and p = 0.003, respectively). Multivariate analysis identified corneal epithelial defects as a significant risk factor for infection (p = 0.029). Conclusions: In patients with ocular GVHD, corneal epithelial defects, corneal neovascularization, and corneal filaments prior to infection were associated with the development of infection. In particular, corneal epithelial defects before infection was a significant risk factor for infection.

참고문헌 (51)

  1. Welniak LA, "Immunobiology of allogeneic hematopoietic stem cell transplantation", Annu Rev Immunol, 25, pp.139~170 (2007)
  2. Ferrara JL, "Graft-versus-host disease", Lancet, 373, pp.1550~1561 (2009)
  3. Ogawa Y, "Dry eye after haematopoietic stem cell transplantation", Br J Ophthalmol, 83, pp.1125~1130 (1999)
  4. Ogawa Y, "Dry eye as a major complication associated with chronic graft-versus-host disease after hematopoietic stem cell transplantation", Cornea, 22(7 Suppl), pp.S19~27 (2003)
  5. Westeneng AC, "Ocular graft-versus-host disease after allogeneic stem cell transplantation", Cornea, 29, pp.758~763 (2010)
  6. Tabbara KF, "Ocular findings after allogeneic hematopoietic stem cell transplantation", Ophthalmology, 116, pp.1624~1629 (2009)
  7. Kim SK, "Update on ocular graft versus host disease", Curr Opin Ophthalmol, 17, pp.344~348 (2006)
  8. Bray LC, "Ocular complications of bone marrow transplantation", Br J Ophthalmol, 75, pp.611~614 (1991)
  9. Anderson NG, "Ocular manifestations of graft versus host disease", Curr Opin Ophthalmol, 15, pp.503~507 (2004)
  10. Franklin RM, "Ocular manifestations of graft-vs-host disease", Ophthalmology, 90, pp.4~13 (1983)
  11. Mencucci R, "Ophthalmological aspects in allogenic bone marrow transplantation : Sjögren-like syndrome in graft-versus-host disease", Eur J Ophthalmol, 7, pp.13~18 (1997)
  12. Hessen M, "Ocular graft-versus-host disease", Curr Opin Allergy Clin Immunol, 12, pp.540~547 (2012)
  13. Jack MK, "Ocular manifestations of graft-v-host disease", Arch Ophthalmol, 101, pp.1080~1084 (1983)
  14. Saito T, "Ocular manifestation of acute graft-versus-host disease after allogeneic peripheral blood stem cell transplantation", Int J Hematol, 75, pp.332~334 (2002)
  15. Shikari H, "Ocular graft-versus-host disease : a review", Surv Ophthalmol, 58, pp.233~251 (2013)
  16. Yeh PT, "Recurrent corneal perforation and acute calcareous corneal degeneration in chronic graft-versus-host disease", J Formos Med Assoc, 105, pp.334~339 (2006)
  17. Mohammadpour M, "Progressive corneal vascularization caused by graft-versus-host disease", Cornea, 26, pp.225~226 (2007)
  18. Westekemper H, "Ocular graft versus host disease : corneal complications", Ophthalmologe, 114, pp.697~702 (2017)
  19. Adrean SD, "Perforated corneal ulcer with subsequent endophthalmitis in a patient with graft-versus-host disease", Cornea, 26, pp.107~108 (2007)
  20. Stevenson W, "Bilateral corneal ulceration in ocular graft-versus-host disease", Clin Ophthalmol, 7, pp.2153~2158 (2013)
  21. Arita R, "Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population", Ophthalmology, 115, pp.911~915 (2008)
  22. 현준영, "Korean Guidelines for the Diagnosis and Management of Dry Eye: Development and Validation of Clinical Efficacy", Korean Journal of Ophthalmology, 28(3), pp.197~206 (2014), 대한안과학회
  23. Bron AJ, "Grading of corneal and conjunctival staining in the context of other dry eye tests", Cornea, 22, pp.640~650 (2003)
  24. Jagasia MH, "national institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 diagnosis and staging working group report", Biol Blood Marrow Transplant, 21, pp.389~401 (2015)
  25. Tatematsu Y, "Grading criteria for chronic ocular graft-versus-host disease : comparing the NIH eye score, Japanese dry eye score, and DEWS 2007 score", Sci Rep, 4, pp.6680~ (2014)
  26. Mukerji N, "Technique of area measurement of epithelial defects", Cornea, 22, pp.549~551 (2003)
  27. Sinha S, "Prevalence of persistent corneal epithelial defects in chronic ocular graft-versus-host disease", Am J Ophthalmol, 218, pp.296~303 (2020)
  28. Balaram M, "Chronic ocular surface disease after allogeneic bone marrow transplantation", Ocul Surf, 3, pp.203~211 (2005)
  29. Wang Y, "Baseline profiles of ocular surface and tear dynamics after allogeneic hematopoietic stem cell transplantation in patients with or without chronic GVHD-related dry eye", Bone Marrow Transplant, 45, pp.1077~1083 (2010)
  30. Jabs DA, "The eye in bone marrow transplantation. II. Histopathology", Arch Ophthalmol, 101, pp.585~590 (1983)
  31. Narayanan S, "Dry eye disease and microbial keratitis : is there a connection?", Ocul Surf, 11, pp.75~92 (2013)
  32. Qiu Y, "Manifestation of clinical categories of ocular graft-versus-host disease", J Ophthalmol, 2018, pp.6430953~ (2018)
  33. Giannaccare G, "Corneal biomechanical alterations in patients with chronic ocular graft versus-host disease", PLoS One, 14, pp.e0213117~ (2019)
  34. Arafat SN, "Elevated neutrophil elastase in tears of ocular graft-versus-host disease patients", Am J Ophthalmol, 176, pp.46~52 (2017)
  35. Nair S, "Tear inflammatory mediators and protein in eyes of post allogenic hematopoeitic stem cell transplant patients", Ocul Surf, 16, pp.352~367 (2018)
  36. Fini ME, "Proteolytic mechanisms in corneal ulceration and repair", Arch Dermatol Res, 290(Suppl), pp.S12~S23 (1998)
  37. Gordon GM, "Comprehensive gene expression profiling and functional analysis of matrix metalloproteinases and TIMPs, and identification of ADAM-10 gene expression, in a corneal model of epithelial resurfacing", J Cell Physiol, 226, pp.1461~1470 (2011)
  38. Ogawa Y, "International chronic ocular graft-vs-host-disease(GVHD)consensus group : proposed diagnostic criteria for chronic GVHD(Part I)", Sci Rep, 3, pp.3419~ (2013)
  39. Sinha S, "Prevalence and risk factors associated with corneal perforation in chronic ocular graft-versus-host-disease", Cornea, 40, pp.877~882 (2021)
  40. Ting DSJ, "Infectious keratitis : an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance", Eye(Lond), 35, pp.1084~1101 (2021)
  41. Ghosh AK, "Fungal keratitis in North India : spectrum of agents, risk factors and treatment", Mycopathologia, 181, pp.843~850 (2016)
  42. Kredics L, "Filamentous fungal infections of the cornea : a global overview of epidemiology and drug sensitivity", Mycoses, 58, pp.243~260 (2015)
  43. Gopinathan U, "Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis : experience of over a decade", Indian J Ophthalmol, 57, pp.273~279 (2009)
  44. Bharathi MJ, "Microbiological diagnosis of infective keratitis : comparative evaluation of direct microscopy and culture results", Br J Ophthalmol, 90, pp.1271~1276 (2006)
  45. Carolina E, "Glucocorticoid impaired the wound healing ability of endothelial progenitor cells by reducing the expression of CXCR4 in the PGE2 pathway", Front Med(Lausanne), 5, pp.276~ (2018)
  46. Rhen T, "Antiinflammatory action of glucocorticoids--new mechanisms for old drugs", N Engl J Med, 353, pp.1711~1723 (2005)
  47. Pfister RR, "Corneal ulceration and perforation associated with Sjögren's syndrome", Arch Ophthalmol, 98, pp.89~94 (1980)
  48. Sugar A, "A randomized trial of topical corticosteroids in epithelial healing after keratoplasty", Cornea, 3, pp.268~271 (1984)
  49. Yülek F, "Effect of topical steroids on corneal epithelial healing after vitreoretinal surgery", Acta Ophthalmol Scand, 84, pp.319~322 (2006)
  50. Bostancı B, "Unusual course of crystalline keratopathy in a patient with graft-versus-host disease", Turk J Ophthalmol, 47, pp.344~347 (2017)
  51. Tarnawska D, "Corneal grafting and aggressive medication for corneal defects in graft-versus-host disease following bone marrow transplantation", Eye(Lond), 21, pp.1493~1500 (2007)

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