안외상 후 후방인공수정체가 결막하 공간으로 이탈한 증례
Traumatic Posterior Chamber Intraocular Lens Dislocation into the Subconjunctival Space
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목적: 안외상 후 후방인공수정체가 결막하 공간으로 이탈한(인공수정체 전위) 증례를 살펴보고자 한다. 증례요약: 우안 포도막염 녹내장으로 섬유주절제술, 방수유출장치삽입술, 공막경유모양체광응고술, 백내장수술을 받은 66세 남자가쇠막대기에 우안을 찔린 후 통증과 시력저하로 방문하였다. 우안의 시력은 안전수동, 안압은 3 mmHg였고, 결막하 출혈과 전방출혈이관찰되었다. 이후 출혈 감소 후 시행한 검사에서 비측 각막윤부 뒤쪽 포도막 탈출, 후낭에 있던 인공수정체가 비측 결막하 공간으로이탈된 모습이 관찰되었다. 외상 전과 비교해서 녹내장수술 여과포 및 튜브의 양상에는 변화가 없었다. 환자가 적극적인 처치를 원하지 않아서 결막 절개 후 인공수정체만 제거하고 경과 관찰하였다. 결론: 녹내장수술, 백내장수술 및 레이저 치료를 받은 눈에서 외상 후 발생한 후낭인공수정체 전위의 증례를 경험하였다. 외상 직후에는 결막하 출혈과 전방출혈 때문에 수정체의 상태를 정확히 파악하기 어려웠다. 외상 후 수정체의 위치가 확실히 관찰되지 않거나탈구된 상태로 판단될 때, 유리체강으로의 탈구뿐만 아니라 결막하 공간으로 전위의 가능성도 고려해야 할 것이다.
Abstract
Purpose: Here we report a case of posterior chamber intraocular lens (IOL) dislocation into the subconjunctival space (pesudophacocele) following ocular trauma. Case summary: A 66-year-old male presented with ocular pain and decreased vision in the right eye following trauma with a metallic rod. The patient had a history of trabeculectomy, glaucoma drainage device implantation, transscleral cyclophotocoagulation, and cataract surgery for uveitic glaucoma and a cataract in the right eye. On examination, vision was hand movement, the intraocular pressure was 3 mmHg, and subconjunctival hemorrhage and hyphema were observed. After the resolution of hemorrhage, uveal tissue prolapse was seen nasally behind the corneal limbus and the IOL was found to be dislocated into the nasal subconjunctival space. There were no changes in the filtering bleb and tube compared to the pre-trauma status. The IOL was removed through a conjunctival incision because the patient refused any active treatment. Conclusions: Pesudophacocele developed in a patient who had a history of glaucoma and cataract surgery in the injured eye. The IOL could not be assessed immediately after the trauma because of subconjunctival hemorrhage and hyphema. When the status of IOL is unclear or suspected to be dislocated after trauma, the possibility of pseudophacocele should be considered, in addition to the dislocation into the vitreous cavity.
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