전층각막이식재수술 후 발생한 아급성 메티실린 내성 호미니스 포도상구균 안내염
Subacute Methicillin-resistant Coagulase-Negative Staphylococcus hominis Endophthalmitis after Penetrating Keratoplasty Re-operation
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목적: 전층각막이식 재수술 후 발생한 아급성 메티실린 내성 응고효소음성 호미니스 포도상구균(Staphylococcus hominis) 안내염1예를 보고하고자 한다. 증례요약: 타병원에서 양안 전층각막이식술을 받은 당뇨, 고혈압의 기저질환을 가진 74세 남자 환자가 우안 각막이식 거부반응으로전층각막이식재수술을 시행받았다. 환자는 우안 말기 녹내장의 병력을 가지고 있었으며, 수술 전 나안시력 안전수지 30 cm에서 수술25일 후 나안시력 0.02로 호전되었으나 각막상피결손이 처음 확인되었다. Herpes simplex virus 감염에 준해 치료하였으나 호전되지않았고, 수술 35일 후 안내염 소견이 보여 전방세척술, 유리체절제술 및 유리체내 항생제 주사를 시행하였으며, 수술 중 시행한 세균배양검사상 메티실린 내성 응고효소음성 포도상구균이 동정되었다. 치료 두 달 후 나안시력 0.06, 전방 및 유리체염증이 회복되었다. 결론: 전층각막이식재수술 후 아급성으로 메티실린 내성 응고효소 음성 포도구균에 의한 안내염이 발생할 수 있으며, 빠른 유리체절제술과 항생제 치료로 감염으로 인한 이식 실패를 피할 수 있었다.
Abstract
Purpose: To report a case of subacute methicillin-resistant coagulase-negative Staphylococcus hominis endophthalmitis after re-operation for penetrating keratoplasty in a patient who had a penetrating keratoplasty rejection. Case summary: A 74-year-old man with underlying diabetes and hypertension who underwent bilateral penetrating keratoplasty at another hospital underwent penetrating keratoplasty reoperation due to corneal transplant rejection in the right eye. He had a history of end-stage glaucoma in the right eye and the visual acuity was finger counting at 30 cm. About 25 days postoperatively, the corneal epithelial defect was first found. Treatment based on suspicion of herpes simplex virus infection did not result in improvement and endophthalmitis was suspected in the right eye about 35 days after surgery. Anterior chamber irrigation, pars planar vitrectomy, and intravitreal antibiotic injection were performed. Culture revealed methicillin-resistant coagulase negative Staphylococcus hominis. After 2 months of treatment, the anterior chamber and vitreous inflammation decreased and best corrected visual acuity in the right eye recovered to 0.06. Conclusions: Subacute endophthalmitis caused by methicillin-resistant coagulase-negative Staphylococcus may occur after penetrating keratoplasty. Transplant failure due to infection can be avoided with vitrectomy and antibiotic treatment at the right time.
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