전방내 리도카인 마취하 백내장수술 후 발생한 독성전방증후군 4례
Four Cases of Toxic Anterior Syndrome after Cataract Surgery under Intracameral 0.5% Lidocaine Anesthesia
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목적: 전방내 0.5% 리도카인 마취하 백내장수술 환자에서 발생한 독성전방증후군 4례를 보고하고자 한다. 증례요약: 4명의 환자가 백내장수술 후 3일 내에 발생한 시력저하로 본원에 의뢰되었다. 각막부종 및 혼탁을 동반한 전방 염증 소견이 관찰되었다. 배양검사를 시행한 후 독성전방증후군으로 진단하여 3명은 전신 스테로이드치료를 병행하였고, 1명은 점안 스테로이드만 사용하였다. 3명은 술 후 3개월째 양호한 시력을 보이며, 염증반응의 소실, 각막부종이 회복된 소견이 보였으나, 전신 스테로이드를 투여하지 않은 1명은 각막부종이 지속되어, 각막이식술을 시행하였다. 결론: 독성전방증후군은 즉각적인 치료가 필요한 수술 후 합병증이며, 점안 스테로이드제 사용과 더불어 전신 스테로이드 사용이 도움될 수 있을 것으로 생각된다. 독성전방증후군의 예방을 위해 수술 과정에서 사용되는 약제의 세밀한 주의가 필요할 것으로 사료된다.
Abstract
Purpose: To report four cases of toxic anterior segment syndrome after cataract surgery under intracameral 0.5% lidocaine anesthesia. Case summary: Four patients had a decrease in visual acuity within 3 days of undergoing cataract surgery. There was evidence of anterior chamber inflammation with corneal edema and opacity. Toxic anterior segment syndrome was diagnosed on the basis of negative microbial cultures and clinical features. Three patients were treated with systemic and topical steroids, and one was treated with topical steroids only. Three months postoperatively, three patients had good visual acuity without inflammation or corneal edema. However, one patient, who did not receive systemic steroids, exhibited persistent corneal edema and required endothelial keratoplasty. Conclusions: Toxic anterior segment syndrome is a surgical complication that requires immediate treatment. Systemic steroids can be helpful with topical steroids. Clinicians should ensure that measures are taken to avoid contamination of surgical procedure with toxic substances to prevent toxic anterior segment syndrome.
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