혼탁한 각막 후부에 숨겨져 있던 나무 가시에 의한 각막염 치료 사례
Keratitis Treatment by Removal of Concealed Retrocorneal Plant Foreign Body
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목적: 전안부빛간섭단층촬영과 전방각경검사를 통해 혼탁한 각막 후부에서 발견된 나무 가시를 제거하고 각막염이 호전된 증례를 보고하고자 한다. 증례요약: 79세 여성이 농사 중 좌안을 가시에 찔린 후 발생한 각막염으로 한 달간 항생제 치료에도 호전이 없어 의뢰되었다. 좌안 시력은 안전수동이었고, 중심부에 각막혼탁과 함께 전방축농이 동반되었으며, 강화 항생제 점안치료에도 전방축농은 호전과 악화를 반복하였다. 각막병변부에 전안부빛간섭단층촬영 및 전방각경검사를 통해 후부 각막 및 전방 내로 돌출된 미세 이물을 확인하였으며, 수술적으로 제거하였다. 이물 제거 후 좌안 전방축농은 소실되었고, 각막혼탁과 상피결손이 호전되었다. 결론: 통상적인 치료로 호전되지 않는 감염각막염에서 외상의 병력이 있고 혼탁으로 인해 각막 후면이 관찰되지 않을 때, 각막내 이물의 잔존 가능성을 의심하여야 하며, 전안부빛간섭단층촬영 및 전방각경검사가 유용한 진단 도구로 활용될 수 있다.
Abstract
Purpose: We report a case of keratitis that improved after removal of a causative plant foreign body from below the posterior surface of an opaque cornea. The foreign body was revealed by anterior segment optical coherence tomography (AS-OCT) and gonioscopy. Case summary: A 79-year-old woman was referred with an impression of left-eye keratitis; the eye had been injured by a branch of a tangerine tree 1 month prior. She had been given the usual topical antibiotics by a local clinic, but they were ineffective. At her initial visit, her visual acuity was only hand motion in the left eye; slit-lamp examination revealed a 3 × 3-mm corneal infiltration with a hypopyon in the anterior chamber. Despite administration of strong topical antibiotics on an hourly basis, the corneal lesion worsened. AS-OCT and gonioscopy revealed a small foreign body below the posterior surface of the cornea; this was surgically removed. The corneal opacity and corneal epithelial defects dramatically improved, and the hypopyon disappeared. Conclusions: The possibility of a residual foreign body should be considered if trauma precedes infectious keratitis that does not improve with conventional treatment and the posterior surface of the cornea is not visible because of corneal opacity. In such a case, AS-OCT and gonioscopy can be useful.
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