각막육아종이 반복되는 스티븐스-존슨증후군 환자에서 무세포 보존 각막의 층판이식술 효과
Lamellar Graft of an Acellular, Preserved Human Cornea for Recurrent Anterior Granuloma in Stevens-Johnson Syndrome
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목적: 각막천공 이후 수차례 양막이식술에도 불구하고 각막의 육아종이 반복적으로 발생하는 스티븐스-존슨증후군 환자에서 무세포보존 각막을 이용한 층판이식술의 효과를 증례 보고하고자 한다. 증례요약: 17년 전 스티븐스-존슨증후군이 발병한 46세 남자 환자가 각막천공 후 수차례 양막이식술을 시행 받았음에도 불구하고 각막육아종이 4차례 반복 발생하였다. 2개월 전부터 각막육아종이 또 다시 재발하였고 이후 빠른 속도로 성장하였다. 전신마취하 각막육아종을 제거한 후 4.0 mm 직경의 원형으로 절제한 무세포 보존 사람 각막(Halo; Eversight Inc., Palo Alto, CA, USA)을 육아종절제부에 층판 이식하였고, 이식 각막 표면에 동일 크기의 양막을 이식하였다. 수술 1달 후 일시적으로 수술 부위 염증 침윤 소견을 보였으나 항생제 치료 후 호전되었으며, 수술 후 8개월간 각막육아종 재발, 수술 부위 융해 및 추가 감염 없이 안정적으로 유지되었다. 결론: 기존 양막이식술 후 각막육아종이 반복적으로 재발하는 스티븐스-존슨증후군 환자에서 무세포 보존 각막을 이용한 층판이식술을 효과적인 수술적 대안으로 고려해볼 수 있겠다.
Abstract
Purpose: We describe a patient with Stevens-Johnson syndrome who exhibited recurrent anterior corneal granulomas after corneal perforation (despite multiple amniotic membrane [AM] transplantations); the patient was successfully treated by lamellar grafting of an acellular, preserved human cornea. Case summary: Corneal granulomas developed four times in a 46-year-old man who had been diagnosed with Stevens-Johnson syndrome 17 years priorly and who had undergone multiple AM transplantations after corneal perforation. A corneal granulomatous mass recurred 2 months prior to presentation in our clinic; it rapidly increased in size. With the patient under general anesthesia, the corneal mass was excised and a 4.0-mm-diameter, acellular preserved human cornea (Halo; Eversight Inc., Palo Alto, CA, USA) was grafted. A similarly sized AM was placed over the grafted cornea. Although the engrafted cornea exhibited stromal infiltration 1 month after surgery, the keratitis improved following brief antibiotic treatment. At 8 months postoperatively, the wound was stable; no granuloma recurrence, no graft melting, and no suspected microbial keratitis were observed in the region of the graft. Conclusions: In patients with Stevens-Johnson syndrome and recurrent anterior granulomas (despite multiple AM transplantations), a lamellar graft of acellular, preserved human cornea may be a good therapeutic choice.
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