유리체절제술 후 소수성 표면을 가진 친수성 아크릴 단초점인공수정체의 지연성 혼탁
Late Opacification of a Hydrophilic Acrylic Monofocal Intraocular Lens with Hydrophobic Surface after Vitrectomy
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목적: 증식당뇨망막병증 환자에서 2회 유리체절제술 후 소수성 표면을 가진 친수성 아크릴 단초점인공수정체 CT SPHERIS® 204에 지연성으로 혼탁이 발생한 증례를 보고하고자 한다. 증례요약: 50세 남자 환자가 우안 시력저하를 주소로 내원하였다. 환자의 기저 질환은 당뇨였다. 내원하기 약 43개월 전 우안 유리체출혈로 유리체절제술, 수정체초음파유화술 및 인공수정체(CT SPHERIS® 204)삽입술, 광응고술, 유리체강내 베바시주맙(Avastin®)주입술을 받았다. 수술 4개월 후 우안에 전방각 신생혈관과 유리체강내 재출혈이 있어 부분 유리체절제술, 전방 및 유리체강내 베바시주맙주입술을 시행하였다. 우안 시력저하로 내원했을 때 우안 최대교정시력은 0.1이었고, 세극등현미경검사상 인공수정체 광학부 표면에 과립성 백색 혼탁이 광범위하게 관찰되었다. 수정체낭과 함께 인공수정체를 제거하였고, 주사전자현미경과 에너지 분산 방사선분광법을 시행하였다. 결론: 본 증례는 소수성 표면을 가진 친수성 아크릴 단초점인공수정체 CT SPHERIS® 204에 지연성으로 혼탁이 발생한 최초의 보고이며, 당뇨망막병증 환자에서 이러한 유형의 인공수정체 사용에 주의할 필요가 있다.
Abstract
Purpose: To report a case of late opacification of a hydrophilic acrylic monofocal intraocular lens (IOL) with a hydrophobic surface (CT SPHERIS® 204) after a second vitrectomy in a patient with proliferative diabetic retinopathy. Case summary: A 50-year-old male with diabetes presented with decreased visual acuity in the right eye. He had undergone phacoemulsification and IOL (CT SPHERIS® 204) implantation, vitrectomy, endolaser photocoagulation, and intravitreal bevacizumab (Avastin®) injection due to vitreous hemorrhage in the right eye about 43 months prior. Four months after the surgery, presenting with recurrent vitreous hemorrhage and neovascularization of the angle, he underwent partial vitrectomy and intravitreal and intracameral bevacizumab (Avastin®) injection. The best-corrected visual acuity was 0.1 in the right eye when he presented with decreased visual acuity. Slit lamp examination of the right eye showed diffuse whitish granular opacity on the surface of the IOL. The IOL was explanted, together with the capsular bag, and examined using scanning electron microscopy and energy- dispersive X-ray spectroscopy. Conclusions: This case is the first to report late opacification of a hydrophilic, acrylic monofocal IOL with a hydrophobic surface, the CT SPHERIS® 204. It is necessary to be cautious in using this type of lens in patients with diabetic retinopathy.
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