브리모니딘 점안에 의한 만성 육아종앞포도막염을 동반한 비전형 결막염 1예
Brimonidine-induced Atypical Conjunctivitis with Chronic Granulomatous Anterior Uveitis
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목적: 브리모니딘 함유 복합제제를 2년간 사용한 후 발생한 양안 만성 육아종앞포도막염 증례를 보고하고자 한다. 증례요약: 82세 환자가 양안 간헐폐쇄각녹내장으로 진단받고 1% 브린졸라미드와 0.2% 브리모니딘 복합제제를 2년간 점안하던 중 최근 1달 전부터 시작된 양안 눈꺼풀부종, 충혈, 눈부심, 점액성 분비물로 인공눈물과 알레르기 치료를 시행하였으나 호전이 없어 내원하였다. 세극등현미경검사상 양안 굳기름각막침착물(mutton fat keratic precipitates), 위, 아래 검결막과 구결막에 충혈과 함께 미만성의 결막 조직 비대, 다수의 여포와 유두비대들이 관찰되었다. 브리모니딘 유발 만성 육아종앞포도막염을 동반한 결막염으로 진단하고 약제 중단 후 인공눈물만 사용하였고, 빠른 속도로 굳기름각막침착물이 저절로 사라져 1달 만에 앞포도막염과 결막염이 완전히 소실되었다. 결론: 브리모니딘 약제로 만성 육아종앞포도막염이 발생하는 경우는 매우 드물지만 약제 중단만으로도 쉽고 빠르게 치료할 수 있다. 브리모니딘 장기 사용 환자에서 포도막염이 발생하였을 경우, 약제 부작용을 염두에 두고 불필요한 검사를 하지 않도록 주의해야 할 것이다.
Abstract
Purpose: To report a case of chronic granulomatous anterior uveitis which occurred after 2-year use of eye drops containing brimonidine. Case summary: A 82-year-old patient with intermittent angle-closure glaucoma had been using 1% brinzolamide/0.2% brimonidine fixed combination eye drops for two years. Bilateral eyelid edema, conjunctival injection, glare, and mucous discharge occurred one month prior, but did not improve, regardless of artificial tears and anti-allergy drug treatment. Mutton fat keratic precipitates, conjunctival injection, and diffuse conjunctiva hypertrophy at the palpebral and bulbar conjunctiva, multiple follicles, and papillary hypertrophy were observed in the slit lamp examination. Based on the diagnosis of chronic granulomatous anterior uveitis with allergic conjunctivitis caused by brimonidine, only an artificial tear preparation was used after the drug was stopped. Anterior uveitis and conjunctivitis improved rapidly and disappeared completely within one month. Conclusions: Brimonidine-induced chronic granulomatous anterior uveitis is a very rare disease, but it can be easily and quickly treated just by withdrawal of the drug. In the case of long-term use of brimonidine, it is essential to diagnose the possible side effects of the drug and to avoid unnecessary investigations and interventions.
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