백내장수술 후 발생한 만성 재발 메티실린 내성 용혈포도상구균 안내염
Chronic Recurrent Methicillin Resistant Staphylococcus Hemolyticus Endophthalmitis after Cataract Surgery
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목적: 백내장수술 후 발생한 재발 메티실린 내성 용혈포도상구균 안내염 1예를 보고한다. 증례요약: 76세 여자 환자가 백내장 술 후 40일째 우안 시력 저하로 내원하였다. 내원 당시 전방 방수 흐림, 후낭과 인공수정체 사이에 혼탁한 액체를 보여 잔존 피질에 의한 포도막염, 낭폐쇄증후군 등을 의심하여 결막하에 덱사메타손 주사, 야그레이저후낭절개술을시행하였다. 이틀 뒤 전방축농, 유리체 혼탁이 관찰되어, 세균성 안내염을 의심하여 유리체절제술, 유리체강 내에 항생제 주사를 시행하였다. 이때 시행한 배양검사는 음성이었다. 술 후 20일째에 전방의 방수흐림, 유리체 혼탁이 다시 생겼다. 인공수정체 주변 조직의 균에 의한 안내염 재발을 의심하여 수정체낭을 포함한 인공수정체 제거, 유리체강 내에 항생제 주사를 시행하였다. 이 때 배양검사에서 메티실린 내성 용혈포도상구균이 검출되어 전신적 반코마이신 투여 및 점안하였다. 그 뒤 20일 후 시력 저하, 전방 내에 염증이 생겼고, 안내 항생제 주사, 점안 항생제를 투여한 후 안내염이 호전되었다. 결론: 백내장수술 후 안내염이 생기는 환자의 감별진단으로 메티실린 내성 용혈포도상구균 안내염이 고려되어야 한다.
Abstract
Purpose: To report a case of recurrent endophthalmitis due to methicillin resistant Staphylococcus hemolyticus after phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Case summary: A 76-year-old female visited our outpatient clinic with decreased vision 40 days after uncomplicated cataract surgery in her right eye. At the visit, anterior chamber inflammation and cloudy fluid between the posterior capsule and IOL were observed. Uveitis due to residual cortex of lens or capsular block syndrome was suspected, so YAG laser capsulotomy and subconjunctival injection of dexamethasone were performed. Two days later, hypopyon and vitreous opacity were seen. The patient underwent an emergency vitrectomy and intravitreal antibiotic injection with suspicion of bacterial endophthalmitis. The culture was negative. Twenty days after the vitrectomy, anterior chamber inflammation and vitreous opacity developed. The recurrence of endophthalmitis was suspected due to infection by bacteria in the surrounding tissue of the IOL, so the patient underwent an IOL and lens capsule removal with intravitreal antibiotic injection. At this time, the culture revealed methicillin resistant staphylococcus hemolyticus. Systemic and topical vancomycin was then administered, resulting in decreased inflammation. Twenty days after the IOL removal, decreased vision, anterior chamber inflammation, and vitreous opacity developed. Endophthalmitis was decreased by intravitreal antibiotic injection and topical antibiotic treatment. Conclusions: Methicillin resistant staphylococcus hemolyticus should be considered in the differential diagnosis of chronic recurrent endophthalmitis after cataract surgery.
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