원발군날개와 동반된 자발각막천공 1예
A Case of Spontaneous Corneal Perforation Combined with Primary Pterygium
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 원발군날개와 동반된 자발적 각막 천공 1예를 보고하고자 한다. 증례요약: 66세 남자가 하루 전부터 발생한 우안의 이물감 및 눈물흘림을 주소로 내원하였다. 전신적인 특이병력은 없었으며, 6년 전 좌안 군날개에 대해 타 병원에서 군날개절제술을 시행 후 하루만에 발생한 각막 천공으로 응급 양막이식술을 시행 받고, 이후 전층각막이식술을 받은 과거력이 있었다. 내원 시 우안 나안시력은 20/25, 안압은 2 mmHg였다. 세극등현미경 소견상 우안은 비측군날개가 관찰되었고, 군날개 머리 부분 아래로 각막의 활동성 방수 누출이 관찰되었다. 군날개와 동반된 각막 천공 의심하에 응급양막이식술을 진행하였다. 군날개를 제거한 뒤 5시 방향 윤부에서 3 mm 떨어진 각막에 2 mm 크기의 천공 부위가 관찰되었으며, 천공 주변으로 각막이 전반적으로 얇아져 있었다. 천공부위 위로 피브린 글루를 도포 후, 양막이식술을 시행하였다. 수술 후 6개월 뒤 우안 교정시력 20/20, 안압 9 mmHg였으며 추가적인 천공이나 군날개 재발 등의 합병증은 관찰되지 않았다. 결론: 원발군날개 환자에서 자연적으로 각막 천공이 발생할 수도 있으므로, 군날개 진료 시 이에 대한 가능성에 대해서도 고려해야 할 것으로 생각된다.
Abstract
Purpose: We report a case of spontaneous corneal perforation combined with primary pterygium. Case summary: A 66-year-old male presented with a foreign body sensation in his right eye. He had no systemic or ocular inflammatory diseases. He had undergone penetrating keratoplasty following amniotic membrane transplantation for corneal perforation at 1 day after pterygium excision in his left eye. The uncorrected visual acuity (UCVA) and intraocular pressure (IOP) in his right eye were 0.8 and 2 mmHg, respectively. Active leakage of an aqueous humor on the head of the pterygium was found on slit lamp examination. With the impression of spontaneous corneal perforation combined with primary pterygium, emergent amniotic membrane transplantation was performed. Diffuse corneal thinning around the 2 mm-sized perforation site was found 3mm away from the limbus in the 5 o’clock after removing the pterygium. The perforation site was covered with amniotic membrane after applying fibrin glue. UCVA and IOP in his right eye were 1.0 and 9 mmHg, respectively, at postoperative 6 months. No definite recurrence of pterygium or additional corneal perforation was found. Conclusion: Spontaneous corneal perforation may be related to primary pterygium.
참고문헌 (15)
- Lim CY, "Risk factors for pterygium in Korea: The Korean National Health and Nutrition Examination Survey V, 2010-2012", Medicine (Baltimore), 94, pp.e1258~ (2015)
- Liu T, "Progress in the pathogenesis of pterygium", Curr Eye Res, 38, pp.1191~1197 (2013)
- Dougherty PJ, "Corneoscleral melt after pterygium surgery using a single intraoperative application of mitomycin-C", Cornea, 15, pp.537~540 (1996)
- Fujitani A, "Corneoscleral ulceration and corneal perforation after pterygium excision and topical mitomycin C therapy", Ophthalmologica, 207, pp.162~164 (1993)
- Kassir MS, "Corneal perforation after excision of pterygium and use of 0.02% mitomycin eyedrops", J Fr Ophthalmol, 22, pp.776~779 (1999)
- Hagen KB, "Progressive nonulcerative paracentral keratolysis associated with elevated corneal metalloproteinases", Cornea, 16, pp.486~492 (1997)
- Lekhanont K, "Progressive keratolysis with pseudopterygium associated with erythema elevatum diutinum", Ophthalmology, 118, pp.927~933 (2011)
- Tsai YY, "Effect of TIMP-1 and MMP in pterygium invasion", Invest Ophth Vis Sci, 51, pp.3462~3467 (2010)
- Di Girolamo N, "Pathogenesis of pterygia: role of cytokines, growth factors, and matrix metalloproteinases", Prog Retin Eye Res, 23, pp.195~228 (2004)
- Di Girolamo N, "Differential expression of matrix metalloproteinases and their tissue inhibitors at the advancing pterygium head", Invest Ophth Vis Sci, 41, pp.4142~4149 (2000)
- Gomez DE, "Tissue inhibitors of metalloproteinases: structure, regulation and biological functions", Eur J Cell Biol, 74, pp.111~122 (1997)
- Fukuda K, "Differential distribution of subchains of the basement membrane components type IV collagen and laminin among the amniotic membrane, cornea, and conjunctiva", Cornea, 18, pp.73~79 (1999)
- Tseng SC, "Suppression of transforming growth factor-beta isoforms, TGF-beta receptor type II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix", J Cell Physiol, 179, pp.325~335 (1999)
- Kim HK, "Fibrin glue-assisted augmented amniotic membrane transplantation for the treatment of large noninfectious corneal perforations", Cornea, 28, pp.170~176 (2009)
- Solomon A, "Amniotic membrane grafts for nontraumatic corneal perforations, descemetoceles, and deep ulcers", Ophthalmology, 109, pp.694~703 (2002)