각막기질 수화 과정에서의 관류 바늘에 의한 각막기질 관통 손상의 1예
A Case of a Corneal Stromal Penetrating Injury via an Ejected Needle during Stromal Hydration
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목적: 백내장 수술의 각막기질 수화 과정에서 분출된 관류 바늘에 의해 각막기질이 수평 관통 손상된 사례를 경험하였고 회복 과정 및 경과를 보고하고자 한다. 증례요약: 우안 시력저하를 주소로 79세 여자 환자가 내원하였다. 환자는 초진 시 최대 교정 시력은 우안 0.3이었고 우안의 백내장은 nuclear opacity 3, cortical opacity 1–2, posterior subcapsular opacity 1으로 분류되었다. 백내장 수술은 점안마취하에 진행되었으며 투명각막절개를 통해 성공적인 수정체 유화술 및 낭내 인공 수정체 삽입술이 시행되었고 관류 바늘이 끼워진 주사기를 이용하여 각막기질 수화로 절개창 폐쇄를 시도하였다. 이 과정에서 헐거워진 관류 바늘이 전방 내에서 각막내피 방향으로 분출되었고 각막기질층을 수평으로 관통하였으나 각막상피로의 관통은 없었다. 수술 후 1일째 우안의 나안 시력은 0.5였으며 난시값은 -1.25디옵터(D) cyl × 30으로 측정되었고 각막부종 및 데스메막주름과 각막내피세포의 미세한 흉터만 관찰되었다. 수술 후 3주째 우안의 나안 시력은 0.9였으며, 난시값 -0.50 D cyl × 59로 측정되었고 각막 혼탁 등의 특이사항은 관찰되지 않았다. 결론: 관류 바늘에 의해 관통 손상된 각막내피세포 및 기질세포는 보상 기전에 의해 각막 부종과 혼탁이 심하게 발생하지 않고 창상회복이 되어 굴절 변화에 큰 영향을 주지 않고 시력을 유지할 수 있었다. 분출된 바늘에 의한 합병증을 예방하기 위해 수술자와 수술보조자는 항상 관류 바늘 연결부위를 주의 깊게 확인하여야 한다.
Abstract
Purpose: We report a case of a horizontally penetrating injury of corneal stroma via an ejected irrigating needle during stromal hydration in cataract surgery. Case summary: A 79-year-old woman presented with decreased visual acuity in her right eye. Her best corrected visual acuity in the right eye was 0.3. The cataract score of her right eye was nuclear opacity 3, cortical opacity 1−2, and posterior subcapsular opacity 1. She underwent phacoemulsification using a clear corneal approach while under topical anesthesia, and an intraocular lens was successfully implanted in the bag. A plastic syringe with an irrigating needle was used to hydrate the corneal stroma at the clear cornea site. As a result of the increased pressure applied to the connection between the syringe and irrigating needle, the loosened irrigating needle was forcefully ejected toward the corneal endothelium, horizontally penetrating the stroma without injuring the corneal epithelium. On the 1st postoperative day, her right eye exhibited a visual acuity of 0.5, astigmatism of -1.25 diopter (D) cyl., corneal edema with Descemet’s folds, and insignificant scarring of the corneal endothelium. Three weeks after surgery, the visual acuity was 0.9, the astigmatism was -0.50 D, and any other abnormalities such as corneal opacity were no longer present. Conclusions: Despite a penetrating needle injury through the corneal endothelium and stroma, the corneal wound healing process did not result in corneal opacity or worsened astigmatism. To prevent sequela due to an ejected irrigating needle, operators and assistants should be actively aware of tight locking between the needle and syringe.
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