백내장 수술 후 발생한 스타필로코쿠스 루그두넨시스 안내염 1예
A Case of Staphylococcus lugdunensis Endophthalmitis after Cataract Surgery
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목적: 백내장 수술 후 발생한 Staphylococcus lugdunensis 안내염 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 59세 여자 환자가 본원에서 좌안 백내장 수술을 받은 후 13일째 발생한 좌안의 통증과 시력저하를 주소로 내원하였다. 좌안의 최대교정시력은 20/200이었고, 세극등현미경 검사에서 좌안의 결막충혈, 전방 내 다수의 염증세포, 1 mm 가량의 전방축농과 삼출성 막이 관찰되었으며 안저는 흐려 잘 보이지 않았다. 전방천자 및 유리체강내항생제주입술(vancomycin 1.0 mg/0.1 mL, ceftazidime 2.0 mg/0.1 mL)을 시행하고 입원하였는데, 다음 날 증상의 호전이 없고 그람양성구균이 자라는 것이 확인되어, 유리체절제술과 함께 유리체강내항생제주입술(vancomycin 1.0 mg/0.1 mL, dexamethasone 0.5 mg/0.1 mL)을 추가로 시행하였다. 수술 7일째, 균 배양검사 결과 Staphylococcus lugdunensis가 동정되었고, 수술 11일째, 염증이 조절되고 증상이 호전되어 퇴원하였다. 수술 3개월 후, 좌안의 최대교정시력은 20/20이며, 안내염의 재발 및 안저의 이상소견은 관찰되지 않았다.
Abstract
Purpose: To report a case of Staphylococcus lugdunensis endophthalmitis following cataract extraction and intraocular lens implantation. Case summary: A 59-year-old woman presented with unilateral vision impairment and eyeball pain in her left eye, thirteen days after phacoemulsification and posterior chamber intraocular lens implantation. Best-corrected visual acuity of her left eye was 20/200. Slit lamp examination of her left eye revealed a severe conjunctival injection, severe chamber reactions with exudative membranes, hypopyon (about 1 mm) in the anterior chamber, and the fundus was not visible. Before the patient was admitted to the hospital, we cultured samples of aqueous fluid and performed an intravitreal antibiotics injection (vancomycin 1.0 mg/0.1 mL, ceftazidime 2.0 mg/0.1 mL). However, on the next day, because the inflammatory reactions of the anterior chamber and vitreous cavity were not improved and Gram positive cocci was confirmed, we performed a pars plana vitrectomy and an additional intravitreal antibiotics injection (vancomycin 1.0 mg/0.1 mL, dexamethasone 0.5 mg/0.1 mL). Seven days after the surgery, Staphylococcus lugdunensis was identified in the aqueous fluids culture. 11 days after the surgery, her inflammation and symptoms were improved and therefore, she could be discharged. Three months after the surgery, best-corrected visual acuity of her left eye was 20/20 and there was no evidence of recurrence of endophthalmitis and no abnormal findings in her fundus.
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