열공망막박리에 대한 공막돌륭술 후 발생한 녹농균 감염 1예
A Case of Pseudomonas aeruginosa Infection after Scleral Buckling for Retinal Detachment
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목적: 열공망막박리에 대한 공막돌륭술 후 공막돌륭물에 발생한 녹농균(Pseudomonas aeruginosa) 감염 이후 성공적으로 치료한1예를 보고하고자 한다. 증례요약: 68세 남자가 이틀 전부터 시작된 우안 통증을 주소로 내원하였다. 과거력상 10년 전 망막박리로 공막돌륭술을 시행 받았고, 1개월 전 우안 상내측에 결막 종괴가 발생해 본원에서 절제생검술을 시행 받았으며, 조직생검 결과 육아조직을 동반한 만성 염증성병변으로 확인되었다. 전안부검사에서 상측 결막의 충혈, 부종과 함께 공막돌륭물 매듭이 노출되어 있었다. 안저검사에서는 맥락막박리와 삼출성 망막박리가 관찰되었다. Moxifloxacin (Avelox®, Bayer, Pittsburgh, PA, USA) 주사제와 Moxiflixacin 0.5% (Vigamox®, Alcon, Fort Worth, TX, USA) 점안약으로 치료하며 경과관찰하였으나 호전되지 않았고 4일째부터 화농성 분비물이 동반되어 균배양검사를 시행한 후 공막돌륭물과 봉합매듭을 제거하였다. 분비물과 돌륭물에서 모두 녹농균이 동정되었다. 항생제 감수성 검사 확인후 Ceftazidime (Dimcef®, Chong Kun Dang, Seoul, Korea) 점안 및 주사제로 치료하였고 결막병변의 호전과 함께 맥락막박리와삼출성 망막박리도 사라졌다. 결론: 공막동률술 후 통증과 함께 결막부종 및 충혈, 화농성 분비물이 보이면 감염을 의심해 보아야 한다. 공막돌륭물의 감염이 의심되면 세균배양검사를 하고 항생제치료를 하며, 공막돌륭술의 제거를 고려하여야 한다.
Abstract
Purpose: To report a case of Pseudomonas aeruginosa infection after scleral buckling for retinal detachment. Case summary: A 68-year-old male presented with a 2-day history of pain in the right eye. The patient had a history of scleral buckling for retinal detachment 10 years earlier and excisional biopsy for conjunctival mass 1 month previously. Biopsy revealed chronic inflammation and granulation tissue formation. Slit-lamp examinations revealed superior conjunctival injection, edema and exposed suture knot. Fundus examination revealed exudative retinal detachment and choroidal detachment. The conjunctival lesion did not improve although the patient was treated with moxifloxacin. After 4 days, bacterial and fungal cultures were performed because the conjunctiva presented with purulent discharge 4 days after treatment. The scleral buckle and suture knot were removed. The cultures revealed growth of Pseudomonas aeruginosa. According to antibiotic sensitivity test results, the authors treated the patient with ceftazidime. The conjunctival lesion, choroidal detachment and exudative retinal detachment were improved. Conclusions: In patients with conjunctival injection, edema, purulent discharge and ocular pain after scleral buckling, presence of infection should be suspected. If scleral buckle infection is suspected, bacterial culture, antibiotics treatment and scleral buckle removal should be considered.
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