녹내장 수술 후 발생한 지연성 안내염
Late-Onset Endophthalmitis Associated with Glaucoma Surgery
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목적: 녹내장 수술 받은 환자에서 발생한 지연성 안내염의 임상경과를 보고하고자 하였다. 대상과 방법: 1988년 1월부터 2013년 3월까지 녹내장 수술을 받은 4,905안을 대상으로 술 후 안내염으로 진행된 14명 14안의 의무기록을 분석하였다. 결과: 총 4,905안 중에 14안(0.29%)이 녹내장 수술 후 안내염으로 진행하였다. 녹내장 수술 후 지연성 안내염이 발생한 시기는 평균8.4년으로 짧게는 술 후 1년부터 길게는 21년까지였다. 안내염이 발생한 환자는 방수유출장치 삽입술을 시행 받은 993안 중 6안(0.60%),섬유주절제술 3,912안 중 8안(0.20%)이었다(p=0.046). 한 명을 제외한 모든 환자들은 유리체강내 강화 항생제 주입술을 시행 받았으며4명은 유리체절제술을 시행 받았다. 방수유출장치를 삽입 후 안내염이 발생한 6안 중 2안은 삽입된 방수유출장치를 제거하였다. 14안중 4안에서 균이 동정되었다(staphylococcus.aureus, streptococcus viridians, propionibacterium acnes, candida parapsilosis). 안내염 진단 후 1년 뒤 4안만이 4/200 이상의 시력을 보였으며 나머지 10안은 안전수동 이하의 시력을 보였다. 3안(33%)에서 녹내장수술 후 다른 안내수술 후에 안내염이 발생하였다. 결론: 녹내장 수술 후 발생한 지연성 안내염은 시력예후가 매우 불량하고, 발생 시기도 예측하기 어려워 녹내장 수술 후 안내염에대한 환자의 교육 및 좀 더 면밀한 정기적 안과 관찰이 필요하다.
Abstract
Purpose: To report cases of late-onset endophthalmitis associated with glaucoma surgery. Methods: We retrospectively reviewed the medical records of 4905 consecutive patients who underwent glaucoma surgery(trabeculectomy or valve implant surgery) from January 1, 1988 to March 31, 2013. Results: There were a total of 14 late-onset endophthalmitis (0.29%) cases associated with glaucoma surgery occurring at 1year to 21 years postoperatively. Six cases (6/993, 0.60%) occurred after valve implantation and the other 8 cases (8/3912,0.20%) occurred after trabeculectomy (p = 0.046). All but one patient were injected with fortified vancomycin and ceftazidim. Four patients also received a vitrectomy with the injection. The implanted valve was removed in 2 cases. In four cases, organismswere found in the culture (staphylococcus.aureus, streptococcus viridians, propionibacterium acnes and candida parapsilosis). After 1 year, only 4 patients achieved a visual acuity above 4/200 compared with other patients who had a final visualacuity of hand motion or worse. Three patients (33%) who developed endophthalmitis underwent other intraocular procedures. Conclusions: Late-onset endophthalmitis associated with glaucoma surgery can often occur with fulminant sight-threateningcomplications. Due to devastating sequelae, the surgeon should carefully check the surgery site in the patients who underwentglaucoma surgery at every follow-up visit. Delayed endophthalmitis after glaucoma surgery still carries a poor visual prognosisand its onset is difficult to predict. Therefore, patients who undergo glaucoma surgery should be educated and carefully evaluatedduring regular follow-ups.
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