사시수술 후 발생한 안와 연조직염
Orbital Cellulitis Following Strabismus Surgery
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 망막박리로 망막수술 받은 과거력을 가진 환자에서 이차감각외사시에 대한 사시수술 후 경과관찰 2주째, 갑자기 발생한 안와연조직염 증례를 경험하였기에 이를 보고하고자 한다. 증례요약: 45세 남자 환자가 3일 전 갑자기 시작된 좌측 안검 부종과 통증을 주소로 내원하였다. 환자는 좌안 열공성 망막박리로 2차례의 유리체절제술 및 공막두르기, 기름주입 및 제거술을 시행 받은 과거력을 가진 자로 이차적으로 발생한 감각외사시에 대해 내원2주 전 좌안 외직근 후전술을 시행 후 경과관찰 중이었다. 내원 시 좌안 최대교정시력은 0.2였으며, 이학적 검사상 좌안 안검 및 결막의 부종과 결막하출혈 소견을 보였다. 1일 뒤 안구운동 제한이 동반되어 시행한 안와 CT상 좌측 안와 연조직염 진단 하에 입원하여광범위 항생제 주사 치료 5일간 유지 후 퇴원하였으나, 증상 악화 및 좌안 결막낭의 농양으로 재입원하였다. 결막낭의 농양에서는페니실린 내성 포도상구균이 배양되었다. 추가로 11일간 항생제 주사치료를 시행하였고, 좌안 안검 부종, 압통, 안구운동 제한이 호전되어 좌안 최대교정시력 0.2로 퇴원하였다.
Abstract
Purpose: To report a case of sudden orbital cellulitis presenting 2 weeks after strabismus surgery in a patient who had previously undergone retinal surgery for rhegmatogenous retinal detachment. Case summary: A 45-year-old male visited the ophthalmology clinic with a 3-day history of left eye pain and lid swelling which suddenly developed 2 weeks after left lateral rectus muscle recession surgery for secondary sensory exotropia. The patient had undergone trans pars plana vitrectomy twice, scleral encircling, oil injection and removal for rhegmatogenous retinal detachment 1.3 years prior. His best corrected visual acuity was 0.2 in his left eye and physical examination revealed eyelid edema, chemosis, and subconjunctival hemorrhage of the left eye. The next day, eye movements were moderately restricted. Computed tomography scanning with contrast enhancement demonstrated diffuse periorbital soft tissue swelling and enhanced fat stranding suggesting left orbital cellulitis. The patient was hospitalized with intravenous broad spectrum antibiotics. He was discharged after a 5-day course of intravenous antibiotic treatment, but readmitted for symptom aggravation and purulent discharge from the left conjunctival fornix. Culture of conjunctival fornices revealed penicillin-resistant staphylococcus aureus. Intravenous anitibiotics were maintained for 11 days additionally and left eye swelling,tenderness and ocular movement restrictions were improved. The patient was discharged from the hospital with a best corrected visual acuity of 0.2.
참고문헌 (18)
- Coats DK, "Strabismus surgery complications", Int Ophthalmol Clin, 50, pp.125~135 (2010)
- Tovilla-Canales JL, "Orbital and periorbital infections", Curr Opin Ophthalmol, 12, pp.335~341 (2001)
- Kivlin JD, "Periocular infection after strabismus surgery. The Periocular Infection Study Group", J Pediatr Ophthalmol Strabismus, 32, pp.42~49 (1995)
- Georgakopoulos CD, "Periorbital and orbital cellulitis: a 10-year review of hospitalized children", Eur J Ophthalmol, 20, pp.1066~1072 (2010)
- Moubayed SP, "Periorbital cellulitis in the pediatric population: clinical features and management of 117 cases", J Otolaryngol Head Neck Surg, 40, pp.266~270 (2011)
- Weakley DR, "Orbital cellulitis complicating strabismus surgery : a case report and review of the literature", Ann Ophthalmol, 23, pp.454~457 (1991)
- Bertino JS Jr, "Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics", Clin Ophthalmol, 3, pp.507~521 (2009)
- Emmett Hurley P, "Subperiosteal abscess of the orbit: duration of intravenous antibiotic therapy in nonsurgical cases", Ophthal Plast Reconstr Surg, 28, pp.22~26 (2012)
- Yang M, "Orbital cellulitis in children- medical treatment versus surgical management", Orbit, 28, pp.124~136 (2009)
- Ing MR, "Infection following strabismus surgery", Ophthalmic Surg, 22, pp.41~43 (1991)
- Armesto A, "Orbital cellulitis after faden operation on the medial rectus", Strabismus, 15, pp.215~219 (2007)
- Basheikh A, "A child with bilateral orbital cellulitis one day after strabismus surgery", J AAPOS, 13, pp.488~490 (2009)
- Hoyama E, "Blinding orbital cellulitis: a complication of strabismus surgery", Ophthal Plast Reconstr Surg, 22, pp.472~473 (2006)
- Palamar M, "Orbital cellulitis after strabismus surgery", J AAPOS, 9, pp.602~603 (2005)
- Lau FH, "An unusual complication after strabismus surgery", Hong Kong Med J, 15, pp.297~298 (2009)
- 이성복, "하이드로젤 공막돌륭물을 이용한 공막돌륭술의 후기 합병증", 대한안과학회지, 47(4), pp.512~518 (2006), 대한안과학회
- Whitcher JP, "Ocular infections--a rational approach to antibiotic therapy", West J Med, 161, pp.615~617 (1994)
- Koederitz NM, "Postoperative povidone-iodine prophylaxis in strabismus surgery", J AAPOS, 12, pp.396~400 (2008)