류마티스 관절염 환자에서 백내장 수술 후 발생한 양안 주변부궤양각막염 1예
A Case of Bilateral Peripheral Ulcerative Keratitis in a Patient with Rheumatoid Arthritis after Cataract Extraction
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목적: 류마티스 관절염 환자에서 투명각막절개로 시행한 백내장수술 후 양안에서 발생한 주변부궤양각막염 1예를 경험하여 이를 보고한다. 증례요약: 67세 여자 환자가 우안 백내장수술 10일 후 발생한 양안의 통증과 시력저하를 주소로 전원되었다. 양안 백내장으로 좌안백내장수술 후 1주일 뒤에 우안 백내장수술을 시행 받았고 수술 중 초음파 첨단에 의한 홍채손상으로 전방출혈이 발생하였다고 한다. 세극등현미경 검사상 양안에 투명각막절개창을 주위에 주변부궤양각막염 및 각막 부종 소견이 있었다. 항생제의 점안과 전신투여를시행하였으나 병변의 호전은 없었다. 각막찰과 및 세균배양검사에서 균은 검출되지 않았다. 류마티스 관절염의 병력과 함께 특징적인손가락의 변형이 관찰되어 무균성 주변부궤양각막염으로 진단 후 경구용 스테로이드, 설파살라진과 국소 스테로이드 점안액을 사용했다. 치료 후 1개월째 각막의 얇아짐과 주변부궤양각막염은 진행하지 않았고 상피의 재생이 이루어졌다. 결론: 류마티스 관절염 환자에서 투명각막절개창을 이용한 백내장수술 후에 주변부궤양각막염이 생길 수 있으므로 수술 중의 안구조직의 손상을 최소화하는 세심한 조작과 수술 전, 후의 관리에 주의를 기울여야 한다.
Abstract
Purpose: To report a case of bilateral peripheral ulcerative keratitis after cataract extraction with a clear corneal incision in a patient with rheumatoid arthritis. Case summary: A 67-year-old woman was referred to our clinic with bilateral ocular pain and visual disturbances, 10 days after a cataract extraction in her right eye. The patient had undergone a cataract extraction with clear corneal incision in the left eye and the same procedure was performed in the right eye after 1 week. During the surgery, hyphema occurred because of the iris damage by the phacoemulsification tip. Slit lamp examination showed bilateral peripheral ulcerative keratitis around the incision site and diffused corneal edema. Topical instillation and systemic administration of antibiotic agents were given as treatment but the patient showed no improvement. Corneal culture and smear were performed and showed a negative result. Because the patient was previously diagnosed with rheumatoid arthritis and showed the characteristic finger deformity, she was diagnosed with a sterile peripheral ulcerative keratitis and was treated with oral steroid, sulfasalazine,and steroid eye drop. After 1 month of treatment, epithelial thinning of the cornea and peripheral corneal ulcer stopped progressing and showed corneal re-epithelization. Conclusions: Because peripheral ulcerative keratitis after cataract extraction with clear corneal incision can occur in a patient with rheumatoid arthritis, caution is necessary to minimize damage by careful manipulation during the operation and requires special attention in preoperative and postoperative management.
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