전신홍반루푸스 환자에서 발생한 전안부 임상양상 2예
Two Clinical Manifestations of Anterior Segment Associated with Systemic Lupus Erythematosus
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목적: 전신홍반루푸스(systemic lupus erythematosus, 루푸스)에 동반된 전안부의 임상 증례를 경험하여 임상경과 및 치료결과를 보고하고자 한다. 증례요약: 첫 번째 증례는 63세 여자로, 좌안 각막궤양과 검구유착, 양안 건성안 진단하 점안 항생제와 자가혈청안약, 인공눈물 치료및 양막이식술과 검구유착 제거술을 시행하였다. 수술적 치료 1개월 뒤 좌안 각막궤양은 호전되었으나 각막이 지속적으로 얇아져 데스메막류가 발생하였다. 두 번째 증례는 24세 여자로 양안 건성안과 실모양 각막염, 재발성 각막 미란, 좌안 포도막염 진단하에 치료용콘택트렌즈와 점안 항생제 및 스테로이드제를 사용하여 증세가 일부 호전되었으나, 6개월 뒤 재발하였고 치료에 반응하지 않아 시행한전신 검사상 루푸스로 진단되어 경구약물 치료를 병행하였으며, 실모양 각막염과 재발성 각막 미란이 호전되었다. 결론: 루푸스에 동반된 전안부 임상양상은 국소적인 치료에 잘 반응하지 않고 재발 가능성이 높아 반드시 전신적인 치료가 동반되어야치료 효과를 기대할 수 있다. 따라서 난치성 안과 질환에서는 항상 전신적인 기저 질환의 가능성을 염두에 두고 치료 방침을 결정하여야 한다.
Abstract
Purpose: To report the clinical course and results of two cases of anterior segment manifestations associated with systemic lupus erythematosus (SLE). Case summary: The first case was a 63-year-old female patient who was diagnosed with corneal ulcer and symblepharon on her left eye and dry eye in both eyes. Although the patient was treated with topical antibiotics, autologous serum and artificial tears, amniotic membrane transplantation and symblepharon removal were subsequently required. At 1 month after medical and surgical treatment, the corneal ulcer improved, but a descemetocele was formed because of persistent corneal thinning. The second case was a 24-year-old female patient diagnosed with filamentary keratitis and recurrent corneal erosion in both eyes and uveitis in her left eye. After treatment with therapeutic contact lenses, topical antibiotics and steroids, her symptoms were slightly improved. After 6 months of treatment, filamentary keratitis and corneal erosion recurred to being intractable. The patient received systemic evaluation and was diagnosed with SLE. After a combined therapy of oral and topical treatments, filamentary keratitis and recurrent corneal erosion improved significantly. Conclusions: Clinical manifestations of anterior segment associated with SLE rarely respond to topical treatment and are apt to recur easily; therefore, systemic treatment should be applied for better prognosis. Thus, the therapeutic strategy in intractable ocular diseases should be designed with consideration of accompanying systemic diseases.
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