원추각막 교정을 위해 시행한 각막링 삽입술 후 발생한 진균성 각막염 1예
A Case of Fungal Keratitis after Intracorneal Ring Segment Implantation for Keratoconus
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목적: 원추각막 교정을 위해 각막링 삽입술 시행 3일 후 발생한 진균성 각막염 1예를 보고하고자 한다. 증례요약: 65세 여자환자가 좌안 원추각막 교정을 위해 타 병원에서 각막링 삽입술을 시행 3일 후 발생한 난치성 감염성 각막염으로수술 4주 후 본원에 내원하였다. 세극등현미경검사에서 좌안 각막의 각막링 삽입 절개부위 주변의 상피결손과 백색의 각막기질 침윤,각막후면침착물이 관찰되었으며 전방염증과 결막부종 및 결막충혈이 관찰되었다. 세균 및 진균 염색과 배양을 위해 각막 찰과표본을채취 후 국소 항생제 점안을 시작하였다. 찰과표본에서 균 배양되지 않았으며 치료 시작 후 증상 및 임상양상 호전 보이지 않았다. 재시행한 각막 찰과표본 검사에서 유격균사(hyphae)가 분리되어, Amphotericin 안약 투여와 경구 항진균제를 복용하였고, 증상 및각막소견 호전되었다. 결론: 각막링 삽입술 후 발생한 감염성 각막염은 드물지만 시력에 치명적인 합병증이다. 각막링 삽입술과 관련된 각막염에서 항생제치료에도 호전되지 않는 임상 양상을 보인다면, 진균에 의한 각막염의 가능성을 염두에 두어야 할 것이며 신속한 진단을 통하여 원인균에 맞는 적절한 항진균제 치료가 필요할 것으로 생각한다.
Abstract
Purpose: To report a case of fungal keratitis 3 days after intracorneal ring segment (ICRS) implantation for keratoconus. Case summary: A 65-year-old woman was referred to our clinic with refractory infectious keratitis in her left eye 3 days after ICRS insertion for keratoconus. Slit lamp examinations revealed infiltrates around the incision site with cellular reaction in the anterior chamber after the ICRS had been removed. Corneal scrapings were obtained for staining and cultures, and intensive topical antibiotics were administered. Initial microscopy and cultures were negative. Despite the use of intensive topical antibiotics, there was no improvement. Hyphae were isolated from additional corneal scrapings. The patient’s symptoms and corneal findings improved following administration of topical amphotericin B and oral itraconazole. Conclusions: Infectious keratitis after ICRS implantation is an uncommon but sight-threatening complication. Fungal keratitis should also be considered if infectious keratitis after ICRS is unresponsive to antibiotics.
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