백내장 수술 후 발생한 독성 전방 증후군
Toxic Anterior Segment Syndrome Following Cataract Surgery
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목적: 백내장 수술 후 시력감소와 심한 염증 반응을 보인 7안의 증례를 소개하고, 그 원인을 고찰해 보고자 한다. 대상과 방법: 2007년 2월부터 2009년 11월까지 백내장 수술 환자 865안 중 술 후 시력감소, 안구통, 전방 내 염증 소견 및 각막 부종을보인 7안의 의무기록을 후향적으로 분석하였다. 결과: 환자들은 모두 60세 이상으로 당뇨병의 기왕력을 가진 경우가 4예, 심혈관계 질환을 가진 경우는 4예였다. 5예에서 친수성 인공수정체를 삽입하였고 수술 순서가 중반 이후였던 경우는 6예였다. 환자들은 평균적으로 술 후 10.4일(술 후 1-15일) 뒤 갑작스런 시력감소와 전방 내 염증, 각막 부종 소견을 보였다. 스테로이드 안약의 점안 횟수 증가와 경구용 스테로이드로 치료 후 전 예에서 시력호전과 염증 반응의 소실, 각막 부종의 감소가 관찰되었다. 결론: 백내장 수술 후 독성전방증후군의 발생률은 0.8%였고, 친수성 인공수정체를 삽입한 284안 중 5안에서(1.76%), 소수성 인공수정체를 삽입한 581안 중 2안에서(0.34%) 독성 전방증후군이 발생하였다(p=0.04). 2예를 제외하고, 5예에서는 술 후 14일째 지연성으로발생하였으며, 스테로이드에 좋은 반응을 보였다.
Abstract
Purpose: To report clinical and laboratory findings of toxic anterior segment syndrome (TASS) in seven patients following cataract surgery with intraocular lens (IOL) implantation. Methods: The medical records of seven patients who underwent cataract surgery associated with postoperative decreased visual acuity, ocular pain, anterior chamber inflammation and corneal edema between Feb 2007 and Nov 2009 were retrospectively reviewed. Results: All patients were over 60 years of age, four patients had diabetes and four patients had cardiovascular disease. Five patients had received hydrophilic IOL, and six patients underwent surgery later in order. All seven patients presented with increased anterior segment inflammation, acute decreased visual acuity, and severe corneal edema an average of 10.4 days (range 1 to 15 days) after surgery. Treatment of the seven patients included intensive topical and oral steroids,and improvement was noted in all patients. Conclusions: The incidence of TASS after cataract surgery was 0.8%, and was significantly higher in cases of hydrophilic IOL insertion (5 of 284 cases, 1.76%) compared to cases of hydrophobic IOL insertion (2 of 581 cases, 0.34%) (p = 0.04). Five of the seven cases presented with TASS at postoperative day 14. Inflammation improved in all patients with steroid treatment.
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