전층각막이식 봉합사 제거 후 외상에 의해 발생한 지연성 축출성 맥락막상강출혈 1예
Delayed-Onset Expulsive Suprachoroidal Hemorrhage Due to a Trauma after Removal of Penetrating Keratoplasty Suture
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목적: 전층각막이식 봉합사 제거 후 외상을 입고 지연되어 발생한 축출성 맥락막상강출혈을 경험하여 보고하고자 한다. 증례요약: 좌안의 수포성각막병으로 진단받은 66세 남자환자가 전층각막이식을 받고 12개월 후 연속봉합사를 제거하였다. 봉합사 제거 4일 후 작업 중 손등에 좌안을 부딪치는 외상을 입고, 외상 2일 후 갑자기 발생한 좌안의 시력저하, 통증과 다량의 출혈을 주소로 내원하였다. 각막이식연접부의 2시부터 10시 사이에 창상열개가 발생하였고, 안구내용물 탈출이 관찰되었다. 수술을 시행하여 재위치 되지 않는 안구내용물을 절제하고, 다시 각막이식편을 단속봉합방법으로 일차 봉합하였다. 술 후 출혈은 멈추었고 2개월 후 눈 속의 응고된 혈종이 줄어들면서 안구는 위축되었다. 결론: 외상 당시 각막이식편 연접부의 창상누출로 인해 수일간 저안압이 지속되면서 축출성 맥락막상강출혈이 발생한 것으로 생각된 다. 전층각막이식술 후 외상은 시력뿐 아니라 안구의 생존에도 큰 영향을 미치므로 외상에 대한 주의와 외상 후 검진에 대한 교육이 필요하겠다.
Abstract
Purpose: To report a case of delayed-onset expulsive suprachoroidal hemorrhage due to trauma after removal of a penetrating keratoplasty suture. Case summary: A 66-year-old man had penetrating keratoplasty for bullous keratopathy performed in his left eye. After 1 year, the continuous suture was removed for adjustment of astigmatism. Four days after removal of the suture, the patient struck his left eye with the back of his hand, although at the time of injury he had no specific symptoms. Two days later, the patient noticed abrupt pain, decreased visual acuity, and massive hemorrhage in his left eye. Examination revealed an inferior wound dehiscence of approximately 8 clock hours (2 thru 10 o’clock) with prolapsed intraocular contents such as the uvea and retina. The patient underwent cornea graft resuturing with resection of ocular contents, which could not be repositioned. Although bleeding was controlled after the operation, vision was lost in his left eye. After two months, according to decrement of intraocular hematoma, the patient had a phthisis bulbi with low intraocular pressure in his left eye. Conclusions: Persistent low intraocular pressure due to wound leakage through the graft-host junction likely resulted in delayed onset of expulsive suprachoroidal hemorrhage. The risk of traumatic corneal graft rupture after penetrating keratoplasty is significant and is associated with a poor visual outcome and eyeball viability. Therefore, patients should be cautioned. In addition, the importance of eye examination after trauma should be emphasized.
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