3차병원을 방문한 플릭텐각결막염 환자의 임상양상 분석
Analysis of Clinical Characteristics in Phlyctenular Keratoconjunctivitis at a Tertiary Center
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목적: 한국에서 3차병원을 방문한 플릭텐각결막염 환자의 임상양상을 분석하고자 하였다. 대상과 방법: 플릭텐각결막염이 진단된 환자 26명 35안의 후향적 의무기록 분석을 통해 의뢰 당시 초진단명, 나이, 성별, 편측성, 발병위 치, 눈꺼풀염의 동반 여부, 눈꺼풀 분비물 배양검사, 치료 및 재발을 조사하였다. 결과: 76.2%가 여자였고, 초진 시 평균 나이는 18.4세였으며, 34.6%에서 양측성이었는데, 상세불명 각막염으로 의뢰된 경우가 30.8%였 다. 80.8%에서 각막염으로 발병하였고, 96.2%에서 눈꺼풀염을 동반하였다. 눈꺼풀 분비물 배양검사를 시행한 17명 중 35.3%에서 표피 포도알균이 동정되었다. 각막염에서 신생혈관의 범위는 평균 2.86시간이었고, 대부분 아래 사분면에서 시작하였다. 1% prednisolone 점안치료 및 눈꺼풀의 항생제세척 치료로 평균 22일에 신생혈관이 퇴행하고, 각결막염이 관해되었다. 유지치료로 0.05% 시클로스포린 을 평균 9.6개월 사용하였는데, 11.5%에서 재발하였다. 관해 후 시력이 초진 시 시력에 비해 유의하게 호전되었다(P = 0.028). 결론: 한국에서 3차병원을 방문한 플릭텐각결막염 환자의 임상양상은 서양 및 일본의 보고와 인구학적 성상, 안검염 동반 및 동정 균주 는 거의 일치하였다. 그러나, 시축을 침범하는 각막염의 빈도가 높았고, 적절한 진단 및 치료를 통해 시력을 호전시킬 수 있음을 알 수 있었다.
Abstract
Purpose: To report the clinical characteristics of patients with phlyctenular keratoconjunctivitis at a tertiary care center in Korea. Methods: The authors of the present study retrospectively reviewed the medical records of 26 patients who were diagnosed with phlyctenular keratoconjunctivitis, identifying the age and sex at diagnosis, diagnosis of the referring clinic, laterality and location of the lesions, the results of bacterial cultures from the meibum, and treatment options. Results: Eighteen patients (76.2%) were female, and the mean age at diagnosis was 18.4 ± 10.5 years. Nine patients (34.6%) showed evidence of bilateral diseases, and corneal lesions were observed in 27 eyes of 21 patients. Bacterial cultures from the meibum were performed for 17 patients, with the following results: 6 cases of Staphylococcus epidermidis, 4 cases of Corynebacterium species, and 1 case of Propionibacterium acne. Neovascularization with corneal phlyctenules occurred from the inferior quadrant mostly. Twenty-four patients received the remission treatment of prednisolone acetate 1% eye drops and evidence of regression of new vessels was observed in all patients. Three patients (16.7%) experienced recurrence despite the maintenance treatment of cyclosporine 0.05% eye drops. Visual acuities improved significantly after the remission treatment, as compared to the initial visit. Conclusions: The phlyctenular keratoconjunctivitis patients who visited the tertiary center in Korea showed similar findings regarding demographics, involvement of blepharitis, and identified microorganisms, as compared with patients in previous reports. However, corneal lesions involving the visual axis were frequent, suggesting that with proper diagnosis and treatment, improvement in visual acuities is possible.
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