나이에 따른 감염각막염 환자의 임상분석: 2병원 연구
Age-related Clinical Analysis of Infectious Keratitis in Two Tertiary Centers
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목적: 감염각막염의 발생에 있어서 나이에 따른 위험인자, 임상양상 및 예후에 대해 알아보고자 하였다. 대상과 방법: 2000년 1월부터 2007년 12월까지 전라도 지역 2개의 3차 병원 안과를 내원한 감염각막염 환자 757명(757안)을 대상으로환자의 성, 연령, 외상의 과거력, 전신질환, 이전의 안질환, 원인균, 치료 방법 등을 분석하여 60세를 기준으로 한 나이에 따라 관련있는 위험인자를 후향적으로 조사하였다. 결과: 총 757명(757안)의 감염각막염이 보고되었으며, 평균 나이는 58.2±18.0세(범위: 4~93세)였으며 남자가 437명(57.7%), 여자가320명(42.3%)이었다. 가장 흔한 위험인자는 나이에 관계없이 외상이었으며, 특히 식물에 의한 경우가 많았다. 이외에 젊은환자군에서는 콘택트렌즈 착용(19.2%)이 흔하였고 노인환자군에서는 이전의 안질환(20.0%), 전신질환(15.5%), 안수술(9.7%) 순으로 흔하였다. 원인균으로는 나이에 관계없이 그람양성균, 특히 표피포도알균이 가장 많았다. 노인환자군에서 젊은환자군보다 각막천공이 더 많이 발생하였고 시력 예후가 나빴으며 수술적 치료를 요하는 경우가 더 많았다. 결론: 감염각막염은 젊은환자군보다 노인환자군에서 더 심한 임상양상과 많은 합병증을 보였으며, 예후가 좋지 않았다. 또한 노인환자군에서는 다양한 위험인자에 의해 발생하였고 이의 예방을 위해 외상, 특히 식물에 의한 안손상에 주의가 필요하며, 노출각막염, 수포각막병증과 같은 안구표면질환을 잘 관리하여야 할 것으로 생각된다.
Abstract
Purpose: To evaluate the age-related risk factors, clinical manifestations, and prognosis in infectious keratitis. Methods: Records of patients with infectious keratitis who visited one of the two tertiary medical centers at Jeolla-do from January 2000 to December 2007 were reviewed. Risk factors depending on patient age distribution standardized over and under the age of 60 were reviewed retrospectively by analyzing sex, age, previous history of trauma, systemic disease, previous ocular disease, causative organism and treatment. Results: A total of 757 patients (757 eyes) visited either one of the two tertiary medical centers. The mean age was 58.2±18.0(4 to 93) years, and patients included 437 males (57.7%), and 320 females (42.3%). The most common risk factor among all age groups was trauma, especially due to vegetable matter. The second most frequent risk factor among the younger patients was contact lens use (19.2%), and common risk factors among the elderly were previous ocular disease (20.0%), systemic disease (15.5%), and ocular surgery (9.7%). The most prevalent causative organisms among all age groups were Gram-positive bacteria,in particular Staphylococcus epidermidis. Elderly patients had a higher frequency of corneal perforation than did younger patients. In addition, elderly patients had a worse prognosis and more often required surgical treatment. Conclusions: Infectious keratitis has more severe clinical manifestations and complications and a worse prognosis in elderly than in younger patients. Elderly patients have more diverse risk factors. Prevention should aim at avoiding ocular trauma, especially by vegetable matter, and at controlling ocular surface diseases, such as exposure keratitis and bullous keratopathy.
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