섬유주절제술 후 발생한 Streptococcus Cristatus 원인의 지연성 안내염 1예
Late-onset Endophthalmitis Caused by Streptococcus Cristatus after Trabeculectomy
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목적: 섬유주절제술 후 발생한 Streptococcus cristatus (S. cristatus) 원인의 여과포 관련 안내염 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 좌안 섬유주절제술 수술을 받은 지 2년 후 발생한 좌안 통증과 시력저하를 주소로 59세 여자 환자가 내원하였다. 좌안 시력은 안전수지였고, 세극등현미경검사에서 상부 결막에 얇아진 백색의 여과포, 심한 결막충혈, 전방 내 염증 소견이 관찰되었으며, 안저는 관찰되지 않았다. 항생제 투여에도 전방 내 염증 소견은 호전되지 않았고, 염증성 막과 전방축농이 동반되었다. 즉시 유리체절제술, 유리체내 항생제주사를 시행하였다. 유리체 검체의 세균배양검사 결과 S. cristatus가 동정되었으며, 수술 7일 후 염증 소견은 점차감소하였다. 수술 후 1개월째 안내염 재발 소견은 없지만, 좌안 최대교정시력은 여전히 안전수지로 유지되고 있다. 결론: 국내에서 아직 보고된 적 없는, 섬유주절제술 후 S. cristatus에 의한 지연성 여과포 관련 안내염을 보고하는 바이며, 섬유주절제술 후 발생한 안내염에서 그람 양성구균이 자랄 경우 S. cristatus에 의한 안내염의 가능성도 고려해야 하겠다.
Abstract
Purpose: To report a case of late-onset bleb-associated endophthalmitis caused by streptococcus cristatus (S. cristatus) after trabeculectomy. Case summary: A 59-year-old woman presented with left ocular pain and visual disturbance. She had undergone trabeculectomy of the left eye 2 years ago. At the initial visit, she was only able to count fingers from the left eye. Whitish thin bleb, conjunctival injection, and inflammation were observed in the left anterior chamber, and the fundus could not be visualized. Despite administering topical and systemic antibiotics, the chamber reaction worsened, and hypopyon and inflammatory membrane were noticed the next day. Vitrectomy with phacoemulsification and intravitreal antibiotic injection was performed, and the intravitreal antibiotic injections were repeated over the next two days. Bacterial culture of vitreous fluid showed a growth of S. cristatus 5 days after the surgery, and inflammation improved after 7 days. One month later, she was still only able to count fingers from the left eye, but there were no signs of endophthalmitis. Conclusions: Postoperative endophthalmitis after glaucoma filtering surgeries caused by S. cristatus has not been reported previously from Korea. To the best of our knowledge, this is the first Korean case of late-onset bleb-associated endophthalmitis caused by S. cristatus. If gram-positive cocci are grown in samples from the patients with endophthalmitis after trabeculectomy, resident oral microflora such as S. cristatus should be considered as the causative pathogen.
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