백내장수술 중 발생한 급성 방수 흐름 이상 증후군 3예
Three Cases of Intraoperative Acute Fluid Misdirection Syndrome during Cataract Surgery
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 백내장수술 중 발생한 급성 방수 흐름 이상 증후군 3예를 보고하고자 한다. 증례요약: 거짓비늘증후군이 있는 82세 여성과 말기 녹내장이 있는 80세 남성에서 단안 백내장수술을, 거짓비늘증후군이 있는 72세 남성에서 전신마취하 양안 백내장수술을 계획하였다. 앞의 두 증례는 각각 피질 흡입 도중, 피질 제거 후에 전방이 유지되지 않아 수술을 중단하고 만니톨 정맥주사 및 경구 아세타졸 투여 후 당일 인공수정체를 삽입하여 수술을 마무리하였다. 세 번째 증례는 우안핵 및 피질 제거 후 수정체낭이 유지되지 않았으나 조심스럽게 인공수정체를 삽입하였고, 좌안은 합병증 없이 수술을 완료하였다. 세 증례 모두 술 후 1개월의 최대교정시력은 향상되었고 안압은 안정적으로 유지되었다. 결론: 거짓비늘증후군, 섬모체소대 약화, 상대적으로 얕은 전방 및 짧은 안축장, 원시안, 고분자량의 점탄물질 사용이 백내장수술 중 방수 흐름 이상 증후군의 위험인자로 작용할 수 있다. 고삼투압제제와 같은 안압하강 치료 후 당일에 인공수정체 삽입을 시행하는 단계적 수술을 고려해 볼 수 있고, 유리체절제술이 필요할 수 있다.
Abstract
Purpose: We report the management of three cases of intraoperative acute fluid misdirection syndrome during cataract surgery. Case summary: Cataract surgery was performed in one eye of an 82-year-old woman with pseudoexfoliation syndrome, one eye of an 80-year-old man with end-stage glaucoma, and both eyes of a 72-year-old man with pseudoexfoliation syndrome. In the first two cases, the capsular bag space decreased during cortex aspiration and after removal of the cortex, respectively. After intravenous mannitol and intake of oral acetazolamide, the intraocular lens was successfully inserted in the first two cases on the same day. In the third case, after first removing the nucleus and cortex of the right eye, the capsular bag space decreased and an intraocular lens was carefully inserted. No intraoperative complications were seen during the left eye operation. One month after the operation, the best-corrected visual acuity had improved and the intraocular pressure was within normal limits for all three cases. Conclusions: A relatively shallow chamber, pseudoexfoliation, zonular laxity, and use of high molecular weight ophthalmic viscosurgical devices may cause acute fluid misdirection syndrome during cataract surgery. Pars plana vitrectomy may be required. However, intravenous high osmotic agent treatment should be attempted first, followed by intraocular lens insertion on the same day.
참고문헌 (15)
- Graefe A, "Contributions to the pathology and therapy of glaucoma", Arch Ophthalmol, 15, pp.108~ (1869)
- Halenda K, "Current concepts on aqueous misdirection", Curr Ophthalmol Rep, 7, pp.150~159 (2019)
- Grzybowski A, "Acute and chronic fluid misdirection syndrome : pathophysiology and treatment", Graefes Arch Clin Exp Ophthalmol, 256, pp.135~154 (2018)
- 이상엽, "원발성개방각녹내장 환자의 백내장수술 중 나타난 악성녹내장 유사 현상 1예", 대한안과학회지, 51(8), pp.1150~1154 (2010), 대한안과학회
- 손지성, "유리체 절제술을 시행한 안에서 발생한 악성 녹내장 1예", 대한안과학회지, 56(4), pp.638~642 (2015), 대한안과학회[DOI]
- Kam AW, "Materials in the vitreous during cataract surgery : nature and incidence, with two cases of histological confirmation", Clin Exp Ophthalmol, 44, pp.797~802 (2016)
- Balekudaru S, "Surgical management of malignant glaucoma : a retrospective analysis of fifty eight eyes", Eye(Lond), 31, pp.947~955 (2017)
- Lau OC, "Acute intraoperative rock-hard eye syndrome and its management", J Cataract Refract Surg, 40, pp.799~804 (2014)
- Kanclerz P, "Fluid misdirection syndrome : the unified definition of malignant glaucoma", J Glaucoma, 28, pp.e165~ (2019)
- Mackool RJ, "Infusion misdirection syndrome", J Cataract Refract Surg, 19, pp.671~672 (1993)
- Qian Z, "Evaluation of two different anterior vitrectomies for fluid misdirection syndrome secondary to cataract surgery combined with goniosynechialysis", J Ophthalmol, 2020, pp.1934086~ (2020)
- Anisimova NS, "Anterior vitreous detachment : risk factor for intraoperative complications during phacoemulsification", J Cataract Refract Surg, 46, pp.55~62 (2020)
- Ozaki M, "Mechanisms of glaucoma in exfoliation syndrome", J Glaucoma, 27(Suppl 1), pp.S83~S86 (2018)
- 오혜영, "거짓비늘증후군과 급성폐쇄각발작의 생체계측 특성 비교", 대한안과학회지, 62(1), pp.85~90 (2021), 대한안과학회
- Ruiz RS, "Expulsive choroidal effusion. A complication of intraocular surgery", Arch Ophthalmol, 94, pp.69~70 (1976)