전층각막이식술 후 발생한 진균각막염의 임상양상
Clinical Manifestations of Fungal Keratitis Following Penetrating Keratoplasty
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 전층각막이식술 후 발생한 진균각막염의 임상양상과 위험인자, 치료 경과 및 예후를 알아보고자 한다. 대상과 방법: 2005년 1월부터 2020년 1월까지 전층각막이식술 후 진균각막염이 발생한 환자 18명의 의무기록을 후향적으로 조사하였다. 성별, 연령, 기저질환, 각막이식의 적응증, 증상 발생으로부터 치료 시작까지의 기간, 감염시 및 치료 후 시력, 감염 전 이식 각막의 상태, 봉합사 관련 여부, 각막상피결손의 크기 및 각막침윤 깊이, 전방축농 여부, 감염 전 사용 안약, 미생물배양검사 결과 등의 임상지표를 조사하였다. 또한 진균각막염 치료 결과에 따라 치료 성공군 및 실패군으로 나누어 이에 대한 위험인자를 비교 분석하였다. 결과: 전층각막이식술을 받은 후 평균 55.31 ± 44.72개월 후에 진균각막염이 발생하였다. 증상 발생으로부터 치료 시작까지의 기간은 평균 10.33 ± 7.36일이었다. 전체 18명의 환자 중 5명(27.8%)이 치료 성공이군, 13명(72.2%)이 치료 실패군으로 분류되었으며, 치료 실패군 중 7명(38.9%)이 수술적 치료를 시행 받았다. 감염 전 발생한 이식 실패 상태, 증상 발생 후 내원까지의 소요 시간, 각막상피결손의 크기가 치료 실패와 유의한 상관관계가 있었다(모두 p<0.05). 다변량 회귀분석에서 치료 실패의 위험인자는 이식 실패 상태(p=0.046)였다. 결론: 감염 발생 전 각막 상태, 증상 발생 후 내원까지의 기간, 각막상피결손의 크기가 전층각막이식 후 발생한 진균 감염의 예후와 관련이 있으며, 치료 실패와 연관된 위험인자는 감염 전 이식 실패 상태이다.
Abstract
Purpose: We evaluated the clinical manifestations and risk factors of fungal keratitis after penetrating keratoplasty (PKP). Methods: Eighteen patients who experienced fungal keratitis after PKP between January 2005 and January 2020 were includedin this retrospective study. Clinical characteristics including sex, age, underlying disease, indication for PKP, symptom duration,visual acuity, graft state before infection, suture-related problems, size of epithelial defect, depth of infiltration, presence of hypopyon,use of eyedrops before infection, and the results of microbiological tests were analyzed. Patients were classified into thetreatment success or failure group, and the risk factors were evaluated accordingly. Results: The mean age at diagnosis was 63.94 ± 15.53 years. Fungal infection occurred a mean of 55.31 ± 44.72 months afterPKP. The mean symptom duration was 10.33 ± 7.36 days. Of the 18 patients, 5 (27.8%) and 13 (72.2%) were in the treatmentsuccess and failure groups, respectively. Of the treatment failure group, seven patients (38.9%) underwent surgicalmanagement. The graft state before infection, symptom duration, and size of epithelial defects had significant correlations withtreatment failure (all p < 0.05). Multivariate analysis identified graft state (p = 0.046) as a significant risk factor for treatmentfailure. Conclusions: Graft state before infection, symptom duration, and size of epithelial defects were associated with the prognosis offungal keratitis after PKP. Graft state before infection was a significant risk factor for treatment failure.
참고문헌 (29)
- Vajpayee RB, "Risk factors for graft infection in India : a case-controlled study", Br J Ophthalmol, 86, pp.261~265 (2002)
- Al-Hazzaa SA, "Bacterial keratitis after penetrating keratoplasty", Ophthalmology, 95, pp.1504~1508 (1988)
- Bates AK, "Microbial keratitis after penetrating keratoplasty", Eye(Lond), 4(Pt 1), pp.74~78 (1990)
- Wagoner MD, "Bacterial keratitis after penetrating keratoplasty incidence, microbiological profile, graft survival, and visual outcome", Ophthalmology, 114, pp.1073~1079 (2007)
- Tixier J, "Infectious keratitis after penetrating keratoplasty", J Fr Ophtalmol, 24, pp.597~602 (2001)
- 하동욱, "전층각막이식술 275안의 임상결과", 대한안과학회지, 42(1), pp.20~29 (2001), 대한안과학회
- 이승재, "잔층각막이식수술 후 10년 경과 관찰", 대한안과학회지, 47(7), pp.1043~1048 (2006), 대한안과학회
- Merchant A, "Candidal endophthalmitis after keratoplasty", Cornea, 20, pp.226~229 (2001)
- García Serrano JL, "Recurrence of bacterial endophthalmitis after penetrating keratoplasty", Arch Soc Esp Oftalmol, 79, pp.89~92 (2004)
- Ghosh AK, "Fungal keratitis in North India : spectrum of agents, risk factors and treatment", Mycopathologia, 181, pp.843~850 (2016)
- Keyhani K, "The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty", Cornea, 24, pp.288~291 (2005)
- Hassan SS, "Eye-banking risk factors for fungal endophthalmitis compared with bacterial endophthalmitis after corneal transplantation", Am J Ophthalmol, 139, pp.685~690 (2005)
- Vajpayee RB, "Infectious keratitis following keratoplasty", Surv Ophthalmol, 52, pp.1~12 (2007)
- Das S, "Microbial keratitis following corneal transplantation", Clin Exp Ophthalmol, 35, pp.427~431 (2007)
- 성미선, "Factors Affecting Treatment Outcome of Graft Infection Following Penetrating Keratoplasty", Korean Journal of Ophthalmology, 29(5), pp.301~308 (2015), 대한안과학회
- Lalitha P, "Risk factors for treatment outcome in fungal keratitis", Ophthalmology, 113, pp.526~530 (2006)
- Akova YA, "Microbial keratitis following penetrating keratoplasty", Ophthalmic Surg Lasers, 30, pp.449~455 (1999)
- Tavakkoli H, "Microbial keratitis following penetrating keratoplasty", Ophthalmic Surg, 25, pp.356~360 (1994)
- Harris DJ Jr, "Late bacterial and fungal keratitis after corneal transplantation. Spectrum of pathogens, graft survival, and visual prognosis", Ophthalmology, 95, pp.1450~1457 (1988)
- Seedor JA, "Survival of corneal grafts from donors supported by mechanical ventilation", Ophthalmology, 94, pp.101~108 (1987)
- Gomes JA, "Positive donor rim culture in penetrating keratoplasty", Cornea, 14, pp.457~462 (1995)
- Antonios SR, "Contamination of donor cornea : postpenetrating keratoplasty endophthalmitis", Cornea, 10, pp.217~220 (1991)
- Sutphin JE, "Donor-to-host transmission of Candida albicans after corneal transplantation", Am J Ophthalmol, 134, pp.120~121 (2002)
- Kredics L, "Filamentous fungal in-fections of the cornea : a global overview of epidemiology and drug sensitivity", Mycoses, 58, pp.243~260 (2015)
- Gopinathan U, "Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis : experience of over a decade", Indian J Ophthalmol, 57, pp.273~279 (2009)
- Bharathi MJ, "Microbiological diagnosis of infective keratitis : comparative evaluation of direct microscopy and culture results", Br J Ophthalmol, 90, pp.1271~1276 (2006)
- Rahman I, "Penetrating keratoplasty : indications, outcomes, and complications", Eye(Lond), 23, pp.1288~1294 (2009)
- Duran Ospina P., "Keratoplasties-surgical techniques and complications" (2012), IntechOpen
- 김미진, "전층각막이식술 후 발생한 감염성 각막염의 임상양상 및 위험인자", 대한안과학회지, 51(4), pp.504~509 (2010), 대한안과학회