각막이식 실패를 초래하는 고위험군에 대한 조사
Patients at High Risk for Failure of Penetrating Keratoplasty
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목적: 각막이식 실패를 초래하는 고위험군에서 임상양상 및 원인 질환에 대해 알아보고자 하였다. 대상과 방법: 2019년 4월부터 2020년 4월까지 국내 5개 병원에 내원한 각막이식 실패를 초래하는 고위험군 104명 119안을 대상으로 원인 질환 및 임상적 특성에 대해 후향적 의무기록 분석을 시행하였다. 결과: 환자의 71.4%가 남자였으며, 원인 질환으로 단순포진각막염이 26.1%로 가장 많았다. 양안 시력이 불량한 경우(양안 시력 모두 안전수지 이하)의 원인으로 스티븐스-존슨 증후군/독성표피괴사용해와 화학화상이 각각 41.7%와 19.4%를 차지했다. 각막이식의 과거력이 3회 이상인 경우는 20.2%였으며 이전 각막이식 과거력의 평균 횟수는 1.02 ± 1.46회였다. 각막혈관신생과 각막혼탁이 존재한 경우는 각각 82.4%와 92.4%였다. 각막신생혈관 정도 및 각막혼탁 정도가 심할수록 대상안의 분포 비율이 높았으며 각막신생혈관의경우 가장 높은 2점이 47.9%, 각막혼탁의 경우 가장 높은 4점이 31.9%를 차지했다. 결론: 각막이식 실패를 초래하는 고위험군에 대한 특성을 분석함으로써 각막이식의 예후가 불량한 원인 질환에 대한 이해가 가능하다. 해당 질환에 대한 보다 주의 깊은 관찰과 적극적인 치료로 각막이식 성공률을 높이기 위한 노력이 필요하며, 연속적인 각막이식 실패 방지를 위해 각막이식의 대안으로 가능한 새로운 치료법에 대한 추후 연구가 필요할 것으로 생각된다. 본 연구의 분석 결과는 각막이식 여부 결정과 술 후 예후 예측에 도움이 되겠으며 추후 연구에 참고 자료로 활용할 수 있다.
Abstract
Purpose: We report the clinical characteristics and the primary underlying diseases of patients at high risk for failure of penetrating keratoplasty (PKP) in Korea. Methods: Patients at high risk of PKP failure among those who visited the ophthalmological clinics of tertiary care hospitals in Korea from April 2019 to April 2020 and who were indicated for PKP were retrospectively enrolled. We epidemiologically investigated 119 eyes of 104 patients via medical chart review. Results: Herpes simplex virus (HSV) keratitis was the most common primary underlying disease (26.1%). The most common primary cause of poor bilateral visual acuity was Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) (41.7%) followed by chemical burns (19.4%). Of the 119 eyes, 40.3% had a history of previous PKP and 20.2% had undergone three or more PKP. The average number of prior PKPs was 1.02 ± 1.46. Corneal neovascularization and corneal opacity were reported in 82.4 and 92.4% of cases, respectively. As the severity of these conditions increased, the eye distributions became larger. Of all patients, 47.9 and 31.9%, respectively, received the highest corneal neovascularization and corneal opacity scores. Conclusions: Our study of patients at high risk of PKP failure improves our understanding of the relevant clinical characteristics and primary underlying diseases. Such patients require careful observation and aggressive treatment. Possible alternatives to PKP should be considered if PKP consistently fails. This study will aid clinicians in deciding whether to proceed to surgery if a poor postoperative prognosis is predictable.
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