각막상피 결손을 동반한 콘택트렌즈 연관 각막염에서 아칸토아메바 중합효소연쇄반응의 진단적 유용성
Diagnostic Utility of Polymerase Chain Reaction for Acanthamoeba in Contact Lens-related Keratitis with Epithelial Defects
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목적: 감별이 어려운 각막상피 결손을 동반한 콘택트렌즈 연관 가시아메바 각막염을 중합효소연쇄반응(polymerase chain reaction, PCR)을 통하여 진단한 예를 보고하고자 한다. 증례요약: 51세 남자가 양안 시력저하, 통증으로 내원하였다. 내원 4일 전부터 양안 각막상피 손상으로 치료용 콘택트렌즈를 착용하였고, 양안 각막상피 손상 및 각막부종을 보였다. 각막부종이 지속되어, 전방 천자하여 시행한 가시아메바 PCR에서 양성을 보였다. 32세 남자가 양안 통증, 시력저하로 내원하였다. 양안 각막상피 손상 과거력이 있었으며, 3일 전부터 각막 손상으로 치료용 콘택트렌즈를 착용하였다. 양안 각막상피 손상으로 반복각막짓무름 재발을 의심하였으나, 각막찰과로 시행한 가시아메바 PCR에서 양성을 보였다. 26세 여자 환자는 좌안 통증, 불편감으로 내원하였다. 심한 안구건조증으로 6주 전부터 치료용 콘택트렌즈를 착용하였다. 좌안 각막세포 침윤 및 상피 손상을 보였다. 각막찰과로 시행한 검사상 세균이 배양되었으며, 동시에 가시아메바 PCR 양성을 보였다. 결론: 콘택트렌즈 연관 각막염에서 각막상피 결손이 동반되어 있는 경우, 가시아메바 각막염 가능성도 고려해야 하며 PCR을 통한 조기 진단이 가능하다.
Abstract
Purpose: To report contact lens related Acanthamoeba keratitis with corneal epithelial defect cases which were diagnosed using polymerase chain reaction (PCR). Case summary: A 51-year-old male visited our hospital for loss of visual acuity and ocular pain in both eyes. He had been wearing therapeutic contact lenses in both eyes for 4 days prior to his visit, and showed a corneal epithelial defect with corneal edema in both eyes. The corneal edema did not improve after treatment for bacterial and herpes keratitis, so we conducted PCR for Acanthamoeba using the aqueous fluid in the anterior chamber, which showed positive results. A 32-year-old male complained of low visual acuity and ocular pain in both eyes. He had a history of corneal erosion. He had been wearing therapeutic contact lenses in both eyes for 3 days prior to his visit for a corneal epithelial defect. We suspected recurrent corneal erosion syndrome, but PCR for Acanthamoeba of the corneal scraping showed positive results. A 26-year-old female visited our hospital for ocular pain, and discomfort in her left eye. Because of severe dry eye, she had been wearing therapeutic contact lenses for 6 weeks prior to her visit. Her left eye showed corneal infiltration and epithelial defects. The left cornea scraping was positive for bacteria, and PCR for Acanthamoeba also showed positive results. Conclusions: Clinicians should consider the use of PCR for the early diagnosis of Acanthamoeba keratitis in contact lens-related keratitis with corneal epithelial defects.
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