아메드밸브삽입술 및 트리암시놀론 테논낭밑주사 후 발생한 결막 괴사
Conjunctival Necrosis following Ahmed Valve Implantation and Subtenon Triamcinolone Injection
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목적: 아메드밸브삽입술 및 트리암시놀론 테논낭밑주사를 시행한 녹내장 환자에서 결막 괴사가 발생한 1예를 보고하고자 한다. 증례요약: 22세 여자 환자가 타 병원에서 우안 섬유주절제술 후 반복적인 마이토마이신 C 결막밑주사에도 불구하고 안압이 조절되지않아 내원하였다. 우안에 아메드밸브삽입술을 시행하면서 트리암시놀론 테논낭밑주사를 병행하였고, 4주 후 결막 괴사가 관찰되었다. 괴사 부위를 제거하였으나 결막 괴사가 재발하여 자가결막이식술을 시행하였다. 한 차례 더 결막 괴사가 재발하여 양막이식술을 시행하였고 이후 결막 상피가 완전히 회복되었다. 결론: 트리암시놀론 주사 후 결막 괴사는 매우 드문 합병증으로 알려져 있다. 하지만 본 증례의 환자처럼 이전에 반복적인 마이토마이신 C 결막밑주사와 같이 결막의 조직학적 약화를 초래할 수 있는 기왕력이 있는 경우에서는 발병 위험이 더 높을 수 있을 것으로 보이며, 적극적인 수술적 치료가 결막 상피의 재건에 도움이 될 것으로 보인다.
Abstract
Purpose: We report a case of conjunctival necrosis in a glaucoma patient who underwent Ahmed valve implantation and subtenon triamcinolone injection. Case summary: A 22-year-old female was referred to our clinic for uncontrolled intraocular pressure despite trabeculectomy and repeated subconjunctival injections of mitomycin C in her right eye. Ahmed valve implantation and subtenon triamcinolone injection were performed in the right eye. Four weeks later, conjunctival necrosis was observed. After debridement of necrotic tissue, an additional conjunctival autograft was needed because of recurrence of the conjunctival necrosis. After amniotic membrane transplantation was performed for one more recurrent conjunctival necrosis, conjunctival epithelialization was completed. Conclusions: Although conjunctival necrosis after periocular injection of triamcinolone is a rare complication, previous multiple usage of antimetabolites such as mitomycin C might be associated with a higher risk of developing conjunctival necrosis. In such cases, aggressive surgical intervention may be helpful in the reconstruction of the conjunctival epithelium.
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