모락셀라 각막염의 임상양상과 치료 결과
Clinical Aspects and Treatment Outcomes of Moraxella keratitis
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목적: 모락셀라 각막염의 임상 경과, 선행 위험인자, 치료 결과에 대하여 알아보고자 하였다. 대상과 방법: 2001년 3월부터 2015년 11월까지 3차병원인 본원 안과에서 시행한 배양검사에서 검출된 모락셀라 각막염 12안에 대하여 의무기록을 후향적으로 분석하였다. 연구는 각막궤양의 위험인자, 임상양상, 치료 결과 등을 분석하였다. 결과: 모락셀라 각막염 환자의 평균 나이는 68세였다. 가장 흔한 원인은 외상(6안, 50.0%)이었고, 그중 절반(3안, 25.0%)은 당뇨를 앓고 있었다. 두 명의 환자(16.6%)에서 이전에 각막이식술을 받은 기왕력이 있었다. 병변의 위치는 중심부(50.0%), 중심주변부(50.0%)였고, 모양은 둥근 형태(58.3%)와 불규칙한 형태(41.7%)였다. 전방축농은 5안(41.7%)에서 관찰되었다. 모든 모락셀라 분리균은 aminoglycoside, fluoroquinolone 항생제에 감수성을 보였고, 3안은 trimethoprim/sulfamethoxazole에 내성을 보였다. 평균 상피 회복 기간은 32.4일이었다. 최종시력은 7안(58.3%)에서 20/1,000 이하였다. 3안은 약물치료에도 불구하고, 각막천공으로 발전되어 안구내용제거술을 시행받았다. 결론: 모락셀라 각막염은 안외상에 의해 종종 발생할 수 있으며, 치료 반응은 매우 느리고 시력적 예후는 대체로 좋지 않다. 이에 적절한 항생제 치료를 장기간으로 고려할 필요가 있다.
Abstract
Purpose: To analyze the clinical presentation, predisposing risk factors, and evaluate the treatment outcomes of Moraxella keratitis. Methods: A retrospective analysis was conducted of 12 culture positive cases of Moraxella keratitis from hospital records between March 2001 and November 2015 at a tertiary hospital to identify and analyze its risk factors, causative microbial organisms, clinical features, and therapeutic outcomes. Results: The mean patient age was 68 years (range, 46–86). The most common cause of keratitis was trauma (six eyes, 50.0%), and half of these patients had diabetes mellitus (three patients, 25.0%). Two patients (16.6%) were previously treated with penetrating keratoplasty. The locations of keratitis involved the central (50.0%) and paracentral (50.0%) regions. Round-shaped corneal infiltration was found in seven eyes (58.3%), and irregular-shaped infiltration was found in five eyes (41.7%). Hypopyon was observed in five eyes (41.7%). All Moraxella isolates were susceptible to aminoglycosides and fluoroquinolones. The isolates from three patients were resistant to trimethoprim/sulfamethoxazole. The mean complete epithelial healing time was 32.4 days. The final visual acuity was 20/1,000 or less in seven eyes (58.3%). Three eyes developed corneal perforations and eventually underwent evisceration. Conclusions: In the Republic of Korea, Moraxella keratitis frequently occurs in eyes with trauma. The treatment response is very slow and has a poor visual outcome; thus, a long period of antibiotic therapy is necessary.
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