혈관전기소작 및 결막하 베바시주맙 주사를 통해 호전된 각막 신생혈관 환자 2예
Two Cases of Corneal Neovascularization Improved by Electrocauterization and Subconjunctival Bevacizumab Injection
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목적: 신생혈관을 동반한 각막혼탁 환자에서 혈관전기소작 및 결막하 베바시주맙 주사 치료를 통해 증상호전을 경험하였기에 이를 보고하고자 한다. 증례요약: (증례 1) 20세 여자 환자가 3년 전부터 발생한 양안 시력저하, 충혈, 이물감을 주소로 내원하였다. 한천석 시력표를 사용한 최대교정시력(decimal)은 우안 0.07, 좌안 0.4였다. 양안 딸기코 각막염으로 진단하에 항생제 및 스테로이드 안약과 경구 항생제를 투여하며 경과관찰 하였으나 호전되지 않았다. 각막혼탁이 심한 우안 각막의 신생혈관 기시부에 혈관전기소작을 시행하고 주변부 결막하에 베바시주맙을 주사하였다. 이후 각막 신생혈관은 폐쇄되어 재발하지 않았고 각막혼탁은 감소되어 최대교정시력은 0.5로 호전되었다. (증례 2) 19세 여자 환자가 3년 전부터 발생한 좌안 결막충혈을 주소로 내원하였다. 최대교정시력은 우안 1.0 좌안 0.08이었다. 좌안 플릭텐각막염 진단하에 항생제 및 스테로이드 안약, 경구 항생제를 투여하며 경과관찰 하였으나 각막 신생혈관과 혼탁이 악화되어, 좌안에 각막 혈관전기소작 및 결막하 베바시주맙 주사를 시행하였고, 이후 각막 신생혈관 및 혼탁 감소 소견을 보였다. 결론: 신생혈관을 동반한 각막혼탁 환자에서 기존의 치료법인 눈꺼풀 위생, 스테로이드 및 항생제 안약 치료에 반응하지 않는 경우, 각막신생혈관 제거를 위해 혈관전기소작을 시행하고 이후 신생혈관의 재발을 막기 위해 결막하 베바시주맙 주사 치료를 병행하는 것이 각막 신생혈관 질환의 치료 방법으로서 고려될 수 있을 것으로 생각한다.
Abstract
Purpose: To report an experience of improving symptoms through treatment with electrocauterization and subconjunctival bevacizumab injection in two patients with keratitis accompanied by corneal neovascularization and opacity. Case summary: (Case 1) A 20-year-old woman visited our institution complaining of binocular blurred vision and congestion for the previous 3 years. Her best corrected visual acuity (BCVA) was 0.07 in the right eye and 0.4 in the left eye (Han Chun-suk visual acuity chart, decimal). The diagnosis was bilateral rosacea keratitis. Antibiotics, steroid eye drops and oral antibiotics were administered, but no improvement was observed. Electrocauterization was performed at the origin of the neovascularization of the cornea and bevacizumab was injected at the peripheral subconjunctiva in the right eye. Thereafter the corneal neovascularization did not recur, corneal opacity was reduced, and BCVA improved to 0.5. (Case 2) A 19-year-old woman visited complaining of left eye congestion for the previous 3 years. Her BCVA was 1.0 in the right eye and 0.08 in the left eye.The diagnosis was phlyctenular keratitis of the left eye. Antibiotics, steroid eye drops and oral antibiotics were administered, but no improvement was observed. Therefore, electrocauterization and subconjunctival bevacizumab injection were performed in the cornea of the left eye, after which corneal neovascularization and opacity decreased. Conclusions: In these cases, we report improvement of symptoms after treatment with electrocauterization and subconjunctival bevacizumab injection after failed treatment of palpebral sanitation, antibiotic and steroid.
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