뇌수막종에 의한 각막 천공 후 생긴 교감성 안염 1예
A Case of Sympathetic Ophthalmia due to Corneal Perforation in a Patient with Meningioma
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 지속적으로 재발하는 접형골 뇌수막종 환자에서 심한 안구돌출을 동반한 노출성 각막염으로 인해 각막 천공이 발생하여 교감성안염까지 이른 증례를 보고하고자 한다. 증례요약: 수년 전부터 좌측 거대 접형골 뇌수막종으로 인해 좌측 안구돌출이 심해지는 34세 여자환자가 여러 차례에 걸친 제거술과방사선치료에도 불구하고 노출성 각막염에 의한 각막천공이 발생하였다. 천공부위로 홍채 탈출이 보여 안구적출을 계획하던 중 양안의 전방 염증반응과 반대쪽 눈에서 각막후면침착물, 삼출성 망막박리와 망막의 다발성 육아종성 결절들이 관찰되었다. 교감성 안염의심하에 좌안 안구적출과 종양 용적 축소술을 시행한 후 고용량 스테로이드 치료를 시행하였다. 5개월 후 우안의 전방 염증은 없으며, 시신경 염증 및 삼출성 망막박리 소견도 회복을 보였다. 결론: 악성 접형골 뇌수막종에 의해 좌안 안구돌출이 지속되어 발생한 노출성각막염이 보전적 치료에도 불구하고 각막 천공에 이르렀으며, 이런 경우 반대안까지 침범하는 교감성 안염이 발생할 수 있음을 유의하며 치료해야겠다.
Abstract
Purpose: To describe a case of sympathetic ophthalmia due to corneal perforation caused by exposure keratitis in a patient withrecurrent sphenoid wing meningioma. Case summary: A 34-year-old female patient presented with proptosis in her left eye caused by left sphenoid greater wing meningiomadespite tumor debulking surgery and radiation treatment. The cornea was perforated with prolapsed iris due to exposurekeratitis, thus enucleation of the left eye was performed. After 2 weeks, an inflammatory reaction occurred in both eyes, keraticprecipitates on corneal endothelium, exudative retinal detachment, and multiple granulomatous nodules on the right eye retina. The patient was diagnosed with sympathetic ophthalmia, thus enucleation of the left eye and debulking of the tumor were performedfollowed by a high-dose intravenous steroid therapy. At 5 months postoperatively, slit lamp biomicroscope showed nochamber reaction; improved disc swelling and exudative retinal detachment in the right eye were observed. Conclusions: Despite conservative treatment for exposure keratitis due to proptosis caused by malignant sphenoid meningioma,corneal perforation can develop. Because sympathetic ophthalmia can occur, the other eye should be monitored.
참고문헌 (16)
- Albert DM., "A historical review of sympathetic ophthalmia and its epidemiology", Surv Ophthalmol, 34, pp.1~14 (1989)
- Mackenzie W, "A practical treatise on the diseases of the eye", pp.1840~ (1840), Longmans
- Makley TA Jr., "Sympathetic ophthalmia. A long-term follow-up", Arch Ophthalmol, 96, pp.257~262 (1978)
- Marak GE Jr., "Recent advances in sympathetic ophthalmia", Surv Ophthalmol, 24, pp.141~156 (1979)
- Lee KS., "A case report of sympathetic ophthalmia", J Korean Ophthalmol Soc, 18, pp.189~195 (1977)
- Yoon YD., "A case of sympathetic ophthalmia with giant subretinal neovascular membrane", J Korean Ophthalmol Soc, 35, pp.112~117 (1994)
- Chan CC., "Immunohistochemistry and electron microscopy of choroidal infiltrates and Dalen-Fuchs nodules in sympathetic ophthalmia", Ophthalmology, 92, pp.580~590 (1985)
- Chan CC., "Sympathetic ophthalmia. Immunopathological findings", Ophthalmology, 93, pp.690~695 (1986)
- Croxatto JO., "Atypical histopathologic features in sympathetic ophthalmia. A study of a hundred cases", Int Ophthalmol, 4, pp.129~135 (1982)
- Albert DM., "A historical review of sympathetic ophthalmia and its epidemiology", Surv Ophthalmol, 34, pp.1~14 (1989)
- Bilyk JR., "Enucleation, evisceration, and sympathetic ophthalmia", Curr Opin Ophthalmol, 11, pp.372~386 (2000)
- Lubin JR., "Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases(1913--1978)", Ophthalmology, 87, pp.109~121 (1980)
- Reynard M., "Effect of corticosteroid treatment and enucleation on the visual prognosis of sympathetic ophthalmia", Am J Ophthalmol, 96, pp.290~294 (1983)
- Chan CC., "32 cases of sympathetic ophthalmia. A retrospective study at the National Eye Institute, Bethesda, Md., from 1982 to 1992", Arch Ophthalmol, 113, pp.597~600 (1995)
- Nussenblatt R., "Uveitis: fundamental and clinical practice", pp.97~323 (1996), Mosby
- Vote BJ., "Changing trends in sympathetic ophthalmia", Clin Experiment Ophthalmol, 32, pp.542~545 (2004)