모낭충 안검염 치료 후 호전된 각막혼탁 1예
A Case of Corneal Opacity Improved by Treatment of Demodex Blepharitis
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목적: 라식 수술 후 발생한 각막혼탁 및 신생혈관이 모낭충 안검염 치료 후 호전되었던 1예를 보고하고자 한다. 증례요약: 50세의 여자 환자가 2년 전 발생한 좌안의 각막혼탁 및 신생혈관으로 본원에 의뢰되었다. 각막혼탁과 신생혈관은 라식절편 아래를 따라 존재하였다. 최대교정시력은 좌안 0.5였으며, 안검연의 혈관 확장과 마이봄샘 장애 소견을 보였다. 내원 시 4개의속눈썹당 모낭충(Demodex folliculorum)이 좌안에서 7마리 관찰되었다. 모낭충 안검염에 대한 치료로 폴리헥사메틸 비구아니드로 하루 2회 안검세척을 하였고 덱사메타손 함유 안연고를 하루 2회 도포하였다. 치료 1년 후 모낭충은 2마리로 감소하였고 좌안 최대교정시력 0.8이었으며, 각막혼탁 및 신생혈관 역시 호전되는 양상을 보였다. 결론: 본 증례를 통하여 모낭충 안검염이 라식 수술 과거력이 있는 환자에서 비전형적인 각막혼탁 및 신생혈관을 유발할 수 있으며,이와 같은 환자에서 모낭충에 대한 검사와 적절한 치료가 중요하다고 할 수 있을 것이다.
Abstract
Purpose: To report a case of corneal opacity improved by treatment of demodex blepharitis. Case summary: A 50-year-old female who received sub-laser-assisted in situ keratomileusis (LASIK) flap surgery was referredto our clinic with corneal opacity and neovascularization in her left eye. Her visual acuity was 0.5. Telangiectasis of the eyelidmargin and meibomian gland dysfunction were observed. Seven Demodex folliculorum were found in 4 eyelashes of the left eye. Lid scrub with 0.4% polyhexamethylene biguanide (PHMB) and ointment containing dexamethasone was started for demodexblepharitis treatment. After 6 months of treatment, the number of Demodex folliculorum was decreased to 2 and the best correctedvisual acuity was 0.8. Corneal opacity and neovascularization were also improved. Conclusions: The present study showed that demodex blepharitis can induce atypical corneal opacity and neovascularization afterLASIK surgery. Evaluation and treatment of demodex blepharitis in these patients is important.
참고문헌 (19)
- English FP, "Demodicosis of ophthalmic concern", Am J Ophthalmol, 91, pp.362~372 (1981)
- 김재훈, "Clinical and Immunological Responses in Ocular Demodecosis", Journal of Korean Medical Science, 26(9), pp.1231~1237 (2011), 대한의학회
- Gao YY, "Clinical treatment of ocular demodecosis by lid scrub with tea tree oil", Cornea, 26, pp.136~143 (2007)
- 구현, "Ocular Surface Discomfort and Demodex: Effect of Tea Tree Oil Eyelid Scrub in Demodex Blepharitis", Journal of Korean Medical Science, 27(12), pp.1574~1579 (2012), 대한의학회
- Kheirkhah A, "Corneal manifestations of ocular demodex infestation", Am J Ophthalmol, 143, pp.743~749 (2007)
- O'Reilly N, "Demodex-associated Bacillus proteins induce an aberrant wound healing response in a corneal epithelial cell line: possible implications for corneal ulcer formation in ocular rosacea", Invest Ophthalmol Vis Sci, 53, pp.3250~3259 (2012)
- Hafezi F, "Persistent subepithelial haze in thin-flap LASIK", J Refract Surg, 26, pp.222~225 (2010)
- Randleman JB, "LASIK interface complications: etiology, management, and outcomes", J Refract Surg, 28, pp.575~586 (2012)
- Fantes FE, "Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys", Arch Ophthalmol, 108, pp.665~675 (1990)
- Norn MS, "Incidence of Demodex folliculorum on skin of lids and nose", Acta Ophthalmol(Copenh), 60, pp.575~583 (1982)
- Lee SH, "Comparative ocular microbial communities in humans with and without blepharitis", Invest Ophthalmol Vis Sci, 53, pp.5585~5593 (2012)
- Moller-Pedersen T, "Stromal wound healing explains refractive instability and haze development after photorefractive keratectomy: a 1-year confocal microscopic study", Ophthalmology, 107, pp.1235~1245 (2000)
- Woessner JF Jr, "Matrix metalloproteinases and their inhibitors in connective tissue remodeling", FASEB J, 5, pp.2145~2154 (1991)
- Strissel KJ, "Role of serum amyloid A as an intermediate in the IL-1 and PMA-stimulated signaling pathways regulating expression of rabbit fibroblast collagenase", Exp Cell Res, 237, pp.275~287 (1997)
- Strissel KJ, "Regulation of paracrine cytokine balance controlling collagenase synthesis by corneal cells", Invest Ophthalmol Vis Sci, 38, pp.546~552 (1997)
- Stockinger B, "Differentiation and function of Th17 T cells", Curr Opin Immunol, 19, pp.281~286 (2007)
- Starnes T, "Cutting edge: IL-17F, a novel cytokine selectively expressed in activated T cells and monocytes, regulates angiogenesis and endothelial cell cytokine production", J Immunol, 167, pp.4137~4140 (2001)
- Numasaki M, "Interleukin-17 promotes angiogenesis and tumor growth", Blood, 101, pp.2620~2627 (2003)
- 문준형, "데모덱스 안검염 환자에서 폴리헥사메틸렌 비구아니드를이용한 안검 세척의 치료효과", 대한안과학회지, 55(4), pp.493~497 (2014), 대한안과학회