수정체 초음파유화술 중 발생한 각막화상 1예
A Case of Corneal Burn During Phacoemulsification
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목적: 초음파유화술 중 중증의 각막화상이 발생한 환자에서 이차적인 수술 및 약물치료를 시행한 결과를 보고하고자 한다. 증례요약: 89세 여자환자가 타 병원에서 성숙백내장에 대해서 초음파유화술을 시행 받던 중 투명각막절개부위에 각막화상이 발생하여본원으로 전원되었다. 내원 당시 시력은 광각있음이었고 세극등현미경 검사상 중증의 각막부종 및 절개부위 주변에 3.0×3.0 mm 크기의 상피결손과 기질혼탁을 보였다. 상부 공막절개창을 만들고 백내장 낭외적출술을 시행 후 삼체형 아크릴 인공수정체를 수정체낭속에 삽입하였다. 술 후 각막부종에 대해서 스테로이드와 함께 5% NaCl 점안액을 사용하였다. 수술 후 1개월째 각막부종 및 투명각막절개부위의 상피결손은 현저하게 감소한 소견을 보였으며 교정시력은 0.06이었다. 수술 후 3개월째 인공수정체의 위치는 안정적이었고, 절개부위 주변으로 중등도의 각막혼탁이 남아 있었으나 각막부종은 거의 소실되었으며, 교정시력은 0.2로 호전되었다. 결론: 초음파유화술 중 발생한 중증의 각막화상에 대하여 추가적인 손상을 막기 위해 공막절개를 통한 백내장 낭외적출술과 약물치료를 시행하여 좋은 결과를 거두어 이를 보고하는 바이다.
Abstract
Purpose: To report a case of severe corneal burn during phacoemulsification that was successfully managed with a secondoperation and medical treatment. Case summary: An 89-year-old female had phacoemulsification of a mature cataract in her right eye, and was transferredto our outpatient clinic after development of a thermal burn at the corneal incision site. On initial examination, visual acuitywas light perception and slit-lamp examination revealed diffuse, severe corneal edema, and a 3.0 × 3.0 mm-sized epithelialdefect with severe stromal opacity around the incision site. Extracapsular cataract extraction through superior scleralincision was performed with posterior chamber implantation of a 3-piece hydrophobic acrylic intraocular lens (IOL). Topical steroids as well as hypertonic saline were used to manage corneal edema postoperatively. One month postoperatively,her best corrected visual acuity was 0.06 and slit-lamp examination showed markedly decreased corneal edemaand epithelial defect. Three months postoperatively, her best corrected visual acuity was 0.2, the IOL was centered inthe capsular bag, and corneal edema nearly disappeared with remnant moderate corneal opacities. Conclusions: We report successful treatment of severe corneal burn during phacoemulsification managed with extracapsularcataract extraction through scleral incision and medical treatment.
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