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유리체강내 덱사메타존 임플란트 삽입 후 발생한급성 안내염 1예

A Case of Acute Endophthalmitis Following a Dexamethasone Intravitreal Implant

김진형|이종현|이도형|염정훈|방종욱|한현철
대한안과학회 (The Korean Ophthalmological Society)|2013.12|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제54권 제12호|pp. 1939-1944

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참고문헌

키워드

Macular edemaEndophthalmitisDexamethasone implantIntravitreal injectionBranch retinal vein occlusion
주제분류안과학

초록

목적: 망막분지정맥폐쇄에 합병된 황반부종으로 유리체강내 덱사메타존 임플란트(Ozurdex®) 삽입 후 발생한 급성 안내염을 보인 1예를보고하고자 한다. 증례요약: 우안 망막분지정맥폐쇄에 합병된 황반부종으로 인한 시력저하를 주소로 63세 남자 환자가 내원하였다. 유리체강내 베바시주맙 주입술을 시행하였으나 황반부종은 호전을 보이지 않았고, 2개월 후 유리체강내 덱사메타존 임플란트 삽입술을 시행하였다. 삽입4일째 심한 시력저하로 내원하였고 세극등현미경 검사에서 경한 충혈, 전방축농, 전방내의 염증, 유리체 혼탁 소견을 보여 급성 안내염진단 하에 유리체절제술 및 유리체강내 항생제 주입술, 덱사메타존 임플란트 제거술, 수정체유화술을 시행하였으며 치료 후 안저소견및 염증반응은 잘 조절되었다. 유리체액 배양검사에서는 coagulase negative staphylococcus가 검출되었다. 결론: 유리체강내 덱사메타존 임플란트를 삽입한 후 발생한 급성 안내염은 스테로이드의 항염증 작용으로 인하여 심한 충혈이나 통증없이 비특이적인 양상을 보일 수 있으므로 시술 후 안내염의 발생을 관찰하는데 있어 주의를 요한다.

Abstract

Purpose: To report a case of acute endophthalmitis after a dexamethasone (Ozurdex®) intravitreal implant for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Case summary: A 63-year-old male patient presented with decreased vision in the right eye due to ME secondary to BRVO. The patient was treated with an intravitreal bevacizumab injection, but ME did not improve. Two months after the injection, dexamethasone (Ozurdex®) intravitreal implantation was performed. Four days after the implantation, the patient visited our clinic complaining of severe visual disturbance. Slight conjunctival injection was observed and inflammatory cells and hypopyon were found in the anterior chamber. Fundus was not visible due to vitreous opacity. The patient was presumed to have acute endophthalmitis. Vitrectomy, intravitreal antibiotics injection, dexamethasone implant removal and phacoemulsification were performed. After treatment, the patient’s fundus markedly improved, the inflammatory response was controlled and coagulase negative staphylococcus was detected from vitreous culture. Conclusions: In cases of intravitreal dexamethasone implant associated with acute endophthalmitis, careful examination for diagnosis of endophthalmitis is recommended because the patient may not present with severe ocular pain and injection due to anti-inflammatory effect of corticosteroid.

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