데스메막박리 자동각막내피층판이식술 후 발생한 단순포진바이러스 각막염 1예
A Case of Herpes Simplex Keratitis after Descemet Stripping Automated Endothelial Keratoplasty
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목적: 데스메막박리 자동각막내피층판이식술을 시행 후 발생한 단순포진바이러스 각막염 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 66세 남자가 우안의 백내장 수술 후 발생한 수포각막병증으로 데스메막박리 자동각막내피층판이식술을 시행받았다. 수술 중 제거된 각막상피는 수술 후 치유되었으나, 수술 후 1개월째 우안의 통증 및 시력 감소가 있어 본원에 내원하였다. 세극등현미경 검사 상 각막상피결손의 크기 증가 및 각막부종 소견이 관찰되었다. 이에 연성콘택트렌즈 착용 및 인공 눈물 등의 약물 치료를 시작하였고 지속각막상피결손의 양상을 보여 양막이식술을 시행하였으나 상피결손은 호전되지 않았다. 양막이식술 후 3개월째 지도형의 각막상피결손이 관찰되어 단순포진바이러스 각막염 의심하에 ganciclovir 안연고와 경구용 acyclovir를 투여하였다. 치료 시작 후 환자의 증상과 각막상피결손의 소견은 호전되었으며 치료 6개월째 경도의 각막 혼탁을 남기고 소실되었다. 결론: 데스메막박리 자동각막내피층판이식술 후 발생한 각막상피결손이 지속될 경우 단순포진바이러스 각막염의 가능성을 염두에 두어야 한다.
Abstract
Purpose: To report a case of herpes simplex keratitis after descemet stripping automated endothelial keratoplasty (DSAEK). Case summary: A 66-year-old male underwent DSAEK in his right eye due to bullous keratopathy after cataract surgery. The corneal epithelium which was removed during surgery was healed, but the patient was experiencing pain and decreased visual acuity in his right eye 1 month after surgery. Increasing corneal epithelial defects and corneal edema were observed on slit-lamp examination. Therapeutic soft contact lenses and artificial tears were used for treatment but were not effective, thus amniotic membrane transplantation was performed. Three months after transplantation, the epithelial defect appeared as a geographic ulcer suspecting to be herpes simplex keratitis; therefore, ganciclovir ophthalmic ointment and oral acyclovir were administered. Six months after antiviral therapy, the epithelial lesion of herpes simplex keratitis completely disappeared, leaving only mild corneal opacity. Conclusions: If corneal epithelial defects are persistent after DSAEK in patients even with no past history of herpes simplex keratitis, herpes simplex keratitis should be considered in the differential diagnosis.
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