실리콘관을 이용한 코경유 눈물주머니코안연결술 후 발생한 급성 결막염의 임상적 고찰
Clinical Study on Acute Conjunctivitis after Endoscopic Dacryocystorhinostomy with Silicone Tube Intubation
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목적: 코경유 눈물주머니코안연결술과 실리콘관 삽입술을 받은 환자에서 급성결막염의 발생빈도와 임상양상을 알아보고자 하였다. 대상과 방법: 실리콘관을 사용한 코경유 눈물주머니코안연결술을 받은 517명 547안을 대상으로 의무기록을 후향적으로 분석하여 급성결막염의 발생시기, 빈도, 병인 및 급성결막염이 수술 결과에 미치는 영향에 대해 조사하였다. 결과: 결막염은 3.8% (21/547안)에서 발생하였으며, 평균 연령은 52.6 ± 14.3세, 평균 관찰기간 18.0 ± 6.4개월이었다. 결막염은 술 후3.2개월(3주-5.5개월)에 발생하였으며, 실리콘관 제거와 항생제 치료로 모두 완치되었다. 결막염 발생 유무에 따른 수술 성공률은 차이가 없었으며(80.95%, 88.97%, p=0.282), 수술 실패한 4안은 성공한 17안에 비해 결막염 증상 발생부터 실리콘관 제거까지의 기간이더 길었다(0.22개월, 1.13개월, p=0.047). 결막염 환자는 76.2%의 높은 비율에서 비강 내 육아종이 동반되었다. 결론: 결막염은 육아종 발생과 밀접한 연관성이 있었으며, 결막염 발생 자체가 수술 성공률에 영향을 주지는 않지만 실리콘관 제거가지연될 경우 성공률을 낮출 수 있다.
Abstract
Purpose: To investigate the incidence and clinical course of acute conjunctivitis after endoscopic dacryocystorhinostomy (DCR) with silicone tube intubation. Methods: A retrospective study was conducted on 547 eyes in 517 patients who had undergone endoscopic DCR with silicone tube intubation between 2005 and 2009. The onset, incidence and symptoms of acute conjunctivitis, the effect of silicone tube intubation on acute conjunctivitis, and the effect of acute conjunctivitis on the success rate of DCR were investigated. Results: The incidence of acute conjunctivitis was 3.8%. The mean age of 21 patients with acute conjunctivitis was 52.6 ±14.3 years and the mean follow-up period of those was 18.0 ± 6.4 months after surgery. All the cases of acute conjunctivitis were resolved with topical antibiotic treatment after silicone tube removal. The success rates between patients with and without conjunctivitis were not significantly different (80.95% and 88.97%, respectively; p = 0.282). However, 4 patients with surgical failure had a longer time from onset of acute conjunctivitis to the removal of the silicone tube than 17 patients with surgical success (0.22 months and 1.13 months, respectively; p = 0.047). A higher rate (76.2%) of conjunctivitis developed in patients with granuloma around the surgical ostium. Conclusions: A correlation may exist between acute conjunctivitis and granuloma in patients with DCR with silicone tube intubation. Acute conjunctivitis did not appear to influence the surgical results, although a delayed timing of silicone tube removal in patients with conjunctivitis could decrease the success rate.
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