괴사성 공막염으로 안내염이 발생하여 유리체절제술 및 영구양막이식술로 치료한 1예 보고
A Case of Endophthalmitis With Necrotizing Scleritis Treated With Vitrectomy and Permanent Amniotic Membrane Transplantation
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목적: 괴사성 공막염으로 감염성 안내염이 발생하여 유리체절제술 및 영구양막이식술을 이용하여 치료한 1례를 보고하고자 한다. 증례요약: 우안 통증 및 시력저하로 내원한 76세 남자 환자가 감염성 안내염으로 진단되었다. 내원 당시 미만성의 결막 및 공막충혈, 각막 부종 및 앞방축농과 비측부의 공막 허혈 및 괴사가 관찰되었고, 시력은 안전수동이었다. 이에 유리체내 항생제 주입술 시행하였 고, 배양검사에서는 녹농균이 배양되었다. 2일 후 응급 유리체절제술 시행 시 비측부 공막 괴사부위에 미세천공에 의한 미만성의 누출 및 각막주변부 괴사가 발견되어, 괴사부위에 10층의 양막을 겹쳐 영구양막이식술을 시행하였다. 술 후 항생제 치료 및 스테로이드 점안, 복용 치료를 추가하고, 경구 cyclophosphamide를 투여하였다. 치료 후 74일째, 안내염은 관해되었고, 시력은 0.5로 개선되었으 며, 공막염은 잘 조절되었다. 결론: 괴사성 공막염이 미세천공을 유발하여 안내염을 발생시킬 수 있음을 주지하고, 이 경우 유리체절제술과 함께 영구양막이식술로 효과적으로 치료할 수 있음을 보고하는 바이다.
Abstract
Purpose: To report a case of a patient with infectious endophthalmitis associated with necrotizing scleritis that was treated with pars plana vitrectomy and permanent amniotic membrane transplantation. Case summary: A 76-year-old man with pain and visual loss in the right eye was diagnosed with infectious endophthalmitis and necrotizing scleritis. The visual acuity in the right eye was hand motion, and the slit lamp examination showed infection of the conjunctiva and sclera, corneal edema, hypopyon, and necrosis of nasal sclera. An intravitreal antibiotic injection was given, and Pseudomonas aeruginosa was cultured in vitreous fluid. Two days afterward, when vitrectomy was performed, leakage from the scleral microperforation and necrosis of the peripheral cornea was observed. Thus, a 10-layered permanent amniotic membrane transplantation was performed. The patient was given topical antibiotics and steroids, oral prednisolone, and cyclophosphamide postoperatively. After 74 days, endophthalmitis was remitted, and scleritis was well controlled. His visual acuity recovered to 20/40. Conclusions: Infectious endophthalmitis due to scleral microperforation by necrotizing scleritis can be treated effectively with vitrectomy combined with permanent amniotic membrane transplantation.
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