라섹수술 후 발생한 중심성 독성 각막병증 1예
Central Toxic Keratopathy After LASEK
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목적: 레이저각막상피절삭성형술 후 일시적으로 각막혼탁 및 원시가 발생한 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 21세 여자 환자가 좌안의 시력 저하를 주소로 내원하였다. 환자는 10일 전 개인병원에서 양안에 LASEK 수술을 받았으며,시술 전 좌안의 중심각막두께는 540 μm였고 굴절이상은 -2.00 Dsph=-0.75 Dcyl ×80A이었다. 예상각막절제량은 52.2 μm였다. 내원 시 좌안의 교정시력은 0.07이었고 중심각막두께는 404 μm였으며, 굴절이상은 +1.00 Dsph=+1.25 Dcyl ×90A이었다. 각막 중심부원형혼탁이 보였고, 명확한 염증소견은 보이지 않아 스테로이드 점안약을 사용하였다. 시술 3주에 중심각막두께는 401 μm였고, 굴절이상은 +11.25 Dsph=-4.00 Dcyl ×145A이었으며 각막중심부 원형혼탁은 지속되었다. 시술 22주에 중심각막두께는 445 μm이며, 굴절이상은 -0.75 Dsph=-1.25 Dcyl ×180A로 호전되었고 각막의 혼탁도 사라졌다. 결론: 레이저굴절수술 후에 일시적으로 중심부에 각막혼탁이 나타나면서 각막기질이 얇아지고 원시로 진행하는 양상을 보일 경우 중심성 독성 각막병증을 고려해야 하겠다.
Abstract
Purpose: We report a case of transient corneal opacity and hyperopia after LASEK surgery. Case summary: A 21-year-old female visited our clinic complaining of decreased visual acuity in the left eye. The patient had undergone LASEK surgeryten days previously. Before LASEK surgery, the central corneal thickness of the left eye was 540 μm,and the refractive error was -2.00 Dsph=-0.75 Dcyl ×80A with an estimated ablation depth of 52.2 μm. At the time of visit (on the tenth day after surgery), the best corrected visual acuity (BCVA) was 0.07, the central corneal thickness was 404 μm, and the refractive error was +1.00D=+1.25D ×90. Slit-lamp biomicroscopy showed round central corneal haziness, but there were no signs of inflammation. At the third weeks after surgery, the central corneal thickness was 401 μm and the refractive error was +11.25D=-4.00D ×145. Slit-lamp biomicroscopy showed sustained round central corneal haze. Twenty-two weeks after surgery,the central corneal thickness was 445 μm and the refractive error was -0.75D=-1.25D ×180. The corneal opacity had disappeared. Conclusions: In case of transient corneal opacity, stromal loss and hyperopic change after LASEK surgery, central toxic keratopathy should be considered.
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