재발성 결절앞공막염에서 유리체강 내 덱사메타손 임플란트의 효과
Effect of Intravitreal Dexamethasone Implant Injection in a Patient with Recurrent Nodular Anterior Scleritis
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목적: 자주 재발하는 결절성 앞공막염 환자에서 유리체강 내 덱사메타손(Ozurdex® , Allergan, Irvine, USA) 시술 후 호전된 증례를보고하고자 한다. 증례요약: 16세 여자가 반복되는 좌안 결막충혈을 주소로 내원하여, 결절성 앞공막염을 진단받고, 안약 및 경구 스테로이드로 치료중, 고안압과 전신발진 등의 부작용으로 스테로이드를 감량한 후 재발하였다. 이에 cyclosporine (Sandimmune® , Novartis, Basel, Switzerland)과 methotrexate (Methotrexate, Korea United Pharm. INC., Seoul, Korea) 등의 면역억제제를 추가하여 치료하였으나공막염은 호전되지 않았으며, 중간포도막염과 유리체출혈이 발생하였다. 유리체절제술을 시행한 후에도 공막염과 중간포도막염이 지속되어, 유리체강 내 오저덱스 주사를 시행하였으며, 이후 중간포도막염과 공막염이 재발없이 호전되었으며 면역억제제와 스테로이드도 중단할 수 있었다. 결론: 중간포도막염 등 합병증이 동반되어 있으면서, 자주 재발되는 전부공막염에서 유리체강 내 덱사메타손 치료가 효과적일 수 있다.
Abstract
Purpose: To report the use of intravitreal dexamethasone implant injection in a patient with recurrent nodular anterior scleritis. Case summary: A 16-year-old patient presented with persistent eye pain and conjunctival injection in the left eye, which were diagnosed as nodular anterior scleritis. The clinical features improved with topical and systemic steroid treatment, but the patient developed side effects related to steroid use, including elevated intraocular pressure and skin rash. The steroid dose was reduced which led to frequent recurrence. Immunosuppressive agents were added to the treatment regimen, but there was no improvement; the patient developed intermediate uveitis and vitreous hemorrhage. Scleritis and intermediate uveitis continued despite vitrectomy; therefore, intravitreal dexamethasone implant injection was performed. There was no scleritis recurrence within 1 year after injection, which allowed tapering of steroids and immunosuppressive drugs. Conclusions: Intravitreal dexamethasone implant injection may be effective for recurrent nodular anterior scleritis in patients who exhibit complications, such as intermediate uveitis.
참고문헌 (15)
- Sims J, "Scleritis : presentations, disease associations and management", Postgrad Med J, 88, pp.713~718 (2012)
- 최승권, "난치성 후부공막염에서 유리체강내 덱사메타손 임플란트 효과", 대한안과학회지, 62(3), pp.322~328 (2021), 대한안과학회
- de Fidelex TS, "Biologic therapy for refractory scleritis : a new treatment perspective", Int Ophthalmol, 35, pp.903~912 (2015)
- 임지원, "Intravitreal Bevacizumab (Avastin) as an Adjuvant for the Treatment of Posterior Scleritis", Korean Journal of Ophthalmology, 25(4), pp.282~284 (2011), 대한안과학회
- He Y, "A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema", BMC Ophthalmol, 18, pp.121~ (2018)
- Boyer DS, "Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant inpatients with diabetic macular edema", Ophthalmology, 121, pp.1904~1914 (2014)
- Mayer WJ, "Twelve-month experience with Ozurdex for the treatment of macular edema associated with retinalvein occlusion", Eye(Lond), 27, pp.816~822 (2013)
- Saincher SS, "Ozurdex(dexamethasone intravitreal implant)for the treatment of intermediate, posterior, and panuveitis : a systematic review of the current evidence", J Ophthalmic Inflamm Infect, 10, pp.1~ (2020)
- Lowder C, "Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis", Arch Ophthalmol, 129, pp.545~553 (2011)
- Dubey N, "Intravitreal dexamethasone implant in a case of recurrent posterior scleritis", J Vitreouretinal Dis, 1, pp.84~87 (2017)
- Pohlmann D, "Intravitreal dexamethasone for the treatment of CMO associated with refractory sclerouveitis", Ocul Immunol Inflamm, 26, pp.160~165 (2018)
- Nascimento H, "Subconjunctival dexamethasone implant for non-necrotizing scleritis", J Ophthalmic Inflamm Infect, 3, pp.7~ (2013)
- Hunter RS, "Dexamethasone intravitreal implant for the treatment of noninfectious uveitis", Clin Ophthalmol, 5, pp.1613~1621 (2011)
- Ahn SJ, "Intravitreal dexamethasone implants for the treatment of refractory scleritis combined with uveitis in adult-onset Still's disease : a case report", BMC Ophthalmology, 16, pp.196~ (2016)
- Tomkins-Netzer O, "Treatment with repeat dexamethasone implants results in long-term disease control in eyes with noninfectious uveitis", Ophthalmology, 121, pp.1649~1654 (2014)