기화된 아민에 의한 각막부종 2예

Two Cases of Corneal Edema Due to Vaporized Amine

목적: 기화된 아민에 의한 각막부종 2예를 보고하고자 한다. 증례요약: 28세 남자 환자가 시력저하를 주소로 내원하였다. 폴리우레탄 액체를 고체화시키는 작업을 했으며 폴리우레탄과 직접적인 접촉은 없어도 작업 시 열기와 기체를 직접 접하게 된다고 했다. 우안 나안시력 0.5, 좌안 0.6, 세극등현미경검사에서 상피하 소낭포소견이 관찰되었고, 경면현미경에서 각막두께는 우안 698 μm 좌안 672 μm로 증가해 있었다. 0.5% moxifloxacin과 1% fluorometholone 을 점안하며 3일 후 나안시력 우안 0.5, 좌안 1.0, 각막두께는 우안 644 μm, 좌안 651 μm로 감소, 좌안 소낭포도 감소했다. 34세 여자 환자가 자동차 의자 충전재를 다루는 공장에서 일하며 시력감소로 내원하였다. 우안 시력 0.8, 좌안 시력 1.0, 중심각막두께는우안 537 μm, 좌안 541 μm를 보였다. 세극등현미경검사에서 양안 각막에 상피하 부종이 관찰되었다. 환자는 초진 이후 내원하지 않았다. 결론: 폴리우레탄 폼 생산과 같이 아민을 취급하는 작업 시 간접적인 증기 노출로도 가역적인 각막 독성을 유발할 수 있으므로 산업장에서 아민류 농도에 관한 고려가 필요하다.

Purpose: We report two cases of corneal edema in patients who presented with bilateral blurry vision due to vaporized amines while working in a polyurethane processing plant. Case summary: A 28-year-old male presented with bilateral blurred vision. His work involved solidifying polyurethane liquid and he often found himself exposed to polyurethane heat and gas. On examination, the patient’s uncorrected visual acuity (UCVA) was 20/40 (right) and 30/50 (left). A slit lamp examination revealed subepithelial microbullae in both eyes. The central corneal thickness (CCT) was also increased in both eyes, measuring 698 μm (right) and 672 μm (left). After prescribing 0.5% moxifloxacin and, 1% fluorometholone eye drops for 3 days in both eyes, the UCVA recovered to 20/40 (right) and 20/20 (left). The CCT decreased to 644 μm (right) and 651 μm (left), and the microbullae improved significantly in the left eye. The second patient was a 34-year-old female who presented with bilateral decreased visual acuity while at work. She worked in a factory that produced car seat filling. Her UCVA was 20/25 (right) and 20/20 (left). The CCT by specular microscopy was 537 μm (right) and 541 μm (left). On slit lamp examination, both eyes demonstrated bilateral central subepithelial edema. The patient did not attend any follow- up outpatient appointments after the initial presentation. Conclusions: Exposure to vaporized amines such as polyurethane may causereversible corneal toxicityeven without direct contact. Further consideration should be given to ocular safety and protection from amine compounds in the industrial field.