데스메막박리 자동각막내피층판이식술 후 발생한 난치성 반복각막진무름의 치료

Refractory Recurrent Corneal Erosion after Descemet’s Stripping Automated Endothelial Keratoplasty

목적: 홍채각막내피증후군에서 데스메막박리 자동각막내피층판이식술 후 발생한 난치성 반복각막진무름의 치료 증례에 대해 보고하고자 한다. 증례요약: 좌안 홍채각막내피증후군을 동반한 62세 남자 환자에서 데스메막박리 자동각막내피층판이식술을 시행하였다. 수술 중 시야 확보를 위해 각막상피를 15번 블레이드로 제거했고, 내피 이식편을 전방 내 삽입하기 전 3군데 각막 통기 절개를 시행하였다. 술 후 1주째 각막상피는 재생되었으나 2주째 상피가 분리되어 느슨한 상피를 제거한 후 치료콘택트렌즈를 착용하였다. 이후 반복적 상피 제거, 치료콘택트렌즈 착용, 5% 염화나트륨 및 자가혈청안약 점안, 독시사이클린, 스테로이드, 발라시클로버 복용에도 불구하고 호전되지 않았고, 이후 3차례의 전부 각막기질천자를 시행하여 8주째 각막상피가 유착되었다. 10주째 각막진무름은 더 이상 관찰되지 않았으나 급성 거부 반응이 발생하여 면역억제치료 후 호전되었다. 술 후 1년째 백내장수술 시행 후 교정 시력은 0.8이었다. 결론: 데스메막박리 자동각막내피층판이식술 후 난치성 반복각막진무름이 발생할 수 있으며 반복적인 전부 각막기질천자를 통한 적극적인 치료가 도움이 될 수 있겠다.

Purpose: To report a case of refractory recurrent corneal erosion that occurred after Descemet’s stripping automated endothelial keratoplasty (DSAEK) in iridocorneal endothelial syndrome. Case summary: A 62-year-old male patient with iridocorneal endothelial syndrome planned to undergo ultrathin DSAEK. At the surgery, corneal epithelial debridement was performed using a No. 15 blade to enhance the surgical field visibility. Three corneal venting incisions were made before graft insertion in the recipient eye. The corneal epithelium was healed at postoperative 1 week. However, the epithelium detached at 2 weeks postoperatively. The loosened epithelium was peeled off, and a therapeutic bandage contact lens was applied. Thereafter, the corneal epithelial detachment did not improve, despite repeated corneal epithelial debridement, prolonged therapeutic bandage contact lens wear, applications of 5% sodium chloride eyedrops and autoserum eyedrops, and intake of doxycycline, steroids, and valaciclovir. Anterior stromal puncture was performed three times, and the corneal epithelium eventually attached at postoperative 8 weeks. Although recurrent corneal erosion was not observed at postoperative 10 weeks, acute graft rejection occurred but improved with immunosuppressive treatment. The corrected visual acuity was 0.8 after cataract surgery, which was performed at 1 year after DSAEK. Conclusions: Refractory recurrent corneal erosion may occur after DSAEK surgery. In such a case, an aggressive treatment including the repeated anterior stromal puncture technique may be helpful.