백내장수술 후 발생한 Exophiala xenobiotica 진균안내염

Exogenous Fungal Endophthalmitis by Exophiala xenobiotica Infection after Cataract Surgery

목적: 백내장수술 후 발생한 Exophiala xenobiotica 감염에 의한 진균안내염 증례를 보고하고자 한다. 증례요약: 79세 남자 환자가 좌안 백내장수술 8개월 후 발생한 시력저하로 내원하였다. 내원 당시 좌안 포도막염으로 진단 후 트리암시놀론 테논낭하주사술을 2회 시행한 후 증상의 호전을 보였다. 하지만 3개월 후 다시 좌안의 시력저하가 발생하였고, 전방축농 및 유리체혼탁이 확인되었다. 백내장수술 이후 발생한 만성 안내염의 가능성을 고려하여 좌안 전방세척술 및 방수의 배양검사를 통해 Exophiala xenobiotica 감염을 확인하였다. 항진균제의 전신 치료 및 유리체내주사술에도 불구하고 안내염은 호전이 없어 유리체절제술을 시행하였다. 하지만 항진균제 치료의 중단 후, 각막절개창 부위의 안내염의 국소적 재발 소견으로 병변 부위의 수술적 조직제거술 및 항진균제의 전방주사술을 시행한 후 전방 및 유리체염증 없이 좌안 최대교정시력은 0.5로 호전되었다. 결론: 백내장수술 이후 발생하는 포도막염에 대해서 수술 후 만성적으로 발생할 수 있는 진균안내염의 가능성을 염두에 두어야 한다.

Purpose: To report a case of fungal endophthalmitis secondary to Exophiala xenobiotica after cataract surgery. Case summary: A 79-year-old male presented with decreased visual acuity in the left eye 8 months after cataract surgery. He was diagnosed with uveitis and received subtenon triamcinolone injection, which has a temporary effect. Three months after the injection, his visual acuity had decreased, such that best-corrected visual acuity (BCVA) of the left eye was hand motion. Anterior chamber cells with hypopyon and severe vitritis with vitreous haze were observed in the left eye. We considered the possibility of endophthalmitis after cataract surgery, and repetitive anterior chamber irrigation with culture was conducted to identify pathogens. Systemic and intravitreal antifungal agents were injected after the isolation of Exophiala xenobiotica. However, there was no improvement of the endophthalmitis, and he underwent pars plana vitrectomy. Although inflammatory symptoms disappeared after surgery, black lesions in the corneal incision site were identified 3 months postoperatively. Ultimately, surgical debridement and anterior chamber injections of antifungal agents were performed for recurring endophthalmitis. After the surgery, there was no inflammation of the anterior chamber or vitreous cavity. The BCVA of the left eye improved to 0.5. Conclusions: Ophthalmologists should consider the possibility of fungal endophthalmitis in patients who suffer from uveitis-like symptoms after cataract surgery.