중증 진균각막염에서 동반된 홍채혈관신생을 전방내 베바시주맙 투여로 치료한 1예

A Case of Iris Neovascularization in Severe Fungal Keratitis Treated with Intracameral Bevacizumab

목적: 홍채신생혈관을 동반한 진균각막염에서 전방내 베바시주맙 투여 후 홍채신생혈관이 호전된 사례를 경험하여 보고하고자 한다. 증례요약: 47세 남성이 나뭇가지에 우안 수상 후 발생한 각막염으로 한 달간 치료 후 악화되어 의뢰되었다. 초진 시 세극등현미경검사에서 각막중심부에 광범위한 동심원 형태 및 깃털 모양 경계의 심부 각막기질침윤, 중심부 상피결손, 전방내 진균덩이, 전방축농 그리고 홍채신생혈관이 관찰되었다. 배양검사에서는 Aspergíllus fumigatus가 검출되었다. 치료로 점안 amphotericin B, voriconazole, natamycin 및 전신 amphotericin B를 투여하였다. 치료 후 각막 병변의 호전을 보였으나 5주째 홍채신생혈관 증가 및 전방출혈이발생하여 전방 세척술 및 전방내 베바시주맙 주입술을 시행하였다. 술 후 2주째 신생혈관은 소실되었으며, 술 후 8주째에 데스메막류를 동반한 각막기질 융해가 발생하여 전층각막이식술을 시행하였다. 홍채신생혈관은 각막이식술 후 6개월까지 관찰되지 않았다. 결론: 감염각막염에서 발생한 홍채신생혈관의 치료로, 적절한 시기에 전방내 베바시주맙을 투여하는 것이 효과적일 수 있다.

Purpose: We report a case in which iris neovascularization (NVI) improved after intracameral bevacizumab injection in a patient who exhibited fungal keratitis with NVI. Case summary: A 47-year-old man experienced a tree branch-induced injury to his right eye and was treated for keratitis for 1 month. However, his condition deteriorated and he was referred to our hospital. Initial slit lamp biomicroscopy findings showed a large, thick central deep stromal infiltration with a concentric circle shaped feathery-like margin, epithelial defect, satellite lesion, fungal ball, hypopyon, and NVI. Aspergíllus fumigatus was isolated in the corneal scraping culture. Amphotericin B, voriconazole, and natamycin were administered as topical treatment along with systemic amphotericin B. After treatment, the corneal lesions gradually improved, but NVI worsened. After the 5th week, total hyphema occurred; anterior chamber irrigation and intracameral bevacizumab injection were performed. Two weeks postoperatively, the NVI exhibited complete regression; corneal stromal melting with descemetocele appeared after 8 weeks. Penetrating keratoplasty was performed and NVI was no longer observed at 6 months after surgery. Conclusions: For the treatment of iris neovascularization in patients with infectious keratitis, intracameral bevacizumab injection at an appropriate time may be effective.