결막하 덱사메타손 주입 후 비특이적 전안부 소견을 보인 백내장 술 후 안내염 1예

A Case of Endophthalmitis with Atypical Anterior Symptom by Subconjunctival Dexamethasone Injection after Cataract Surgery

목적: 백내장 술 후 발생한 앞방 염증에 대해, 결막하 덱사메타손 주입 및 앞방 세척을 시행하여, 앞방에서 전형적인 안내염 증상이 나타나지 않아, 진단이 지연된 안내염 1예를 보고하고자 한다. 증례요약: 74세 여자 환자가 백내장 술 후 5일째, 시력저하 및 앞방 염증 소견으로 결막하 덱사메타손 주입 및 앞방 세척을 시행 받았다. 술 후 7일째, 시력 호전은 없으나, 앞방 염증 호전으로 결막하 덱사메타손 주입이 추가되었다. 다음날 시력 호전이 없어 본원으로 의뢰되었다. 내원 시 시력은 안전수동이었고, 경한 각막 부종이 있었다. 앞방 세포는 명확하지 않았으나, 1+로 추정되었다. 전안부 소견과 달리, 심한 유리체 혼탁과 유리체 세포가 관찰되었고, 안저가 명확하게 관찰되지 않았다. 술 후 안내염으로 진단하고 유리체절제술 및 유리체강내 항생제 주입을 하였다. 술 후 7주째, 시력 0.6으로 호전되었으며, 안내염의 재발은 없었다. 결론: 백내장 술 후 발생한 안내염을 독성전방증후군으로 오인하고 결막하 덱사메타손 주입 및 앞방 세척을 하였을 때, 앞방의 증상을 비특이적으로 보여 안내염 진단이 지연될 수 있으므로 술 후 강한 염증 치료제 사용에 유의하여야 한다.

Purpose: To report a case of endophthalmitis with non-specific anterior segment symptom by subconjunctival dexamethasone injection and anterior chamber irrigation for the anterior chamber inflammation resulted in delayed diagnosis after cataract surgery. Case summary: A 74-year-old female patient with visual disturbance and anterior chamber inflammation had subconjunctival dexamethasone injection and anterior chamber irrigation after 5 days of cataract surgery. On the 7th day after surgery, the anterior chamber inflammation had decreased without visual acuity improvement and additional subconjunctival dexamethasone injection was done. The next day, she was referred to our hospital because there were no improvements in her visual symptom. When the patient visit our hospital, visual acuity was hand motion and cornea edema was shown. Because of corneal edema, anterior chamber cells were obscure, but it was assumed as 1+ grade. Severe vitreous opacity and increased vitreous cells were observed, so the fundus was barely visible. With diagnosis of endophthalmitis, vitrectomy and intravitreal antibiotic injection were performed. Seven weeks after surgery, best corrected visual acuity increased to 0.6, and there was no sign of recurrence. Conclusions: When the endophthalmitis after cataract surgery was misdiagnosed as toxic anterior chamber syndrome and subconjunctival dexamethasone injection and anterior chamber irrigation were performed, the diagnosis of endophthalmitis could be delayed because the symptoms of the anterior chamber could be non-specific. Therefore, it is important to take careful use of strong anti-inflammation medications after cataract surgery.