데스메막박리 자동각막내피층판이식술 후 발생한 난치성 반복각막진무름의 치료

김민정(Minjeong Kim),오자영(Ja Young Oh),김경우(Kyoung Woo Kim) 대한안과학회 2022 대한안과학회지 Vol.63 No.1

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.

후부다형각막이상증의 특징을 보이는 홍채각막내피증후군

나정호,이효경 대한안과학회 2019 대한안과학회지 Vol.60 No.9

Purpose: To report a case of iridocorneal endothelial syndrome, which overlapped with some of the features of posterior polymorphous corneal dystrophy. Case summary: A 61-year-old female presented with tearing pain and blurred vision in her left eye, which was aggravated in the morning. The symptom started approximately 1 year prior to her visit. At the initial visit, the visual acuities were 1.0 in both eyes and the intraocular pressures were normal. On slit-lamp examination, a single pair of horizontal parallel lines was observed at the central corneal endothelial layer in the right eye. In contrast, multiple pairs of oblique parallel lines were observed in the left eye. The lines of the lesions were more prominent and wavier in the left eye than those of the right eye. The overlying cornea was clear, and the corneal thicknesses were in the normal range in both eyes. Using a gonioscopic examination, localized peripheral anterior synechiae were observed only in the left eye. The pupil and iris were normal in both eyes. On specular microscopic examination, the corneal endothelial cell size in the right eye increased and the corneal endothelial density decreased to 668 cells/mm2. In the left eye, multiple abnormal endothelial cells with dark-light reversal were observed. In conclusion, the patient was subsequently diagnosed with iridocorneal syndrome, rather than posterior polymorphous corneal dystrophy. Conclusions: Posterior polymorphous corneal dystrophy and iridocorneal endothelial syndrome may present with many similarities. Therefore, in cases of uncertain diagnosis, an understanding of the clinical features is important for proper diagnosis. 목적: 후부다형각막이상증의 특징이 혼재된 홍채각막내피증후군 1예를 보고하고자 한다. 증례요약: 61세 여자 환자가 1년 전부터 시작된, 아침 기상 시 좌안의 찢어질 듯한 통증과 시야 흐림을 주소로 내원하였다. 초진 시시력은 양안 1.0이었고 안압은 정상이었다. 세극등검사상 우안 각막 중심부의 내피층에서 수평으로 주행하는 한 쌍의 평행한 선이, 좌안에서는 비스듬하게 주행하는 여러 쌍의 평행한 선이 관찰되었다. 띠 모양 병변은 좌안에서 더 두껍고 구불구불하였다. 내피세포병변 위의 각막은 깨끗하였고, 각막두께는 모두 정상 범위였다. 전방각경검사상 좌안에서만 국소적인 주변부 홍채 앞 유착이 관찰되었다. 홍채 및 동공은 양안 모두 정상이었다. 경면현미경검사상 우안은 각막내피세포의 크기가 커져 있었고 밀도가 668 cells/mm2로감소해 있었으며 좌안은 명암 반전이 뚜렷한 비정상적인 내피세포가 다수 관찰되었다. 결론적으로 본 증례는 후부다형각막이상증보다는 홍채각막내피증후군에 더 합당할 것으로 판단하였다. 결론: 후부다형각막이상증과 홍채각막내피증후군에서는 다수의 유사한 소견이 관찰될 수 있으므로 적절한 진단을 위하여 임상적 특징을 이해하는 것이 중요하다.

색소녹내장이 동반된 홍채각막내피증후군 1예

김지연,강자헌,Ji Yeon Kim,Ja Heon Kang 대한안과학회 2006 대한안과학회지 Vol.47 No.10

Purpose: To report a case of iridocorneal endothelial syndrome with pigmentary glaucoma. Methods: We encountered a 44-year-old unilateral glaucoma patient who complained of intermittently decreased visual acuity in the right eye. For differential diagnosis, we carried out ophthalmic and systemic examination. Results: Binocular corrected visual acuity was 1.0. His intraocular pressure, measured using a Goldmann applanation tonometer, was 50 mm Hg in the right eye and 18mm Hg in the left. Upon examination of the right eye, we found pigments with a Krukenberg`s spindle appearance on the corneal endothelium, peripheral anterior synechia extending beyond Schwalbe`s line, trabecular hyperpigmentation, endothelial pleomorphism, polymegathism, cell loss, dark area within the cells, a light central spot and light peripheral zone, retinal nerve fiber layer defects, and visual field defects, which together led to the diagnosis of iridocorneal endothelial syndrome with pigmentary glaucoma. We observed progressed glaucomatous injury upon examination of the disc stereo photograph, retinal nerve fiber layer photograph, and visual field test, even though we used topical IOP reducers. Eventually, we performed a trabeculectomy in the right eye. Conclusions: We experienced a case of iridocorneal endothelial syndrome with unilateral pigmentary glaucoma. The glaucoma was not well-controlled with topical IOP reducers. The glaucoma was then treated by a trabeculectomy. We report this case with a review of the literature.

홍채각막내피증후군 환자에서 섬유주절제술과 안내밸브삽입술 후 치료 성적 비교

김정림,양재욱,Jung Lim Kim,Jae Wook Yang 대한안과학회 2012 대한안과학회지 Vol.53 No.5

Purpose: To compare surgical outcomes and corneal endothelial cell densities in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome who underwent trabeculectomy with mitomycin-C (MMC) versus those who underwent Ahmed Glaucoma Valve (AGV) implantation. Methods: Twenty-one patients with ICE syndrome who underwent either trabeculectomy with MMC or AGV implantation were included in this study. All patients had more than 12 months of follow-up after glaucoma surgery. Intraocular pressure (IOP), visual acuity (VA) and corneal endothelial cell density were compared according to the method of surgery. Results: Ten eyes had undergone a trabeculectomy with MMC, and 11 eyes had an AGV implantation. In eyes that underwent a trabeculectomy with a MMC, there were no statistically significant differences between preoperative and postoperative month 12 in IOP, VA or corneal endothelial cell density. In eyes that underwent AGV implantation, postoperative IOP, VA and corneal endothelial cell density were statistically significantly lower than the preoperative values. Conclusions: When determining the method of glaucoma surgery in patients with ICE syndrome, the additional procedures needed to maintain the surgical success of trabeculectomy with MMC and the corneal decompensation which is caused by a decrease in corneal endothelial cell density after AGV implantation should be considered. J Korean Ophthalmol Soc 2012;53(5):668-673

A Case study on improvement of ICE syndrome using Ortho-Cellular Nutrition Therapy (OCNT)

조종빈 셀메드 세포교정의약학회 2024 셀메드 (CellMed) Vol.14 No.3

Objective: A Case study on improvement of ICE syndrome through the use of OCNT. Methods: OCNT was performed on a 45-year-old Korean female who had difficulty in opening the eyes widely due to painful and xerophthalmias, and suffered inconvenience in daily life due to myodesopsia. Results: After the implementation of OCNT, the intraocular pressure (IOP) level was restored to normal, and the pain, dryness and myodesopsia symptoms were alleviated. This resulted in improvement in depressive symptoms and quality of life. Conclusion: For patients suffering from problems such as elevated intraocular pressure, myodesopsia, and xerophthalmia, OCNT can be helpful in improvement and treatment of symptoms.