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.

안내렌즈삽입술 후 안압과 전방각의 변화

전연숙,이종호,이제명,박인기,Yeoun Sook Chun,Jong Ho Lee,Jae Myung Lee,In Ki Park 대한안과학회 2005 대한안과학회지 Vol.46 No.2

Purpose: To evaluate the effects of ICL implantation on angle structures, intraocular pressure (IOP) and pupil diameter. Methods: A Staar implantable contact lens (ICL) was implanted in 81 eyes of 43 patients with spherical equivalent over -6D. Gonioscopy was done 1 day after laser iridotomy and 6 months after ICL implantation and postoperative changes in gonioscopic findings were evaluated. Also IOP and pupil diameter were examined. Results: There were occlusion or narrowing of the LI opening site in 10 eyes (12.3%). Width of angle was wide over 30° in all cases but that was narrowed under 20° in 16 eyes (19.8%) at postoperative 6 months. The mean pigmentation was 2.11 in inferior, 0.47 in nasal, 0.22 in temporal and 0.18 in superior angle at 6 months postoperatively by semiquantitative method (Grade 0~4). There was decrease of pigmentation in nasal and temporal angle but no change in inferior and superior angle after ICL implantation. There was temporary increase of IOP at 1 week and 1 month postoperatively due to steroid eye drops but returned to preoperative level and maintained until the 6 months postoperatively. There was significant decrease of pupil diameter at postoperative 1 and 3 months but returned to the preoperative level at postoperative 6 months. There was no evidence of pigment dispersion syndrome and pigmentary glaucoma. Conclusions: ICL implantation caused the narrowing of width of angle but did not increase trabecular pigmentation. We expect that ICL implantation is safe about pigment dispersion syndrome and pigmentary glaucoma.

광범위 약제내성 폐결핵 약물치료 중 발생한 색소녹내장 1예

정재우(Jae Woo Jung),조성호(Seong Ho Jo),서제현(Je Hyun Seo),김윤성(Yun Seong Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 광범위 약제내성 폐결핵치료를 위해 clofazimine을 복용하던 중 발생한 색소녹내장 1예를 보고하고자 한다. 증례요약: 23세 남자가 광범위 약제내성 결핵으로 약물 치료 중 양안 시야 흐림을 주소로 내원하였다. 환자는 타 병원에서 폐결핵으로 일차항결핵제를 처방 받았으나 불규칙하게 복용 중 광범위 약제내성 결핵으로 진단 후 6개월 전부터 결핵치료를 위해 clofazimine 경구 약을 추가한 후 얼굴피부가 어두운 갈색으로 변하는 소견을 호소하였다. 초진 시 교정시력이 우안 0.15, 좌안 0.5, 안압은 우안 50 mmHg, 좌안 48 mmHg로 측정되었다. 세극등검사상 양안의 각막부종과 각막혼탁이 관찰되었으며, 전방은 흐린 염증소견이 관찰 되었다. 색각검사상 양안 모두 색약의심 소견 및 시야검사상 양안 상비측 시야결손이 관찰되었다. 양안의 전방각경검사상 개방각이었으나 섬유주에 침착된 색소가 관찰되었다. 결핵약에 의한 색소녹내장 진단하에 최대 약물 치료를 시행하였으나 안압 조절이 불량하여 양안 섬유주절제술을 시행하였다. 수술 후 안압은 양안 12 mmHg, 시력은 우안 0.9, 좌안 1.2로 호전되었다. 결론: Clofazimine 복용의 안과합병증으로 기존에 보고되지 않았던 녹내장 발병의 첫 번째 증례이고, 녹내장 발병 기전으로는 clofazimine의 전신적인 색소침착과 관련된 안구 내 전방각의 색소 침착에 의한 녹내장으로 생각된다. 본 증례보고상 녹내장 안약으로는 안압이 조절되지 않아서 섬유주절제술을 시행하여 안압을 성공적으로 조절할 수 있었다. <대한안과학회지 2016;57(6):1026-1030> Purpose: To report a case of secondary pigmentary glaucoma due to clofazimine treatment for extensive drug-resistant tuberculosis. Case summary: A 23-year-old man presented with blurred vision in both eyes. The patient started to take clofazimine for extensive drug-resistant tuberculosis six months prior, after which his facial skin color changed to a dark-brown. Intraocular pressure (IOP) was 50 mm Hg in the right eye and 48 mm Hg in the left eye. Slit lamp examination revealed corneal edema, opacity, and flare in the anterior chamber in both eyes. A color vision test revealed a mild color defect in both eyes. Visual field (VF) test revealed superior temporal VF loss in the left eye. Gonioscopy revealed open angles with high pigmentation in the trabecular meshwork in both eyes. The patient was diagnosed with pigmentary glaucoma, and maximum tolerated medical therapy was performed. However, the IOP was uncontrolled. Trabeculectomy was performed in both eyes. Postoperative IOP was measured to be 12 mm Hg in both eyes without medication, and visual acuity measured 20/22 in the right eye and 20/17 in the left eye. Conclusions: To the best of our knowledge, this report is the first case of clofazimine being a possible cause of pigmentary glaucoma in a patient with extensive drug-resistant tuberculosis. J Korean Ophthalmol Soc 2016;57(6):1026-1030

안내후방콘택트렌즈 삽입술에 의해 발생한 색소녹내장 1예

박강윤,김해송,이지웅.Kang Yeun Pak. MD. Hae Song Kim. MD. PhD. Ji Woong Lee. MD. PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: To report a case of secondary pigmentary glaucoma after implantable contact lens (ICL) implantation successfully treated with trabeculectomy without ICL removal. Case summary: A 29-year-old woman presented with refractory intraocular pressure (IOP) increase in both eyes. IOP was 22 mm Hg in the right eye and 39 mm Hg in the left eye. The patient received posterior chamber phakic intraocular lens implantation in both eyes 22 months prior. Slit lamp examination revealed patent iridotomy sites in both eyes. Gonioscopy revealed open angles with 4-degree pigment deposits on the trabecular meshwork in both eyes. Ultrasound biomicroscopy examination confirmed contact between ICL and the posterior surface of the iris. In spite of well tolerated medical therapy and selective laser trabeculoplasty, IOP was 46 mm Hg in her left eye. Trabeculectomy was performed in her left eye without ICL removal. At 6 months postoperative, IOP measured 6 mm Hg without any anti-glaucoma medication and bleb was maintained in good condition in the left eye. Conclusions: The results from this case study indicate that ICL implantation can lead to secondary pigmentary glaucoma and trabeculectomy without ICL removal may help to decrease the IOP.

Trabecular Pigment Change Following Posterior Chamber Intraocular Lens Implantation

Ahn, Byung-Heon,Cha, Moo-Byung,Park, Keun-Sung,Kim, Chang-Sik 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.1

백내장수술 후 색소분산의 정도와 안압 변화의 관계를 알아보기 위하여 82명의 환자 82안에서 전방각촬영술과 안압 측정을 시행하였다. 대상군의 평균 연령은 51.7세(24-78세)였으며 42안은 계획적 백내장낭외적출술을, 40안은 수정체유화술로 백내장을 제거하고 후방인공수정체를 삽입하였다. 수술후 평균 추적기간은 14.6개월(6-42개월)이었다. 수술 전 섬유주 색소는 하방이 1+이고 다른 부위는 색소침착이 없는 경우가 82안 중 36안(43.9%)으로 가장 흔하였으며 수술 후에는 33안(40.2%)에서 하방 3+, 비측 2+, 이측 1+ 또는 2+, 상방은 1+ 색소침착이 보였다. 항상 색소침착은 하방, 비측, 이측, 상방의 순으로 심하였다. 수술 후 4+ 색소침착이 최소한 한 개의 4분위에서 관찰된 예는 22안(26.8%)이었으며 이 중 2안(2.4)은 전체 4분위에, 1안(1.2%)은 3개, 8안(9.8%)은 2개의 4분위에서 보였다. 수술 후 3안(3.7%)에서 지속적 안압 상승이 있었으며 1안은 수술 직후에 2안은 각각 1.5년후에 발생하였고 모두 약물치료가 필요하였다. 다른 한 눈은 수술 후 1년 째에 불안정한 안압 상승이 있었다. 이상의 4안은 모두 전체 대상 중에서 가장 색소침착이 심하였던 예들로 270°이상에서 4+의 색소침착을 보였다. 본 연구로 백내장 수술 후 2개월 내에 전방각경검사를 시행하여 270°범위 이상에 4+ 섬유주색소침착이 관찰되면 향후에 녹내장 발생 가능성이 많으므로 밀접한 추적 관찰을 하여야 할 것으로 나타났다. To study the relationship between pigment dispersion and intraocular pressure(IOP) change after cataract extraction, goniophotographic assessment of pigment on the trabecular meshwork(TM) and IOP measurements were performed in 82 eyes of 82 subjects with a mean age of 51.7 years(range, 24 to 78 years), who underwent a planned extracapsular cataract extraction(42 eyes) or phacoemulsification(40 eyes) with posterior chamber intraocular lens(PC-IOL) implantation. The average followup period was 14.6 months(range, 6-42 months). The most frequent gonioscopic appearance of TM pigment was that of 1+ inferiorly and nil in the other quadrants in 36 of 82 eyes(43.9%) preoperatively, and pigment of 3+ inferiorly, 2+ nasally, 1+ or 2+ temporally and 1+ superiorly in 33 eyes(40.2%) after PC-IOL implantation. This also implies a conspicuous tendency of quadrantal differences in TM pigment density, that is always inferior >nasal >temporal >superior. After cataract extraction, TM pigment increased in all operated eyes with involving multiple quadrants of the angle. The eye with a heavy 4+ pigmentation at least in one quadrant of TM was observed in 22 eyes (26.8%) ; two eyes(2.4%) with 4+ pigment in 4 quadrants, one eye(1.2%) in 3 quadrants and eight eyes(9.8%) in 2 quadrants. Three eyes(3.7%) developed a persistent IOP rise, one in the immediate postoperative days and two 1.5 years postoperatively, and they continued to be on antiglaucoma medication. One more eye had a fluctuating increase in IOP at one year after surgery. All the four eyes ranked the first to the fourth in TM pigment density among all the subjects and had 4+ pigment in 270˚or greater angle. From the study, we may suggest a gonioscopy within two months after PC-IOL implantation would give us a decision clue whether the patient will be followed up with caution or not, based on the gonioscopic finding of 4 + pigment over 270°of the angle.