마이토마이신 병용 미용적 결막절제술 후 발생한 공막각막염 및 이차성 녹내장 1예 = Secondary Glaucoma and Sclerokeratitis After Cosmetic Eye Whitening by Regional Conjunctivectomy with Mitomycin C Application

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of secondary glaucoma and sclerokeratitis after cosmetic eye whitening by regional conjunctivectomy
with Mitomycin C application.
Case summary: A 69 year-old man was referred to our clinic for a left ocular pain and ocular hypertension sustained for 3
months after cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application for chronic conjunctival
hyperemia. On first examination, the scleromalacia and large conjunctival epithelium defect in the nasal quadrant of the limbus
area and diffuse sclerokeratitis were observed. Conjunctival and episcleral vessel deficit were seen except superior 30% portion
in the left eye. The anterior chamber depth in the left eye was very shallow compared to the right eye and cell reaction in the
left anterior chamber was detected. Intraocular pressure (IOP) in the left eye was 28 mmHg after CosoptⓇ and 15% mannitol 500
ml use. Glaucomatous cupping was detected. During follow-up, left IOP increased over 40 mmHg despite the maximal medical
treatment and the progression of visual field defects was detected, so then left phacoemulsification, Ahmed valve implantation
and amnion membrane transplantation were done. After surgery, the conjunctival epithelial defect and sclerokeratitis were
improved much and IOP was regulated 20~30 mmHg without medication. Digital massage was done 2 times per day for decreasing
IOP and wound remodeling after 1 month. At 3 month after surgery, the conjunctival epithelial defect recurred and
scleromalacia was also progressed, so then we performed autoconjunctival flap and amnion membrane transplantation in left eye.
The conjunctival epithelial defect were recovered completely, IOP was regulated 24~36 mmHg without medication, and 20~24
mmHg with Cosopt.Ⓡ The compliance of patient is very poor, further management may be needed for IOP control.
Conclusions: Cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application can cause serious
complications such as scleromalcia and secondary glaucoma. This case shows that particular care should be taken in order
to minimize these complications.

국문 초록 (Abstract)

목적: 마이토마이신 병용 미용적 결막절제술 후 발생한 공막각막염 및 이차성 녹내장의 증례를 경험하였기에 이를 보고하고자 한다.
증례요약: 69세 남자가 3개월 전 좌안의 만성적인 결막충혈로 마이토마이신 병용 미용적 결막 절제술을 시행 받은 후 지속되는 좌안
통증 및 안압상승으로 전원되었다. 초진 시 비측 공막괴사와 광범위한 결막상피결손 및 염증소견이 있었고, 미만성의 점모양 각막병증
이 관찰되었으며, 위쪽 결막 부위를 제외한 광범위한 결막 및 상공막 혈관 결손이 관찰되었다. 좌안의 전방깊이는 우안에 비해 매우
얕은 상태로 세포가 관찰되었고, 좌안 안압은 CosoptⓇ과 15% mannitol 500 ml 주사 후 28 mmHg로 측정되었고, 녹내장성 시신경손상
도 관찰되었다. 경과관찰 중 좌안 안압이 상승하여 Alphagan,Ⓡ XalatanⓇ을 추가하였으나 지속적으로 안압이 40 mmHg 이상으로 측정
되고 시신경손상도 진행하여, 좌안 백내장 수술과 아메드밸브 삽입술 및 양막이식술을 시행하였다. 수술 후 결막결손과 공막괴사는
많은 호전을 보였고, 안압은 약물 사용 없이 20~30 mmHg로 조절되었다. 수술 후 1개월째 안압 조절을 위해 안구지압을 하루 2번
시행하였다. 수술 3개월 후 결막 결손부위가 다시 증가하고 공막괴사가 진행하여, 자가결막이식술 및 양막이식술을 시행하였고, 수술
후 결막결손부위는 치료가 되었다. 안압은 약물사용 없이 24~36 mmHg로 조절되었고, CosoptⓇ을 사용하고 20~24 mmHg 정도로
조절되고 있으며, 환자가 약물의 순응도가 나빠 추가적인 안압조절이 필요한 상태이다.
결론: 마이토마이신 병용 미용적 결막절제술 시 과도한 결막절제 및 마이토마이신 사용 그리고 수술 후 장기간 사용하는 스테로이드안
약사용에 주의를 요하며, 공막각막염 및 이차성 녹내장 등의 심각한 합병증이 발생할 수 있음을 보고하는 바이다.

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