원추각막 교정을 위해 시행한 각막링 삽입술 후 발생한 진균성 각막염 1예 = A Case of Fungal Keratitis after Intracorneal Ring Segment Implantation for Keratoconus

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of fungal keratitis 3 days after intracorneal ring segment (ICRS) implantation for keratoconus. Case summary: A 65-year-old woman was referred to our clinic with refractory infectious keratitis in her left eye 3 days after ICRS insertion for keratoconus. Slit lamp examinations revealed infiltrates around the incision site with cellular reaction in the anterior chamber after the ICRS had been removed. Corneal scrapings were obtained for staining and cultures, and intensive topical antibiotics were administered. Initial microscopy and cultures were negative. Despite the use of intensive topical antibiotics, there was no improvement. Hyphae were isolated from additional corneal scrapings. The patient’s symptoms and corneal findings improved following administration of topical amphotericin B and oral itraconazole. Conclusions: Infectious keratitis after ICRS implantation is an uncommon but sight-threatening complication. Fungal keratitis should also be considered if infectious keratitis after ICRS is unresponsive to antibiotics. J Korean Ophthalmol Soc 2012;53(6):866-871

참고문헌 (Reference)

1 Schanzlin DJ, "Two-year outcomes of intrastromal corneal ring segments for the correction of myopia" 108 : 1688-1694, 2001

2 Coskunseven E, "One-year results of intrastromal corneal ring segment implantation (KeraRing) using femtosecond laser in patients with keratoconus" 145 : 775-779, 2008

3 Ruckhofer J, "One year results of European Multicenter Study of intrastromal corneal ring segments. Part 2: complications, visual symptoms, and patient satisfaction" 27 : 287-296, 2001

4 Chalasani R, "Microbial keratitis following intracorneal ring segment implantation" 94 : 1541-, 2010

5 Hashemi H, "Microbial keratitis after INTACS implantation with loose suture" 24 : 551-552, 2008

6 Kymionis GD, "Management of post-LASIK corneal ectasia with Intacs inserts: one-year results" 121 : 322-326, 2003

7 Siganos CS, "Management of keratoconus with Intacs" 135 : 64-70, 2003

8 Siganos CS, "Management of corneal ectasia after laser in situ keratomileusis with INTACS" 18 : 43-46, 2002

9 Galvis V, "Late bacterial keratitis after intracorneal ring segments (Ferrara ring) insertion for keratoconus" 26 : 1282-1284, 2007

10 Bourcier T, "Late bacterial keratitis after implantation of intrastromal corneal ring segments" 29 : 407-409, 2003

11 McAlister JC, "Keratitis after intracorneal ring segment insertion for keratoconus" 32 : 676-678, 2006

12 Shehadeh-Masha'our R, "Keratitis after implantation of intrastromal corneal ring segments" 30 : 1802-1804, 2004

13 Shabayek MH, "Intrastromal corneal ring segment implantation by femtosecond laser for keratoconus correction" 114 : 1643-1652, 2007

14 Lovisolo CF, "Intracorneal ring segments for iatrogenic keratectasia after laser in situ keratomileusis or photorefractive keratectomy" 18 : 535-541, 2002

15 Zare MA, "Intracorneal ring segment implantation for the management of keratoconus: safety and efficacy" 33 : 1886-1891, 2007

16 Boxer Wachler BS, "Intacs for keratoconus" 110 : 1031-1040, 2003

17 Kwitko S, "Ferrara intracorneal ring segments for keratoconus" 30 : 812-820, 2004

18 Hofling-Lima AL, "Corneal infections after implantation of intracorneal ring segments" 23 : 547-549, 2004

19 Coskunseven E, "Complications of intrastromal corneal ring segment implantation using a femtosecond laser for channel creation: a survey of 850 eyes with keratoconus" 89 : 54-57, 2011

20 Ruckhofer J, "Clinical characteristics of lamellar channel deposits after implantation of intacs" 26 : 1473-1479, 2000

21 Boorstein SM, "Atopy: a patient-specific risk factor for diffuse lamellar keratitis" 110 : 131-137, 2003

22 Slade DS, "Acanthamoeba and fungal keratitis in a woman with a history of Intacs corneal implants" 34 : 185-187, 2008