헤르페스 각막염 치료 중 발생한 홍채 후면 칸디다 진균구

• 영문명: Fungal Abscess in Posterior Iris during Herpes Keratitis Treatment
• 발행기관: 대한검안학회
• 저자명: 방슬기(Seul Ki Bang) 강민석(Min Seok Kang) 김태기(Tae Gi Kim) 진경현(Kyung Hyun Jin)
• 간행물 정보: 『Annals of optometry and contact lens』Vol.17 No.2, 39~43쪽, 전체 5쪽
• 주제분류: 의약학 > 기타의약학
• 파일형태: PDF
• 발행일자: 2018.06.30

영문 초록

Purpose: To report a case of fungal infection in posterior iris during medical and surgical management of herpetic keratitis. Case summary: A 44-year-old women diagnosed with a dilated cardiomyopathy was presented with decreased visual acuity in the left eye. Best corrected visual acuity was 0.05 in the left eye and slit-lamp examination revealed peripheral ulcerative dendritic keratitis with stromal infiltration. The anti-viral agents and steroid eye drops were initiated under impression of herpetic keratitis and corneal endothelitis. The inflammatory reactions in anterior chamber were increased and the thinning of ulcerative lesion was aggravated at 6 months after treatment. The amniotic membrane transplantation (AMT) was done in the left eye. Despite the continuous medical management, ulcerative thinning readily progressed and the hypopyon in anterior chamber with anterior protrusion of iris in inferonasal portion was observed at 3 months after AMT. The corneal perforation occurred during secondary AMT and iris exposure was observed as perforated region enlarged. The primary closure with conjunctival flap was performed and the penetrating keratoplasty (PKP) was done at 3 days later. The whitish abscess pocket with 1 to 2 mm diameter was found in the posterior portion of protruded iris and the fungal keratitis was confirmed following biopsy. The intravitreal amphotericin B injection was done and fortified voriconazole eye drops were maintained for 4 months after PKP. Both anterior and posterior segment showed no inflammatory reaction and recurrence for 20 months follow-up period after PKP. Conclusions: Infective keratitis that do not respond to treatment after long-term use of anti-viral agents and steroids in immune-suppressed patients may also be accompanied by fungal infection and abscess in posterior iris.

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키워드

Fungal abscess Herpetic keratitis Posterior iris Fungal infection