Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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The Therapeutic Effect of Sclerocorneal Lens in Coexisting Corneal Ectasia and Stevens-Johnson Syndrome

각막확장증과 스티븐스존슨증후군 합병증 환자에서 미니공막렌즈의 치료 효과 1예

  • Baek, Jin Uk (Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Chang Hyun (Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Na, Kyung Sun (Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyun Seung (Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 백진욱 (가톨릭대학교 의과대학 여의도성모병원 안과 및 시과학교실) ;
  • 박창현 (가톨릭대학교 의과대학 여의도성모병원 안과 및 시과학교실) ;
  • 나경선 (가톨릭대학교 의과대학 여의도성모병원 안과 및 시과학교실) ;
  • 김현승 (가톨릭대학교 의과대학 여의도성모병원 안과 및 시과학교실)
  • Received : 2017.08.31
  • Accepted : 2018.09.27
  • Published : 2018.10.15
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Abstract

Purpose: We report short-term treatment effects of a mini-scleral lens in patients with Stevens-Johnson syndrome and corneal ectasia. Case summary: A 54-year-old female who had been diagnosed with Stevens-Johnson syndrome and keratoconus presented with persistent right eye pain and decreased visual acuity. Therapeutic lenses, topical antibiotic eye drops, and topical steroid eye drops were used; however the symptoms were not controlled, then the patient was treated with a mini-scleral contact lens in the right eye. At the time of the first visit to our hospital 17 years ago, and the best-corrected visual acuity (BCVA) of the right eye was logMAR 0.22. However, Stevens-Johnson syndrome and corneal ectasia were severe and cataract surgery was considered because of worsening cataracts, but the patients refused this surgery. At the time, the BCVA of the right eye was then reduced to logMAR 1.10. On ophthalmic examination, there was conjunctival fibrosis and corneal neovascularization of the right eye. The symptoms were not managed with a using a therapeutic lens, and then the patient was prescribed a mini-scleral contact lens. After wearing the mini-scleral contact lens, the corneal and conjunctival neovascularization was reduced. After 6 months, the BCVA of the right eye improved to logMAR 0.60. Conclusions: In patients with Stevens-Johnson syndrome and corneal ecstasia, mini-scleral contact lens can be considered as a useful treatment option for visual improvement and symptom control.

목적: 스티븐스존슨증후군과 각막확장증이 동반된 환자에서 미니공막렌즈를 사용하였을 때 단기간의 치료 효과 사례를 보고하고자 한다. 증례요약: 34년 전 설파제 및 피린계 항생제에 의한 알레르기로 스티븐스존슨증후군을 진단 받고, 이후 20년 전 원추각막증을 진단받은 54세 여자 환자가 지속되는 우안 통증 및 시력저하를 주소로 내원하였다. 치료용 렌즈, 항생제 및 국소 스테로이드 점안제 등을 사용하였으나, 증세가 조절되지 않아 우안 미니공막렌즈 착용을 고려하였다. 17년 전 병원에 처음 내원할 당시 우안은 나안시력 logMAR 1.0, 최대교정시력 logMAR 0.22로 측정되었다. 그러나 스티븐스존슨증후군과 각막확장증이 심해졌고, 백내장의 악화로 수술을 고려하였으나 환자는 백내장수술을 거부하였다. 이후 최대교정시력은 logMAR 1.10까지 저하되었다. 전안부 검사상 우안 결막 섬유화, 유두 비대 및 여포가 있었으며, 각막에 전반적인 표층 점상 탈락과 윤부결핍으로 인한 각막 주변부에 신생혈관이 관찰되었다. 치료용 렌즈를 통한 증상 조절 중 치료용 렌즈로 인한 염증 악화 소견을 보여 미니공막렌즈를 처방하였다. 이후 각막 및 결막의 신생 혈관이 줄어드는 양상을 보이며 미니공막렌즈 착용 6개월 후 우안 나안시력 logMAR 0.80, 최대교정시력 logMAR 0.60까지 개선되었다. 결론: 스티븐스존슨증후군과 각막확장증이 동반된 환자에서 미니공막렌즈를 사용할 경우 시력 개선 및 증상 조절에 유용한 치료 수단으로 고려될 수 있겠다.

Keywords

References

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