Aims: To study the long term toxic effects of intraocular benzalkonium chloride (BAC). Methods: 19 patients exposed to intraocular BAC preserved viscoelastic during cataract surgery in February 1999 developed severe striate keratopathy immediately postoperatively. 16 patients, including two who underwent penetrating keratoplasty, were studied in the period April to June 2000. Ocular symptoms, visual acuity, biomicroscopy, intraocular pressure, dilated funduscopy, specular endothelial microscopy, and corneal pachymetry findings were recorded. The corneal and iris specimens of the two patients who underwent keratoplasty were studied by light, transmission, and scanning electron microscopy. Results: Six males and 10 females, aged 64-98 years, were studied 14-16 months postoperatively. All patients were symptomatic. 12 patients had best corrected visual acuity of 6/12 or better and four patients of between 6/18 and 6/60. Five patients had corneal epithelial oedema and 11 had Descemet's membrane folds. The central corneal thickness, 620 (SD 71) µm, in affected eyes was significantly higher (p<0.005, two tailed paired t test) than that of the contralateral eyes, 563 (SD 48) µm. The endothelial cell density was significantly lower (p<0. . There was no significant difference in the coefficient of variation of cell size between the two eyes (p=0.3, two tailed paired t test). Two corneal specimens displayed morphological features of bullous keratopathy and other nonspecific abnormalities. Extracellular melanosomes were present in a portion of the iris of one case. Conclusion: BAC is toxic to the corneal endothelium when used intraocularly, leading to severe striate keratopathy. This cleared in most cases but left varying degrees of residual stromal thickening in all eyes. If penetrating keratoplasty is required the results are excellent.
Streptococcus pneumoniae (pneumococcus) has been known to cause pneumonia, sinusitus, otitis media, meningitis, endocardiditis, myelitis and arthritis. Spinal epidural abscess by S. pneumoniae has been diagnosed rarely among the patients with spinal trauma, intravenous drug abuse, alcoholism, diabetes mellitus, long term steroid use, chronic renal failure, and acquired immune deficiency syndrome. We experienced a case of pneumococcal spinal epidural abscess occurred in 75-year-old female with L1 compression fracture since 4 years ago. Her spine magnetic resonance imaging revealed epidural abscess at the level from L3 to S1. S. pneumonia was identified on blood which was susceptible to penicillin. She was immediately treated with antibiotics and surgical exploration. The pneumococcal spinal epidural abscess is very unusual. Therefore, we report here this case with a brief review of the literature. 서 론 척수 경막 외 농양(spinal epidural abscess)은 입원 환자 10,000명 당 0.2-2명 정도로 드물게 발생하며, 남자에서 여자보다 2배로, 30 세에서 60세 사이에서 주로 발생한다[1,2]. 척수 경막 외 농양은 73%에서 포도알균을 원인으로 하여 발병하는 것으로 알려져 있다 [2]. 척수 경막 외 농양을 발생시키는 대표적인 위험인자로서는 척 수 외상(척수 관련 수술, 경막하 마취 포함), 정맥 약물 남용(마약 중독 포함), 알코올중독 등이 있으며, 여러 연구를 통하여 장기간의 스테로이드 사용, 당뇨병, 만성 신부전, 후천성 면역결핍증 등 면역 부전이 동반된 경우에도 잘 발생할 수 있다고 알려지고 있다[3]. 폐 렴연쇄구균(Streptococcus pneumoniae, pneumococcus, 폐렴구 균)은 흔히 폐렴, 부비동염, 중이염을 일으키며, 드물게 심내막염, 뇌수막염, 골수염, 관절염을 일으키기도 하지만[3], 척수 경막 외 농 양을 발생시키는 경우는 드물다[2]. 본 저자 등은 최근 수년 전부터 지속적으로 요추부 압박 골절이 존재하였던 노인 여성에서 폐렴구 균 혈증에 의하여 발생한 척수 경막 외 농양의 예를 혈액배양검사 및 척수 자기공명영상(spine magnetic resonance imaging, spine MRI)으로 진단하고, 정주 항생제 및 농양제거술로 치료하였는 바 문헌 고찰과 함께 보고하는 바이다. 증 례 75세 여자 환자가 내원 일주일 전부터 지속되는 발열감과 함께 발생한 요추부 통증으로 인하대병원 응급실을 통해 입원하였다. 환자는 과거력상에 내원 4년 전 발생한 제1요추 압박 골절에 이환 된 바 있었고, 골절에 대한 특별한 처치 없이 개인병원에서 물리치 료만 시행하던 상태였으며, 6년 전부터 고혈압으로 항 고혈압제 투 약 중인 병력 외에 기타의 다른 과거력, 사회력, 가족력상의 특이사 항은 없었다. 환자는 배부의 요통을 심하게 호소하였고, 내원 당시
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