직접 또는 간접적인 봉독에 의한 안구 독성 2예에 대한 비교 및 고찰 = A Report of Two Case of Ocular Toxicity Resulting from Direct or Indirect Bee Venom

다국어 초록 (Multilingual Abstract)

Purpose: To report a patient stung by a bee, who was diagnosed with sterile endopthalmitis and another patient diagnosed with optic neuritis, with decreasing visual acuity, after refined bee venom injection around the orbital tissue.
Case summary: A 82-year-old female visited our hospital for decreased visual acuity in the right eye and ocular pain due to a bee sting. The bee sting penetrated the sclera into the vitreous. In the anterior segment, severe cornea edema and anterior chamber cells were seen. Using ultrasonography, inflammation was seen around the intravitreal area. After 3 months, intravitreal inflammation regressed but the patient’s visual acuity was light perception negative, and corneal opacity, neovascularization, and phthisis bulbi were detected. A 55-year-old male visited our hospital for ocular pain in the right eye and decreasing visual acuity after refined bee venom injection around the orbital tissue. The best-corrected visual acuity in the right eye was 15/100, there was moderate injection on the conjunctiva. A relative afferent pupillary defect, abnormal color vision test results, and a defect in the visual field test were observed. There was no pain during external ocular movement, and other general blood tests, and a brain MRI were normal. Based on these symptoms, methylprednisolone megatherapy was started for treatment of optic neuritis. After treatment, visual acuity of the right eye was 9/10 and all other clinical optic neuritis symptoms regressed.
Conclusions: Based on these two cases, ocular toxicity from bee venom could result from both direct and indirect courses. Treatment using refined bee venom might be harmful, and caution is recommended in its use.

국문 초록 (Abstract)

목적: 눈에 벌침을 쏘여 내원한 환자에게 무균성 안내염을 진단한 1예와 안와 주변에 정제된 봉독주사를 맞은 후 갑자기 발생한 시력저하로 내원한 환자로 시신경염을 진단한 1예를 경험하였기에 벌침에 의한 안손상 및 정제된 봉독의 위험성에 대해 보고하고자 한다.
증례요약: (증례 1) 우안에 벌침 손상으로 안구통증 및 시력저하로 내원하였다. 심한 각막부종 및 전방 내 염증이 있었으며, 벌침은 공막을 관통하여 유리체내에 들어가 있었다. 치료 후 유리체염은 호전되었으나, 결국 안구 위축이 되었다. (증례 2) 내원 5일 전 우안안와 주변부에 정제된 봉독주사를 맞은 후 발생한 안구통증 및 시력저하를 주소로 내원하였다. 시력은 5/100이었고, 가벼운 충혈 소견이 있었다. 우안에 상대 구심성 동공운동장애가 있고, 색각검사 이상 및 주변부 시야결손 소견이 관찰되었다. 혈액검사, 뇌자기공명검사에서는 정상이었다. 시신경염 대하여 고용량 스테로이드 전신 투여를 시행하였다.
결론: 본 증례들을 통하여 벌에 의한 안구 독성은 직접적인 안구 침범으로도 올 수 있으나 간접적인 정제된 봉독주사의 효과로도 안구에 영향을 줄 수 있어 봉독을 이용한 치료의 위험성을 보고하는 바이다.

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