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1 대한안과학회지 2014 년제 55 권제 4 호 J Korean Ophthalmol Soc 2014;55(4): pissn: eissn: Original Article 한국의매독포도막염의임상양상 Clinical Manifestations of Syphilitic Uveitis in the Korean Population 곽현덕 1 김현웅 1 이지은 2 이주은 3 이상준 4 윤일한 1 Hyun Duck Kwak, MD 1, Hyun Woong Kim, MD, PhD 1, Ji Eun Lee, MD, PhD 2, Joo Eun Lee, MD, PhD 3, Sang Jun Lee, MD, PhD 4, Il Han Yun, MD, PhD 1 인제대학교의과대학부산백병원안과학교실 1, 부산대학교의학전문대학원안과학교실 2, 인제대학교의과대학해운대백병원안과학교실 3, 고신대학교의과대학안과학교실 4 Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine 1, Busan, Korea Department of Ophthalmology, Pusan National University School of Medicine 2, Busan, Korea Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine 3, Busan, Korea Department of Ophthalmology, Kosin University College of Medicine 4, Busan, Korea Purpose: In recent, years, an increase of syphilis infections has become an issue in Korea as well as globally. Herein, we report a recent clinical manifestation of syphilitic uveitis in a Korean population. Methods: Over a 5-year period ( ), we collected and analyzed the medical records of 16 patients with syphilitic uveitis in three tertiary eye clinics in Pusan. Sixteen patients were confirmed to have syphilis based on serological tests. Retrospective chart review was performed to determine the best corrected visual acuity, anterior and posterior segments, and treatment regimen, as well as ancillary test results including fluorescein angiogram (FAG). Results: Of the 16 patients, 12 were males and four were females. The mean age of the patients was years. Non-granulomatous anterior uveitis was observed in nine eyes (47.4%). Vitritis was the most frequently observed posterior segment finding (16 eyes, 84.2%). Retinal vasculitis and chorioretinitis were found in 11 (57.9%) and five eyes (26.3%), respectively. All patients had negative results in the serum HIV antibody test. Of the 16 patients, 15 were treated with penicillin or ceftriaxone due to neurosyphilis. Mean visual acuity improved from 1.33 ± 1.1 to 0.58 ± 0.68 after treatment. Conclusions: Clinical manifestation of syphilitic uveitis in Korean patients is different from occurrences in Western countries. Ophthalmological findings of syphilitic uveitis are diverse; thus, serological testing for syphilis is recommended for all uveitis patients. Further research regarding long-term treatment, relapse of syphilitic uveitis, and complications is necessary. J Korean Ophthalmol Soc 2014;55(4): Key Words: Human immunodeficiency virus, Syphilis, Uveitis Received: Revised: Accepted: Address reprint requests to Hyun Woong Kim, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan , Korea Tel: , Fax: maekbak@hanmail.net * This study was presented as a poster at the 105th Annual Meeting of the Korean Ophthalmological Society * This work was supported by the 2013 Inje University Ophthalmology research grant. 매독 (syphilis) 은트레포내마 (treponema pallidum) 에의해발생하는만성전신성감염질환으로대부분매독환자와직접적인성접촉을할때노출된병변또는체액을통해감염되며드물게수혈이나임신중태반을통해수직감염되기도한다. 1 전세계적으로매년 1200만명의환자들이매독에감염되는것으로알려졌으며그중 90% 는개발도상국에서발병한다. 미국에서는이전 10년간매독발병이감소추세이다가 2000년에서 2004년사이다시발병률이증가했다. 미국질병관리본부에서발표한 2004년매독감염자료에따 c2014 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 555

2 - 대한안과학회지 2014 년제 55 권제 4 호 - 르면 2000년 10만명당 2.1 명에서 2004년 10만명당 2.7명으로매독발병률이증가함을보고했다. 2 이러한추세는미국뿐아니라프랑스, 영국에서도마찬가지로보고되었으며아시아권에서는싱가포르지역의매독발병률이 1999년 10 만명당 3.08명에서 2003년 10만명당 5.07명으로증가했고매독에의한안병증의발병률또한증가되었다고한다. 3-6 매독의안과적발현양상은다양하며매독의어떤단계에서든발생할수있다. 매독은결막, 공막, 각막, 수정체, 포도막, 망막, 망막혈관, 시신경, 동공운동계, 외안근과연관된뇌신경계등안구의모든구조물에영향을끼칠수있다. 7,8 매독으로인한안병증의가장흔한임상양상은포도막염으로전체포도막염중 1-2% 미만을차지한다. 9 보고된바에의하면매독포도막염의임상양상은육아종성홍채염 (46%), 비육아종성홍채염 (25%), 범포도막염 (13%), 후극부포도막염 (8%), 각막포도막염 (8%) 의순으로나타난다. 10 저자들은최근세계적인매독및매독포도막염발병률의증가추세를고려하여한국에서의매독포도막염의임상양상 을정확하게파악함으로써, 포도막염환자의진단및치료에도움을줄수있을것이라생각하여본연구를진행하였다. 대상과방법 2007년에서 2013년까지인제대학교부산백병원및해운대백병원, 고신대학복음병원, 부산대학교병원안과를내원한포도막염환자중매독포도막염으로확진된환자 16 명, 19안을대상으로후향적의무기록분석을시행하였다. 매독은혈청학적검사를토대로진단하였다. 매독의혈청학적진단을위해모든환자에서 nontreponemal test인 Venereal Disease Research Laboratory (VDRL) 와 treponemal test인 fluorescent treponemal antibody absorbed (FTA-ABS), 혹은 T. pallidum particle hemagglutination assay (TPHA) 를시행하였다. 매독포도막염의진단은안구염증을보이며혈청학적검사인 treponemal test에서양성소견과 VDRL 역가의상승이동반되며, 포도막염의다른원인이없을경우매독포 Table 1. Demographic characteristics of ocular syphilis patient Male (n = 12) Female (n = 4) Total (n = 16) Involved eye (OD:OS:OU) 6:4:2 0:3:1 7:6:3 Mean age (range) 53 ± (31-80) 46 ± (15-73) ± (15-80) Mean duration of the symptom (weeks) 2.25 ± 2 (1-8) 6.75 ± 6.9 (1-16) 3.38 ± 4.1 (1-16) Mean follow up period (months) 6.75 ± (1-39) 7.5 ± 3 (6-12) 693 ± 9.7 (0-39) Serum HIV Ab. FTA-ABS (IgG) 12 (100%) 4 (100%) 16 (100%) VDRL (Qualiative) 12 (100%) 4 (100%) 16 (100%) VDRL (Quantiative) 1:2-1:128 1:8-1:64 1:2-1:128 OD = right eye; OS = left eye; OU = both eye; HIV = human immunodeficiency virus; FTA-ABS = fluorescent treponemal antibody-absorption; VDRL = venereal disease research laboratory. Values are presented as mean ± SD. A B Figure 1. Syphilitic uveitis. (A) At initial presentation, fundus photograph showed severe vitiritis in right eye. Patient's visual aucity was and VDRL titer was 1:128 (B) After treatment with three times of weekly intramuscular penicillin G benzathine injection, patient visual acuity increased to 0.63 and VDRL titer decreased to 1:2. After 3 months of treatment, fundus photograph showed resolving of vitritis. 556

3 - 곽현덕외 : 매독포도막염 - A B C D Figure 2. Syphilitic uveitis. (A, B) Fundus photograph showed vitritis, retinal vasculitis and inflammatory retinal infiltration in both eyes. VDRL titer was 1:128 and FTA-ABS test was positive. On CSF examination, increased lymphocyte count and VDRL titer were examined. (C, D) Patient treated with daily 2 gm of intravenous ceftriaxone injection for 2 weeks. At 4 months after treatment, fundus photography showed no evidence of uveitis. FTA-ABS = fluorescent treponemal antibody-absorption; CSF = cerbrospinal fluid. 도막염으로진단하였다. 매독이외다른요인에의한포도막염을배제하기위한혈청학적검사로전체혈구세포검사, 적혈구침강반응검사, 전해질검사, 크레아티닌검사, 간기능검사, 안지오텐신전환효소검사, HLA-B27 유전자검사, 인체면역결핍바이러스, 톡소플라즈마, 단순헤르페스바이러스, 수두대상포진바이러스, 거대세포바이러스에대한항체검사등을시행하였으며단순가슴 X-ray 촬영또한시행후이상소견과함께포도막염을유발할수있다고생각되어지는경우는대상에서제외하였다. 또한신경매독의판별을위해시행하는뇌척수액검사의시행여부및검사결과 ( 혈구세포수및분율, VDRL titer, FTA-ABS antibody 등 ) 에대해조사하였다. 모든환자에서성별, 연령및침범안, 최대교정시력및세극등검사, 안저검사, 형광안저혈관조영술결과를조사하 여안과적임상양상을분석하였다. 안과적, 내과치료와그결과및치료후최대교정시력을조사하였다. 결과 매독포도막염환자의연령분포는남성평균 53.2 ± 17.1 세, 여성평균 46.7 ± 28.3세, 전체평균 51.1 ± 19.6 세였으며 15세에서 80세까지다양한연령분포를보였다. 남자는 12 명, 여자는 4명으로남자가여자보다많았으며양안이침범된경우가 3명이었으며나머지 13명은단안이침범되었다. 안과에내원하여매독포도막염으로진단되어치료받기전환자들이호소했던증상중가장흔한것은시력저하였으며일부환자에서는눈부심증상을호소하였고기간은적게는 1주에서많게는 2달정도로조사되었다. 대상환자중 557

4 - 대한안과학회지 2014년 제 55 권 제 4 호 - Table 2. Ophthalmologic finding of ocular syphilis patient VA (log MAR) Anterior segment findings Granulomatous ant. uveitis Non granulomatous ant. uveitis Scleritis/episcleritis Interstitial keratitis Posterior segment findings Vitritis Optic neuropathy (papillitis/retrobulbar) Retinal vasculitis Chorioretinitis Exudative RD Baseline (n= 19) 1.33 ± (47.4%) 3 (16%) 16 (84%) 5 (26%) 11 (58%) 5 (26%) 1 (5%) Last visit (n = 19) 0.58 ± (5%) 2 (11%) 5 (26%) 1 (5%) 1 (5%) VA = visual acuity; RD = retinal detachment. Values are presented as mean ± SD or number (%). A B C D Figure 3. Fundus photograph and fluorescein angiography of syphilitic optic neuritis case. Presenting symptoms were decreased visual acuity and pain with ocular movement. (A) At the initial fundus photograph showed mild blurring and swelling of the optic disc margin. There ware no other inflammatory signs such as vasculitis, vitritis and retinitis. (B) Early phase of fluerescein angiography showed fluoresein leakage at the optic disc. At first, patient was misdiagnosised with optic neuritis, but at serologic test, VDRL titer was incread to 1:64 and FTA-ABS as positive. (C) 10 days after penicillin treatment, ocualr pain decreased and in fundus photograph optic disc blurring was decreasd. (D) 21 days after treatment, VDRL titer decreased to 4:1 and there were no blurring of the optic disc margin. 558

5 - 곽현덕외 : 매독포도막염 - Table 3. Comparison of therapeutic regimen and effect IM Penicilin (n = 8) IV penicilin (n = 2) IV Ceftriaxone (n = 5) Dose 2.4 million IU 2.0 milion IU 2 g/day Duration (once a week 3 times) 13 days 14 days Result Improved visual acutiy * 6 (75%) 2 (100%) 4 (80%) Decreased VDRL titier 8 (100%) 2 (100%) 5 (100%) IM = intramuscular injection; IV = intravenous injection; IU = international unit(s); VDRL = venereal disease research laboratory. * Visual acuity improved more than 2 lines compared to baseline; Decreased serologic titer more than 4 times compared to baseline. 동성애자또는양성애자는없었으며평균관찰기간은 6.9 개월이었다 (Table 1). 초진시최대교정시력은안전수동에서 0.1 (logmar) 로다양하였으며침범안의평균시력은 1.33 ± 1.10 (logmar) 이었다. 초진시세극등검사에서비육아종성전방포도막염을 9안 (47.4%) 에서관찰할수있었으나, 육아종성전방포도막염, 상공막염또는공막염소견을보이는환자는관찰되지않았다. 3안에서는간질각막염이관찰되었다. 안저검사및형광안저혈관조영술검사에서유리체염소견 (Fig. 1) 이가장많은 16안 (84.2%) 에서관찰되었다. 망막혈관염 (Fig. 2) 11안 (57.9%), 맥락망막염 5안 (26.3%), 시신경병증 5안 (26.3%) 에서발견되었다. 삼출성망막박리는 1안 (5.3%) 에서확인되었다 (Table 2). 전신검사상보행장애, 동안신경마비등의신경학적증상을보인환자는없었다. 1명의환자에서양쪽손바닥의매독진소견을확인하였으나나머지 15명의환자는안과적이상소견이외의매독으로인한다른전신증상은나타나지않았다. 1명의환자에서 20년전매독을진단받고치료받은병력이있었다. 모든환자에게서 VDRL 및 FTA-ABS 검사를매독의선별및확진을위하여시행하였다. 일부환자에서는 TPHA 검사도시행하였다. 모든환자는 VDRL 및 FTA-ABS 검사상양성소견을보였으며 VDRL 역가는 1:2에서 1:128까지나타났다. 다른동반감염질환을감별하기위하여시행한인체면역결핍바이러스, 항체검사상 16명모두음성소견을보였다 (Table 1). 톡소플라즈마, 단순헤르페스바이러스, 수두대상포진바이러스, 거대세포바이러스에대한항체검사에서는의미있는양성결과를보이지않았으며, 안지오텐신전환효소및적혈구침강속도검사도큰상승소견을보이지않았다. 모든환자에게뇌척수액검사의필요성을설명하였으나 5명만이검사에응하였다. 5명중 3명의뇌척수액검사에서 FTA-ABS 검사양성및증가된백혈구세포수를확인하였다. 나머지 2명은특이이상소견을보이지않았다. 모든환자는각병원의감염내과에의뢰되어치료를의 뢰하였으며대상자 16명중 1명을제외한 15명이치료에응하였다. 뇌척수액검사상양성을보인 3명중 2명은 penicillin G potassium 200만 IU를정맥주사로 13일동안투여하였으며피부반응검사상 penicillin 양성을보인 1명은 3세대세파계열항생제인 ceftriaxone sodium (2 g/day) 을 14일동안정맥주사하였다. 뇌척수액검사에서음성을보인 12명중 8명은 penicillin G benzathine (240만 IU) 을일주일에한번씩총 3회근육주사를시행하였다. 4명은피부반응검사상 penicillin에양성반응을보여 ceftriaxone (2 g/day) 을 14일동안정맥주사하였다 (Table 3). 모든환자는경구스테로이드 ( mg/kg/day) 를복용하였으며치료경과관찰기간동안감량을시행하였다. 치료를시행한 15명중 12명 (80%) 에서마지막방문시 2 줄이상의시력호전소견을보였다 (Table 3). 정맥내 penicillin 치료를받은환자 2명및정맥내 ceftriaxone 치료를시행한 5명중 4명에서 2줄이상의시력호전소견을보였다. 근육내 penicillin 주사치료를시행한 1명의환자는임상증상의호전에도불구하고시력저하소견을보였다. 마지막 VDRL 역가검사에서모든환자가 4배이상의역가감소소견을보였다. 초진시관찰되었던유리체염소견은 5 명 (26%) 에서마지막방문시관찰되었으나그중증도는감소하였으며시신경병증, 맥락망막염이관찰된환자는없었다. 1명 (5.3%) 에서망막혈관염및비육아종성전방포도막염이만성적으로지속되었다. 스테로이드를포함한모든치료를끊고 3개월이상경과관찰이가능하였던 9명중 8명에서는염증의재발이없었다. 고찰 포도막염의원인중매독은드물며미국과프랑스에서는매독포도막염이전체포도막염환자의 1-5% 라고보고되고있다 유럽의 3차의료기관에서 2.5년간조사했던매독안병증환자가 8명이었던것에비추어보았을때 년부터 2012년까지약 5년간, 국내 3차의료기관에서조사한매독포도막염환자가 16명이었다는사실은결코적은숫 559

6 - 대한안과학회지 2014 년제 55 권제 4 호 - 자라볼수없으며이는한국에서도최근매독포도막염환자가증가함을시사하는것이라고생각된다. 실제로서울지역일반인을대상으로실시한매독유병률검사상 1977 년부터지속적으로감소하던매독유병률이 2000년 0.2% (29/15,402) 에서 2005년 0.7% (83/12,453) 로상승하는소견을보였다. 14 또한트레포네마균은일반적인배양배지에서는자라지않으며전신증상이사라질경우매독포도막염을의심하기쉽지않다. 게다가매독포도막염은다양한감염성, 염증성안질환과유사한증상을보이기때문에더욱진단이어렵다. 따라서한국에서도매독유병률이늘어남을인지하고, 매독이다양한임상증상을나타낸다는것을고려하여모든포도막염환자에게서선별검사시매독검사를시행해야하겠다. 최근세계적으로증가하는매독환자군의특징으로인체면역결핍바이러스동시감염및남성환자, 동성애자가높은빈도를차지한다고보고되었다. 또한환자군의연령대는청장년층의남자연령층이많았다고한다 (37세에서 65세사이, 평균 52 ± 11.8세 ). 13 특히매독환자에서인체면역결핍바이러스동시감염시임상양상이더심하고눈을잘침범하며비전형적인임상양상을보인다고알려져있어인체면역결핍바이러스동시감염여부는매독환자에서중요한검사항목이다. 15,16 그러나본연구의환자에서는위와같은세계적추세와달리모든환자에서인체면역결핍바이러스음성소견을보였다. 남성환자의비율이높았으나연령대또한외국과달리 10대에서 80대까지다양한연령대를보였다. 한국의의료환경정서상성관계양상및동성연애, 성관계시보호구사용여부, 약물남용여부를정확히조사하지는못했으나동성연애자라고밝혀진환자는없었고 1명의 15세, 여자환자에서산부인과검사상성매개질환인인간유두종바이러스검사양성소견을보였다. 아직한국에서는서구및아프리카에비하여인체면역결핍바이러스의유병률이높지않고, 본연구의대상자수가작기때문에인체면역결핍바이러스동시감염환자가포함되지않은것으로생각된다. 비슷하게싱가포르의 22명의매독안병증으로인한포도막염환자에서도모두인체면역결핍바이러스검사음성소견을보임을보고하였다. 5 하지만 1999년 186명의새로운인체면역결핍바이러스감염환자가 2006년 749명, 2010 년 773명으로급격히증가 (Korean Center for Disease Control and Prevention, KCDC, Sep 18, 2011) 하고있어한국에서도매독안병증으로인한포도막염환자에서인체면역결핍바이러스의동시감염여부는반드시확인해보아야할검사이다. 매독포도막염의임상양상또한외국의보고와본연구 는차이가있었다. 서양의매독포도막염환자에대해보고한바에의하면전부포도막염인육아종성홍채염 (46%) 이가장흔하였으며비육아종성홍채염 (25%), 범포도막염 (13%), 후부포도막염 (8%), 각막포도막염 (8%) 의순으로보고하였다. 후부포도막염의가장흔한양상은맥락망막염이며대개유리체염증과동반되는경우가많으며양안을침범하는경우가 67-89% 로보고하였다. 17,18 하지만본연구에서나타난임상양상은서양의결과와차이가있어많은환자들이범포도막염의양상을보였으며유리체염및망막혈관염이 (Figs. 1, 2) 가장많은후부포도막염의양상으로나타났다. 맥락망막염은상대적으로적은비율을나타내었다. 전부포도막염의양상을본다면전부포도막염을보인모든환자에서비육아종성전부포도막염을보였다. 이러한결과는 Anshu and Cheng 5 이보고한아시아인결과 ( 비육아종성전부포도막염 (62.1%), 유리체염 (65%)) 와유사한결과이다. 또한맥락망막염및망막염, 급성망막괴사의경우매독과인체면역결핍바이러스동시감염시잘나타난다는보고되어있으므로본연구에서인체면역결핍바이러스동시감염자가한명도없는것이서양과다른매독임상양상의원인중하나일것으로생각된다 서양과다른임상양상의차이는인종간의차이점, 인체면역결핍바이러스동시감염자가적었다는점에서기인한것으로생각할수있으나증례의숫자가적으므로확실한원인을알기는어렵다. 또한본연구에서 1명의환자는시신경염소견 (Fig. 3) 만나타내어오진할수있었으나적절한혈청학적검사를토대로하여매독안병증을진단하여치료후좋은예후를보였다. 매독포도막염을시사하는징후는없으며다양한임상양상을나타내므로포도막염환자뿐만아니라시신경염환자에서도매독감염에의한증상가능성을염두에두어야하겠다. 본연구에서뇌척수액검사는 13안중 5안에서시행되었고그중 3안에서양성소견을보였다. 뇌척수액검사에서매독양성소견은신경매독으로진단할수있다. 또한뇌척수액검사에서 VDRL 검사가음성이더라도단백질총량이증가되어있거나림프구의증가등이보이면이는신경매독을시사하는소견으로볼수있으므로이에준하여치료하여야한다. 22 원칙상모든환자에서뇌척수액검사를시행하였어야하나신경학적증상이없는환자들이증상을이해하고자발적으로동의하기가쉽지않아모든경우시행하지못하였으나시행한 5안중 3안에서의미있는소견을보였다매독에의한안과적병변은 3차매독의징후로볼수있다. 이에본연구에서는매독포도막염 19안중 18안에서 3 560

7 - 곽현덕외 : 매독포도막염 - 기또는신경매독에준하여 MMWR (Morbidity Mortality Weekly Report, 2002, USA) 지침을따라 penicillin 또는 ceftriaxone 치료를시행하였다. Ceftriaxone은최근 penicillin을대신하여사용되는항생제로중추신경계침투력이좋고모체에서태아로의태반투과력도좋으며반감기가 7시간으로길다. 또한하루 1 g의정맥주사용량으로트레포네마균의최소저지농도 (MIC: minimum inhibitory concentration) 수치인 μg/ml에도달할수있다 % 의 penicillin 알러지환자에서 ceftriaxone 에대하여교차알러지반응을보인다는보고가있으나여러보고에서큰부작용없이 penicillin 알러지환자에서사용할수있음을보고하였으며본연구의환자에서도교차반응없이효과적인치료를시행할수있었다. 27,28 대부분의연구에서매독포도막염은항생제치료후좋은결과를나타낸다고보고되고있으며본연구또한항생제치료후재발한안없이평균시력의호전을보였다. 특히혈관염및유리체염의호전소견은매독에의한후부포도막염은다른후부포도막염과달리적절히치료된다면좋은경과를보일수있음을시사한다. 본연구의한계점은연구지역이한국중부산지역에만국한되어있으며대상환자수가충분하지못하여본연구의결과가전체한국매독포도막염환자의임상양상과동일하다고볼수는없겠다. 따라서매독포도막염의발병률및임상양상에대한대규모연구를통해한국매독포도막염의임상양상의특징및외국과의차이점을밝히는추가적인연구가이루어진다면더욱좋은비교가될것으로생각된다. 또한사회적인인식으로인하여환자의성생활등에대한자세한문진의한계점이있어외국과의정확한비교가이루어지지못했다는한계가있다. 마지막으로평균관찰기간이단기간이라좀더장기간의재발및합병증발생여부에대한연구가필요할것으로생각된다. REFERENCES 1) Goldsmith LA, Katz SI, Gilchrest BA, et al. Fitzpatrick's Dermatology in General Medicine, 8th ed. New York: McGraw-Hill, 2008; ) Primary and secondary syphilis--united States, MMWR Morb Mortal Wkly Rep, 2006;55: ) Herida M, Michel A, Goulet V, et al. Epidemiology of sexually transmitted infections in France. Med Mal Infect 2005;35: ) Parc CE, Chahed S, Patel SV, Salmon-Ceron D. Manifestations and treatment of ocular syphilis during an epidemic in France. Sex Transm Dis 2007;34: ) Anshu A, Cheng CL, Chee SP. Syphilitic uveitis: an Asian perspective. Br J Ophthalmol 2008;92: ) Gaudio PA. Update on ocular syphilis. Curr Opin Ophthalmol 2006;17: ) Baughn RE, Musher DM. Secondary syphilitic lesions. Clin Microbiol Rev 2005;18: ) Singh AE, Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev 1999;12: ) C. Stephen Foster, Albert T. Vitale, Pomerantz, et al. Diagnosis and Treatment of Uveitis. Philadelphia: WB Sounders CO., ) Barile GR, Flynn TE. Syphilis exposure in patients with uveitis. Ophthalmology 1997;104: ) Tamesis RR, Foster CS. Ocular syphilis. Ophthalmology 1990;97: ) Drancourt M, Berger P, Terrada C, et al. High prevalence of fastidious bacteria in 1520 cases of uveitis of unknown etiology. Medicine (Baltimore) 2008;87: ) Puech C, Gennai S, Pavese P, et al. Ocular manifestations of syphilis: recent cases over a 2.5-year period. Graefes Arch Clin Exp Ophthalmol 2010;248: ) Baek JO, Jee HJ, KIm TK, et al. Recent trends of syphilis prevalence in normal population in Korea: a single center study in Seoul. Korean J Dermatol 2011;49: ) Marra CM. Syphilis and human immunodeficiency virus: prevention and politics. Arch Neurol 2004;61: ) Shalaby IA, Dunn JP, Semba RD, Jabs DA. Syphilitic uveitis in human immunodeficiency virus-infected patients. Arch Ophthalmol 1997;115: ) Tran TH, Cassoux N, Bodaghi B, et al. Syphilitic uveitis in patients infected with human immunodeficiency virus. Graefes Arch Clin Exp Ophthalmol 2005;243: ) Becerra LI, Ksiazek SM, Savino PJ, et al. Syphilitic uveitis in human immunodeficiency virus-infected and noninfected patients. Ophthalmology 1989;96: ) Gass JD, Braunstein RA, Chenoweth RG. Acute syphilitic posterior placoid chorioretinitis. Ophthalmology 1990;97: ) Wickremasinghe S, Ling C, Stawell R, et al. Syphilitic punctate inner retinitis in immunocompetent gay men. Ophthalmology 2009; 116: ) Mendelsohn AD, Jampol LM. Syphilitic retinitis. A cause of necrotizing retinitis. Retina 1984;4: ) Jay CA. Treatment of neurosyphilis. Curr Treat Options Neurol 2006;8: ) Shann S, Wilson J. Treatment of neurosyphilis with ceftriaxone. Sex Transm Infect 2003;79: ) Zhou P, Gu Z, Xu J, et al. A study evaluating ceftriaxone as a treatment agent for primary and secondary syphilis in pregnancy. Sex Transm Dis 2005;32: ) Steele RW. Ceftriaxone therapy of meningitis and serious infections. Am J Med 1984;77: ) Marra CM, Boutin P, McArthur JC, et al. A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Clin Infect Dis 2000;30: ) Augenbraun M, Workowski K. Ceftriaxone therapy for syphilis: report from the emerging infections network. Clin Infect Dis 1999; 29: ) Dayan L, Ooi C. Syphilis treatment: old and new. Expert Opin Pharmacother 2005;6:

8 - 대한안과학회지 2014 년제 55 권제 4 호 - = 국문초록 = 한국의매독포도막염의임상양상 목적 : 한국에서매독포도막염의임상양상을조사해보고자한다. 대상과방법 : 2007 년에서 2012 년까지부산지역 3 개, 3 차의료기관에서확진된매독포도막염환자 16 명을대상으로후향적의무기록분석을시행하였다. 환자들은혈청학적검사를통해매독으로진단되었으며최대교정시력및세극등검사, 안저검사, 형광안저혈관조영술검사결과및어떠한치료가이루어졌는지조사해보았다. 결과 : 매독포도막염으로진단받은환자중남자는 12 명, 여자는 4 명이, 평균나이는 세였다. 비육아종성전부포도막염이 9 안에서관찰되었다. 후부포도막염의가장흔한양상은유리체염으로 16 안에서관찰되었으며, 망막혈관염이 11 안, 맥락망막염이 5 안에서관찰되었다. 인체면역결핍바이러스검사는모두음성소견을보였다. 15 명에게신경매독에준하여페니실린또는세프트리악손항생제치료를시행하였다. 환자의치료전평균시력은 logmar 시력으로 1.33 ± 1.1 에서치료후 0.58 ± 068 로호전되었다. 결론 : 한국의매독포도막염의임상양상은외국의보고와는차이를보였다. 매독포도막염의다양한임상양상은포도막염환자의진단시매독검사의필요성을보여준다. 매독포도막염의임상양상및치료후장기간재발및합병증발생에대한추가연구가필요할것으로생각된다. < 대한안과학회지 2014;55(4): > 562

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<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실

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