개방각녹내장 환자에서 수정체유화술 시 안압하강에 영향을 미치는 인자 분석

박율리(Yuli Park),문정일(Jung Il Moon),조경진(Kyong Jin Cho) 대한안과학회 2018 대한안과학회지 Vol.59 No.10

목적: 원발개방각녹내장 환자에서 수정체 초음파유화술 시 안압하강에 영향을 미치는 인자에 대해 알아보고자 하였다. 대상과 방법: 원발개방각녹내장 환자 중 초음파유화술 시행 후 3년 이상 경과한 145안을 대상으로 후향적 의무기록 분석을 시행하였다. 나이, 안압, 안축장, 전방 깊이, 수정체 위치, 굴절력, 초음파유화술 시간, 누적소비에너지, 평형염액 사용량 등을 술 후 6, 12, 24, 36개월째 비교 분석하였다. 단변량 및 다변량 회귀분석을 이용하여 위 인자들과 술 후 안압의 관계를 분석하였다. 결과: 술 후 6, 12, 24, 36개월에 각각 평균 -1.9 ± 2.9, -1.6 ± 2.8, -1.4 ± 3.1, 그리고 -1.2 ± 2.7 mmHg의 통계적으로 유의한 안압하강을 보였다(p<0.01). 단변량 회귀분석상 술 전 안압이 높을수록(p<0.001), 술 전 수정체가 앞쪽으로 위치하였을수록(p<0.001), 초음파유화술 시간이 길수록(p<0.05), 누적소비에너지가 클수록(p<0.05) 술 후 안압하강이 더 컸다. 다변량 회귀분석상 술 전 안압(p<0.01), 수정체 위치(p=0.04), 그리고 초음파유화술 시간(p=0.04)이 술 후 3년까지 안압하강과 연관이 있었다. 결론: 원발개방각녹내장 환자에서 높은 술 전 안압은 초음파유화술 후 더 큰 안압하강 효과를 보였고, 술 전 안압과 나이를 보정하였을 때 초음파유화술 시간과 앞쪽으로의 수정체 위치가 안압하강과 연관성을 보였다. 이는 개방각녹내장 환자에서 수정체 초음파유화술과 녹내장 수술의 동시 수술 여부의 결정에 있어 도움이 될 것으로 생각된다. Purpose: To identify independent predictors of long-term postoperative intraocular pressure (IOP) reduction after phacoemulsification in patients with primary open-angle glaucoma (POAG). Methods: This was a retrospective review of 145 eyes with open-angle glaucoma (OAG) who were followed up for more than 3 years after uncomplicated phacoemulsification cataract surgeries. Demographic, clinical, biometric, and intraoperative variables such as IOP, refractive errors, anterior chamber depth, axial length, relative lens position (RLP), and phacoemulsification parameters such as phaco time, cumulative dissipated energy (CDE), and balanced salt solution volume were evaluated at 6, 12, 24, and 36 months after surgery. Univariate and multivariate linear regression were used to analyze the relationship between these variables and the postoperative IOP. Results: There was a statistically significant average postoperative IOP reduction at 6, 12, 24, and 36 months of -1.9 ± 2.9, -1.6 ± 2.8, -1.4 ± 3.1, and -1.2 ± 2.7 mmHg, respectively (p < 0.01). Higher preoperative IOP (p < 0.001), a more relative anterior lens position (p < 0.001), shorter phaco time (p < 0.05), and higher CDE (p < 0.05) were significantly associated with a greater postoperative decrease in IOP using univariate analyses. Using multivariate analyses, preoperative IOP (p < 0.01), lens position (p = 0.04), and phaco time (p = 0.04) were associated with greater postoperative IOP reduction at 3 years. Conclusions: Higher preoperative IOP was associated with a greater IOP-lowering effect after phacoemulsification in OAG patients. Phaco time and anterior RLP were independently associated with IOP reduction after adjusting for age and preoperative IOP. These findings have important implications when considering combined cataract extraction and filtration surgery for POAG patients.

접촉식과 광학적 방식에 의한 전방깊이 측정값의 비교

박율리,황형빈,정성근.Yuli Park. MD. Hyung Bin Hwang. MD. Sung Kun Chung. MD. PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.8

Purpose: To assess the reproducibility and reliability of applanation A-scan ultrasonography (Pacscan 300A, Sonomed Inc., Chicago, IL, USA) and optical measurements with IOL Master<sup>® (Carl Zeiss Meditec, Germany), Pentacam<sup>® (Oculus, Wetzlar, Germany), and Orbscan II<sup>® (Orbtek Inc., Laredo, TX, USA) when measuring anterior chamber depth (ACD). Methods: In this study of 188 eyes of 94 patients, ACD estimation prior to cataract surgery was preformed by the applanation A-scan method and IOL Master<sup>®, Pentacam<sup>®, and Orbscan II<sup>® optical methods. Repeatability from each device was evaluated by coefficient of variation, standard deviation, and intraclass correlation coefficient. RM-ANOVA on Ranks was used to compare the differences in ACD among the devices. The Bland-Altman plot was performed to assess agreement in measurements between the devices. Results: The mean ACD according to the applanation A-scan method and IOL Master<sup>®, Pentacam<sup>®, and Orbscan II<sup>® optical methods were 2.89 ± 0.49 mm, 3.25 ± 0.45 mm, 3.21 ± 0.46 mm, and 3.19 ± 0.47 mm, respectively, and the differences were statistically significant (p < 0.01). The coefficient of variation for the 4 methods was 2.50% in the A-scan, 0.87% in the IOL Master<sup>®, 1.25% in the Pentacam<sup>®, and 1.04% with Orbscan II<sup>®, and reproducibility was higher with the optical principle devices. The correlation coefficient between A-scan and IOL Master<sup>® was 0.65, between IOL Master<sup>® and Pentacam<sup>® 0.91, between IOL Master<sup>® and Orbscan II<sup>® 0.90, between A-scan and Pentacam<sup>® 0.69, between A-scan and Orbscan II<sup>® 0.71, and between Pentacam<sup>® and Orbscan II<sup>® 0.93. Conclusions: Applanation A-scan provided lower measurements for ACD compared with IOL Master<sup>®, Pentacam<sup>® and Orbscan II<sup>®. There was good agreement between results obtained with the latter 3 methods, and reproducibility was high with optical measurements. The coefficient of variation was low for IOL Master<sup>®.

약제로 잘 조절되는 원발개방각녹내장에서 수정체초음파유화술이 안압에 미치는 장기적 영향

이문형(Moon Hyung Lee),조경진(Kyong Jin Cho),박율리(Yuli Park) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.1

Purpose: To investigate the long-term effect of phacoemulsification on intraocular pressure (IOP) in patients with medically controlled primary open-angle glaucoma (POAG). Methods: This is a retrospective review of 120 eyes with POAG who underwent uncomplicated phacoemulsification with longitudinal follow-up. Demographic, clinical, and biometric variables such as age, axial length, central corneal thickness, gonioscopic results, anterior chamber depth, IOP, number of glaucoma medications were evaluated at 1, 2, 3, and 4 years after surgery. Results: Postoperative IOP change through 1, 2, 3, and 4 years of -1.47 ± 2.59, -1.21 ± 2.48, -1.15 ± 1.68, and -0.98 ± 1.53 mmHg was statistically significant (p < 0.01). The number of glaucoma medications remained unchanged (p = 0.18). Higher preoperative IOP was significantly associated with greater postoperative decrease in IOP (p < 0.001). Four years after phacoemulsification, 81.3% of the POAG eyes maintained the same number of glaucoma medications while 14.6% had a decrease and 5.1% of the eyes required additional glaucoma medications. Conclusions: After 4 years of phacoemulsification in patients with medically controlled POAG resulted in a very small IOP decrease without a change in the number of glaucoma medications. These findings have important implications when considering cataract surgery in POAG eyes for IOP reduction.

원발개방각녹내장, 정상안압녹내장 및 원발폐쇄각녹내장에서 시야진행의 비교 연구

김중희(Joong Hee Kim),조경진(Kyong Jin Cho),박율리(Yuli Park) 대한안과학회 2022 대한안과학회지 Vol.63 No.1

목적: 원발개방각녹내장, 정상안압녹내장 및 원발폐쇄각녹내장 환자에서 시야 진행의 패턴, 속도 및 위치에 대해 비교해보고자 하였다. 대상과 방법: 115안의 원발개방각녹내장, 123안의 정상안압녹내장, 92안의 원발폐쇄각녹내장 환자를 대상으로 후향적 의무기록 분석을 시행하였다. Mean deviation을 이용하여 전반적인 시야진행 속도를 분석하였고, 국소적인 시야진행은 암점확대와 암점심화로 나누어 각 군별로 상측활모양영역, 하측활모양영역, 중심부영역에서 분석하였다. 결과: 평균 전반적인 시야진행속도의 변화는 원발개방각녹내장군에서 -0.52 ± 0.74 dB/year, 정상안압녹내장군에서 -0.35 ± 0.41 dB/year, 원발폐쇄각녹내장군에서 -0.38 ± 0.45 dB/year로 원발개방각녹내장군에서 통계적으로 유의하게 빠른 진행 소견을 보였다(p<0.01). 원발개방각녹내장군은 상측활모양영역에서, 정상안압녹내장군은 중심부영역에서, 원발폐쇄각녹내장군은 하측활모양영역에서 큰 암점확대와 암점심화를 보였다. 결론: 원발개방각녹내장군에서는 상측활모양영역에서, 정상안압녹내장군에서는 중심부영역에서, 원발폐쇄각녹내장군에서는 하측활모양영역에서 큰 시야진행을 보였다. Purpose: We compared visual field progression among patients with primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), and primary angle-closure glaucoma (PACG). Methods: A total of 115 POAG, 123 NTG, and 92 PACG eyes were retrospectively analyzed. Global VF progression was evaluated by calculating the changes of mean deviations. To examine local VF deterioration, scotoma enlargement and deepening were analyzed in the superior, and inferior arcuate, and the central, zones. Results: The mean global rate of change in POAG eyes was -0.52 ± 0.74 dB/year, and -0.35 ± 0.41, and -0.38 ± 0.45 dB/year in NTG and PACG eyes; POAG eyes showed significantly more rapid progression than NTG and PACG eyes (p < 0.01). The superior arcuate zone of POAG eyes, the central zone of NTG eyes, and the inferior arcuate zone of PACG eyes exhibited more scotoma enlargement and scotoma deepening than did other zones. Conclusions: The superior arcuate zone of POAG eyes, the central zone of NTG eyes, and the inferior arcuate zone of PACG eyes showed greater VF progression.

눈꺼풀 막스선의 앞쪽 이동 유무에 따른 안구건조증 환자의 임상양상 분석

이다빈(Da Bin Lee),이문형(Moon Hyeong Lee),조경진(Kyong Jin Cho),박율리(Yuli Park) 대한검안학회 2021 Annals of optometry and contact lens Vol.20 No.4

목적: 안구건조증 환자들을 대상으로 막스선의 앞쪽 이동 유무에 따른 안구건조증의 임상적 특징을 분석해 보고자 하였다. 대상과 방법: 본 연구는 후향적 연구로서 안구건조증 환자 127명의 127안을 대상으로 막스선의 위치를 검사하고 분석하였다. 안구건조증은 1군 눈물 생성 부족(쇼그렌증후군 포함), 2군 마이봄샘기능부전, 3군 기타 눈물층 불안정으로 나누었다. 모든 환자들을 대상으로안구건조증 자각 증상 점수 설문 조사(Ocular Surface Disease Index), 각막 플루레신 염색 정도(score 0-15), 결막 리사민그린 염색 정도(score 0-12), 눈물막파괴시간(tear break up time), 쉬르머검사(Shirmer test)를 측정하였다. 결과: 막스선의 전방전위가 있는 군에서 마이봄샘기능부전(2군)의 비율이 가장 높았다(p<0.05). 또한 막스선의 전방전위와 안구건조증 객관적 지표들의 상관성을 분석해 보았을 때, 막스선의 전방전위가 있는 경우 쉬르머검사의 측정치가 통계적으로 유의하게 낮게 나왔다(p<0.05). 결론: 막스선의 전방전위는 마이봄샘기능부전이 동반된 안구건조증 환자에서 많이 나타났다. 향후 마이봄샘기능부전을 진단 및 치료하는 데에 있어 막스선을 유용한 보조적 마커로서 활용해볼 가치가 있겠다. Purpose: To evaluate the clinical characteristics of patients with dry eye syndrome according to anterior displacement of the Marx line. Methods: This retrospective study involved 127 eyes in 127 patients with dry eye, who were divided into three groups: group 1, aqueous-deficient, including Sjögren syndrome; group 2, meibomian gland dysfunction (MGD) dry eye; and group 3, other tear layer instability. A detailed assessment was conducted, involving the Ocular Surface Disease Index, corneal fluorescein staining (score: 0-15), conjunctival Lissamine green staining (score: 0-12), measurement of tear breakup time, and Schirmer’s test. Results: The proportion of patients with MGD was highest in the group with anterior displacement of the Marx line (p < 0.05). The correlation between anterior dislocation of the Marx line and Schirmer’s test, an objective indicator of dry eye syndrome, was significantly weaker when there was anterior displacement of the Marx line. Conclusions: Anterior dislocation of the Marx line was more common in patients with MGD. The Marx line is a useful marker for diagnosing MGD.