안와관통상으로 인해 발생한 안와첨증후군의 장기 경과 관찰 1예

백성욱,이민정.Sung Uk Baek. MD. Min Joung Lee. MD 대한안과학회 2013 대한안과학회지 Vol.54 No.8

Purpose: To report a case of orbital apex syndrome induced by penetrating orbital injury by a wire with the recovery process and clinical outcomes. Case summary: A 40-year-old female visited our clinic after a penetrating orbital injury through the left inferomedial conjunctiva by a wire. The best corrected visual acuity of the left eye was 0.6, and ptosis and total ophthalmoplegia were observed. The patient showed a dilated pupil, swelling of the optic disc on fundus exam, and an inferior field defect on the automated perimetry. The computed tomography image revealed mild retrobulbar hemorrhage, but there was no orbital bony fracture. Enhancement of the optic nerve sheath was observed on the magnetic resonance image. The patient was admitted and received systemic antibiotics and steroid treatment. After 1 month, visual acuity, ptosis, and limitation in adduction were partly improved. After 3 months, depression and adduction were improved and the pupil size was normalized. However, further improvement was not observed after the one-year follow-up. Conclusions: The recovery from orbital apex syndrome was achieved until 3 months after injury. The final outcomes may depend on the mechanism and pathophysiology of the injury. Emergent diagnosis and proper management are essential to achieve optimal clinical results.

간헐외사시 수술의 장기적인 결과

백성욱,이주연,Sung Uk Baek,MD,Joo Yeon Lee,MD,PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.7

Purpose: To evaluate long-term outcomes of surgery for intermittent exotropia. Methods: The authors evaluated 78 patients who underwent surgery for intermittent exotropia and were available for a follow- up over a 5-year period. According to distant exodeviation and fusion control at the last visit, the patients were classified into either the stable group (distant exodeviation ≤10 PD) or the recurrent group (distant exodeviation >10 PD). The recurrent group was reclassified into the clinical success group (distant exodeviation >10 PD, <20 PD with good fusion control) or the clinical failure group (distant exodeviation ≥20 PD or distant exodeviation >10 PD, <20 PD with poor fusion control). We analyzed recurrence rate, success rate, and clinical outcome. Results: Recurrence rate was 65.3% (n = 51), and the surgical success rate calculated as the rate of stable group and clinical success group was 73% (n = 57). The postoperative angle of exodeviation was more decreased than the preoperative angle in 93.6% of patients. When comparing postoperative with preoperative sensory function, only 2.6% of patients demonstrated worse distant fusion control grades, 66.7% of patients remained the same, 30.8% improved, and 5.1% of patients demonstrated poorer near stereopsis. The rest of patients had better or equal fusion control and stereoacuity. Age at surgery in the recurrent group was less than in the stable group (p = 0.004) and the recurrent group had worse preoperative distant fusion control (p = 0.021). Exodeviation angle of the recurrent group at postoperative 1 month, 3 months and 6 months was greater than that of the stable group (p < 0.005). Conclusions: Despite a high recurrence rate, surgery for intermittent exotropia showed a high clinical success rate and good long-term efficacy and safety in both deviation angle and sensory function.

원발급성폐쇄각발작에서 레이저홍채절개술에 이은 조기 수정체적출술 병합치료의 효과

백성욱(Sung Uk Baek),최동철(Dong Chul Choi),이경화(Kyung Wha Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.7

목적: 원발급성폐쇄각발작 환자에서 발작안에 레이저홍채절개술만 시행한 환자군과 레이저홍채절개술에 이은 조기 수정체적출술을 시행한 환자군에 대해 장기간의 안압 변화를 알아보았다. 대상과 방법: 후향적 의무기록 분석을 통해 원발급성폐쇄각발작으로 내원하여 발작안에 레이저홍채절개술만을 시행한 환자군(A군)과 1달 이내 레이저홍채절개술에 이은 수정체적출술을 시행한 환자군(B군)을 대상으로 조사하였다. 내원한 초진 시부터 12개월까지 A, B군에 대해 안압 변화를 알아보았다. 결과: 총 대상 환자는 99명으로 A군 37명, B군 62명이었다. A, B군 간의 각 시기별 평균 안압은 수술 후 1개월째 유의한 차이를 보이지 않았으나, 3개월, 6개월, 12개월째 B군이 A군에 비해 유의하게 낮은 양상을 보였다(p=0.003, <0.001, <0.001). 두 군 간 안압의 재상승(IOP ≥ 21 mmHg) 빈도는 3개월, 6개월, 12개월에 각각 A군은 3명(8.11%), 5명(13.51%), 5명(13.51%), B군 0명, 2명(5.41%), 1명 (1.61%)으로 유의하게 B군에 안압의 재상승 빈도가 낮았다(p=0.050, 0.038, 0.026). 결론: 레이저홍채절개술에 이은 조기 수정체적출 시행 후 1년간의 관찰 결과 성공적으로 안압 조절이 가능하였으며 레이저홍채절개술만 시행한 군에 비해 안정적인 결과를 보였다. 본 연구를 통해 원발급성폐쇄각발작 환자에서 백내장이 동반된 경우 레이저홍채절개술에 이은 조기 수정체적출술은 장기적 치료 효과 측면에서 권장할 만한 방법으로 판단된다. <대한안과학회지 2016;57(7):1126-1133> Purpose: To evaluate long-term change in intraocular pressure (IOP) in eyes undergoing laser iridotomy (LI) and early phacoemulsification after LI in patients with acute angle-closure glaucoma (AACG). Methods: The retrospective, comparative chart review included patients with AACG, Group A who underwent only LI and Group B who underwent early phacoemulsification within 1 month after LI. Patients were followed up on day 1; week 1; and months 1, 3, 6, and 12 after LI. IOP changes were studied. Results: This study included a total 99 eyes from 99 patients, 37 in group A and 62 in group B. The mean IOP were not significantly different between the two groups at the initial visit or 1 month later. However, group B showed a consistently lower mean IOP that that of group A at 3, 6, and 12 months (p = 0.003, <0.001, <0.001, respectively). The prevalence of IOP increase to greater than 21 mmHg was 3 (8.11%), 5 (13.51%), and 5 patients (13.51%) in group A and 0, 2 (5.41%), and 1 patients (1.61%) in group B at 3, 6, and 12 months, respectively. Group B showed a significantly lower prevalence of IOP increase (p = 0.050, 0.038, 0.026). Conclusions: We found that patients treated with early phacoemulsification after LI had better outcomes of well-maintained IOP compared to those undergoing LI alone. For AACG patients with coexisting cataract, early phacoemulsification after LI can be considered as a reasonable treatment to maintain IOP. J Korean Ophthalmol Soc 2016;57(7):1126-1133

한국에서의 소아 류마티스관절염에서 발생한 포도막염의 임상양상

권순일,백성욱,박인원,김광남,박찬기,Soon Il Kwon,Sung Uk Baek,In Won Park,Kwang Nam Kim,Chan Kee Park 대한안과학회 2013 대한안과학회지 Vol.54 No.12

Purpose: To investigate the incidence and clinical characteristics of juvenile idiopathic arthritis (JIA)-associated uveitis in Korea and to identify the risk factors for developing uveitis and poor visual outcome.<br /> Methods: We performed a retrospective chart review of 149 patients who were diagnosed as JIA between January 2001 and December 2012. Patients were classified based on the International League of Associations for Rheumatology (ILAR) criteria and the incidence and clinical course of uveitis according to each subtype was investigated. We also evaluated the risk factors for poor prognostic outcomes.<br /> Results: The present study included 79 males and 70 females and the mean age was 7.42 ± 3.82 years. In 13 patients (8.6%), uveitis manifested evenly among JIA subtypes, including 5 patients with oligoarthritis type, 4 patients with polyarthritis rheumatoid negative type, and 4 patients with systemic type. Anti-nuclear antibody (ANA) was detected more in the uveitic group (46.13%). The characteristics of uveitis were acute (85%), bilateral (85%), and anterior uveitis (92%). Chronic uveitis occurred in only 2 patients who had uveitis at an early age (mean age of 5 years) and had severe anterior chamber reaction at presentation. Poor visual outcome was associated with band keratopathy and posterior synechiae preceded by the chronic uveitis.<br /> Conclusions: JIA-associated uveitis occurred evenly in each subtype. Uveitis was increased in the presence of ANA. Most uveitis showed good visual outcomes but in cases of early uveitis onset and with severe anterior chamber reaction at presentation the risk of chronic uveitis increased resulting in poor visual outcomes. <br /> J Korean Ophthalmol Soc 2013;54(12):1838-1843

원발급성폐쇄각발작 환자 반대편안의 예방적레이저홍채절개술과 수정체적출술 후 장기적 안압 변화

최동철(Dong chul Choi),백성욱(Sung uk Baek),이경화(Kyung Wha Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.5

목적: 원발급성폐쇄각발작 환자의 반대편안에서 예방적레이저홍채절개술만 시행한 환자군과 예방적레이저홍채절개술에 이은 수정체 적출술을 시행한 환자군에 대해 장기간의 안압 변화를 알아보고자 한다. 대상과 방법: 원발급성폐쇄각발작으로 내원하여 반대편안에 예방적레이저홍채절개술만을 시행한 환자군(A군) 35명과 예방적레이저 홍채절개술에 이은 1달 이내 수정체 적출술을 시행한 환자군(B군) 27명, 총 62명을 대상으로 조사하였다. 내원한 초진 시, 예방적레이저홍채절개술 시술 후 1시간, 1일, 1주일, 3개월, 6개월, 12개월에서 A, B군에 대해 발작 반대편안에 대한 안압 변화, 시력, 레이저홍채절개술과 수정체 적출 및 인공수정체 삽입술 후 합병증 등을 조사하였다. 결과: A군의 경우 반대편안에 레이저홍채절개술 시행 후 1개월부터는 레이저홍채절개술 시행 이전으로 안압이 상승되었으나(내원 시 15.9 ± 5.0 mmHg, 12개월 15.9 ± 2.6 mmHg) B군의 경우 레이저홍채절개술 및 수정체 적출술 후 안압의 상승 없이(내원 시 17.0 ± 3.3 mmHg, 12개월 13.3 ± 2.8 mmHg) 장기간 유지되는 결과를 보였다. 반대편안에 안압의 상승으로 약물치료가 추가로 필요했던 환자는 1년간 장기 관찰 중 A군 13명(37.14%), B군 4명(14.8%)으로 B군에서 유의하게 적었다(p=0.032). 반대편안의 평균 최대교정시력은 내원 시 A군 0.78 ± 0.21, B군 0.71 ± 0.22 최종 관찰 시 A군에서 0.73 ± 0.31, B군에서 0.93 ± 0.27로 B군에서 시력개선 효과가 의미 있게 높았다(p=0.003) 결론: 원발급성폐쇄각발작 시 반대편안에 대해서 레이저홍채절개술에 이은 조기 수정체 적출 시행 후 1년간의 관찰 결과 모두 성공적으로 안압 조절이 가능하였으며 레이저홍채절개술만 시행한 군에 비해 안정적인 결과를 보였다. 본 연구를 통해 원발급성폐쇄각발작시 반대편안에 대해서 예방적레이저홍채절개술에 이은 조기에 수정체 적출 및 인공수정체 삽입술을 시행함으로써 장기적인 안압 하강과 시력 호전을 가져 올 수 있음을 확인할 수 있었다. Purpose: To evaluate long-term change in intraocular pressure (IOP) in the fellow eyes after laser iridotomy and early phacoemusification with laser iridotomy in patients with acute angle-closure glaucoma. Methods: We performed a retrospective, comparative chart review of 62 patients with acute angle-closure glaucoma, 35 patients (Group A) who underwent only prophylactic laser iridotomy on fellow eyes and 27 patients (Group B) who underwent prophylactic laser iridotomy and early phacoemusification on fellow eyes. Patients were followed up at 1 day, 1 week and 1, 3, 6 and 12 months. IOP change was analyzed after laser iridotomy 1 hour and at every follow-up. In addition, visual acuity and complications of laser iridotomy and phacoemusification were determined. Results: In Group A, the mean IOP increase in fellow eyes occurred within 1 month after laser iridotomy (initial, 15.9 ± 5.0 mm Hg, final, 15.9 ± 2.6 mm Hg), However, in Group B, the mean IOP of fellow eyes was maintained up to 12 months without an increase in IOP (initial, 17.0 ± 3.3 mm Hg, final, 13.3 ± 2.8 mm Hg) Among the fellow eyes, 13 patients in Group A (37.14%) and 4 patients in Group B (14.81%, p = 0.032) underwent further medical therapy. The initial visual acuity of fellow eyes in Group A was 0.78 ± 0.21 and 0.71 ± 0.22 in Group B, and at the final visit, 0.73 ± 0.31 in Group A and 0.93 ± 0.27 in Group B (p = 0.003). Conclusions: We found that most fellow eyes treated with laser iridotomy and phacoemulsification maintained satisfactory IOP and good vision. These results support that laser iridotomy and phacoemulsification in the fellow eye with acute angle-closure glaucoma is a reasonable prophylactic treatment.

말기녹내장으로 처음 진단받은 환자의 진단 경로 및 임상양상 분석 : 단일 3차 의료기관 경험

장준혁(Joon Hyuck Jang),이경화(Kyung Wha Lee),백성욱(Sung Uk Baek) 대한안과학회 2021 대한안과학회지 Vol.62 No.11

목적: 건강검진의 확대에도 불구하고 첫 진단 시 말기녹내장으로 진단을 받는 환자들이 적지 않다. 이들의 진단 경로 및 임상양상을 분석하여 연관 인자를 알아보고자 하였다. 대상과 방법: 2016년부터 2018년도까지 3차 의료기관에서 녹내장으로 처음 진단 받은 환자 중에서 연속된 초기 시야검사에서 mean deviation (MD) 값이 -12 dB 이하이며, 상응하는 구조 손상이 확인된 자를 대상으로 하였다. 전체 대상군을 각각 ‘단안, 양안말기녹내장’, ‘고안압, 정상안압녹내장’ 그리고 인공수정체안, 수정체안 으로 양안성, 치료 전 안압, 그리고 백내장수술 여부에 따라 분류, 비교 분석하였다. 결과: 전체 대상 환자는 73명으로 평균 나이 69.3세, 평균 MD값은 -19.6 dB이었다. 양안 말기녹내장군은 우연히 안과검진을 통해 진단된 경우가 가장 많고(52.2%), 중심 섬 양상의 시야결손이 가장 많았으나(54.2%), 단안군은 녹내장 연관증상으로 진단된 경우가 가장 많고(46.9%), 상하측 양상의 결손이 가장 많았다(42.8%). 고안압녹내장군에서 녹내장연관증상을 주소로 내원한 경우가 68.2%, 정상안압녹내장군에서 22.8%였으며, 중심 섬 양상의 시야결손은 고안압녹내장군에서 43.6%, 정상안압녹내장군에서 29.4%였다. 결론: 본 연구는 말기녹내장의 진단 경로 및 임상양상을 분석한 연구로서, 양안 말기녹내장군에서 안과검진으로 우연히 진단된 경우가 많았다. 세부분석에서 양안 말기녹내장, 고안압녹내장, 인공수정체안에서 중심 섬 양상의 시야결손의 비율이 높았다. 추후 사회경제적 요소 및 다기관 자료를 통한 보완 분석이 필요하다. Purpose: As routine health examinations become more common, many patients first diagnosed with glaucoma have advanced glaucoma. We analyzed the routes to diagnosis and the characteristics of patients initially diagnosed with advanced glaucoma. Methods: We retrospectively retrieved the medical records of patients first diagnosed with advanced glaucoma in our tertiary care center. The inclusion criteria were a mean deviation (MD) less than -12 dB on the visual field test, accompanied by structural damage. All patients were classified in terms of unilateral/bilateral disease, the intraocular pressure before medication, and lens status. We divided patients into those with monocular or binocular advanced glaucoma, high- or normal-pressure glaucoma, and those who were pseudophakic or phakic. Results: We included 73 patients of mean age 69.3 years. The visual field test MD was -19.6 dB. In those with binocular advanced glaucoma, incidental ophthalmic examination was the most common means of diagnosis (52.2%). Central-island visual field defects were the most common defects (54.2%). In those with monocular advanced glaucoma, glaucoma-associated symptoms most commonly triggered diagnosis (46.9%). Both superior and inferiorvisual field defects were the most common defects (42.8%). Glaucoma-associated symptoms were present in 68.2 and 22.8% of patients with high- and normal-pressure glaucoma, respectively. Central-island visual field defects were present in 43.6 and 29.4% of those with high- and normal-pressure glaucoma, respectively. Conclusions: We analyzed the routes to diagnosis and the clinical characteristics of patients with advanced glaucoma. In those with binocular disease, glaucoma was most commonly diagnosed on incidental ophthalmic examination. Central-island visual field defects were the most common defects in patients with binocular and high-pressure glaucoma, and the pseudophakic group. A multi-center longitudinal study on risk factors for delayed glaucoma diagnosis is needed.