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사시수술 후 빛간섭단층촬영을 이용한 눈물띠의 변화 분석
김지혜(Ji Hye Kim),김체론(Che Ron Kim),김성재(Seong Jae Kim),정인영(In Young Chung),서성욱(Seong Wook Seo),유지명(Ji Myong Yoo) 대한안과학회 2016 대한안과학회지 Vol.57 No.12
목적: 소아에서 사시수술 후 안구표면인자의 변화와 빛간섭단층촬영(optical coherence tomography, OCT)을 이용한 눈물띠의 변화 및 인공눈물 사용유무에 따른 변화를 관찰하고자 하였다. 대상과 방법: 25프리즘디옵터 이상의 외사시로 양안에 외직근 후전술을 시행한 환자 총 30명을 대상으로 하였다. 대상자들은 수술 후 인공눈물을 좌안에만 점안하였다. 눈물막파괴시간검사, Schirmer 검사, 각막염색검사, 결막압흔세포검사, OCT를 이용한 눈물띠 높이, 넓이 검사를 수술 전과 수술 후에 시행하여 비교 분석하였다. 결과: 대상자들의 평균나이는 8.7세였다. 수술 후 8주에 눈물막파괴시간검사, 각막염색검사는 인공눈물 점안을 시행한 경우 12.3 ± 1.5초, 1.3 ± 0.4였으며, 인공눈물을 사용하지 않은 경우 9.5 ± 1.0초, 2.0 ± 0.7로 측정되었다(모두 p<0.000). OCT를 이용한 눈물띠 높이와 넓이 검사에서 수술 후 4주에 인공눈물 점안을 시행한 경우 290.2 ± 42.3 μm, 566.7 ± 48.2 pixels였으며, 인공눈물을 점안하지 않은 경우 246 ± 45.5 μm, 504.0 ± 29.7 pixels로 양안의 유의한 차이를 보였다(p=0.045, p=0.019). 결막압흔세포검사에서 인공눈물을 사용 유무에 따라 수술 후 8주째 유의한 술잔세포 수 차이가 있었다(p=0.033). 결론: 사시 수술 후 발생한 눈물막의 불안정성을 눈물막파괴시간검사, Schirmer 검사, 각막염색검사, 결막압흔세포검사, OCT를 이용하여 확인할 수 있다. 수술 후 인공눈물의 점안은 각결막의 빠른 치유와 눈물막의 안정성을 높여 수술 후 발생하는 안구건조증의 치료에 도움이 된다. Purpose: In this study, the changes in ocular surface parameters and tear meniscus after strabismus surgery when treated with or without artificial tears were evaluated using optical coherence tomography (OCT). Methods: The present study included 30 patients who received bilateral lateral rectus recession surgery for exotropia. The patients instilled artificial tear eye drops only in the left eye. Before and 2, 4, 8, and 12 weeks after surgery, tear film break-up time (BUT), Schirmer’s test, corneal staining test, tear meniscus height and area were measured using OCT and compared in both eyes. Before and 8 weeks after surgery, conjunctival compression cytology test was performed. Results: The mean patient age was 8.7 years. After 8 weeks, BUT and corneal staining scores were 12.3 ± 1.5 seconds and 1.3 ± 0.4 in patients treated with artificial tears and 9.5 ± 1.0 seconds and 2.0 ± 0.7 in patients not treated with artificial tears (both p < 0.000). Four weeks after surgery, tear meniscus height and area using OCT were 290.2 ± 42.3 μm and 566.7 ± 48.2 pixels in patients treated with artificial tears and 246 ± 45.5 μm and 504.0 ± 29.7 pixels in patients not treated with artificial tears (p = 0.045 and p = 0.019, respectively). Goblet cell count was significantly different between the eyes 8 weeks after surgery (p = 0.033). Conclusions: Instability of tear meniscus can be detected after strabismus surgery using BUT, Schirmer’s test, corneal staining test, tear meniscus height and area, and OCT. After surgery, artificial tears help treat dry eye symptoms by corneo-conjunctival wound healing mechanism and increasing tear meniscus stability.
김지혜(Ji Hye Kim),유웅선(Woong Sun Yoo),공민귀(Min Gui Kong),한용섭(Yong Seop Han),정인영(In Young Chung),서성욱(Seong Wook Seo),유지명(Ji Myong Yoo),김성재(Seong Jae Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.9
목적: 외상이나 수술의 과거력 없이 자연적으로 발생한 수정체 관련 포도막염을 진단하고 치료하였기에 보고하고자 한다. 증례요약: 77세 여성이 내원 4일 전부터 발생한 우안의 시력 저하 및 안통을 주소로 내원하였다. 환자는 우안에 외상이나 수술 등의 과거력은 없었으며, 내원 당시 교정시력은 우안 안전수동, 좌안 0.22였고 안압은 우안이 27 mmHg, 좌안은 15 mmHg로 측정되었다. 전안부 검사에서 우안에 각막 부종, 전방축농과 심한 염증으로 수정체는 관찰되지 않았으며 안구초음파 검사에서는 수정체 뒤쪽으로 유리체 혼탁이 보였다. 우안 안내염으로 진단하에 전방 천자를 통한 염색 및 배양검사, 전방세척술을 시행하였다. 전방세척술 후 전낭손상 없이 과숙백내장이 관찰되어 수정체낭외적출술을 시행하고 유리체내 항생제 주입술을 함께 시행하였다. 술 후 도말 검사 및 세균배양검사는 모두 음성이었으며, 광학현미경 검사에서 수정체단백을 포식한 대식세포가 관찰되어 과숙백내장으로 인해 발생한 수정체 관련 포도막염으로 진단하였다. 술 후 항생제와 스테로이드 안약을 점안하고 경구 스테로이드를 사용하였으며 염증의 재발없이 치료되었다. 결론: 안내염과 비슷한 양상으로 내원한 환자에서 과숙백내장에 의한 포도막염을 진단하고 치료하였기에 보고하고자 한다. Purpose: To report a case of phacoanaphylactic uveitis presenting as endophthalmitis. Case summary: A 77-year-old woman presented with sudden visual disturbance and painful red right eye. She did not have a history of trauma or surgery in her right eye. Her best corrected visual acuity was hand movement in the right eye and log MAR 0.22 in the left eye; intraocular pressure was 27 mm Hg in the right eye and 15 mm Hg in the left eye. Slit-lamp examination revealed corneal edema and prominent inflammation with hypopyon in the anterior chamber. B-scan showed vitreous opacity behind the lens. Based on the diagnosis of endophthalmitis, anterior chamber paracentesis and irrigation were performed. After irrigation, a hypermature cataract with intact anterior capsule was observed. Therefore, we performed extracapsular cataract extraction and intravitreal antibiotics injection. Gram staining of the aqueous humor revealed numerous macrophages filled with lens protein but no organisms. She was treated with hourly topical corticosteroid and an antibiotic agent. One month later, the anterior chamber is clear, and the cultures remained negative. Conclusions: We report a case of spontaneous phacoanaphylactic uveitis presenting as endophthalmitis in a patient with no history of eye trauma or surgery.
김언정,김종명,유지명.Eon Jeong Kim. M.D.. Jong Myong Kim. M.D.. Ji Myong Yoo. M.D. 대한안과학회 2006 대한안과학회지 Vol.47 No.2
Purpose: Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare disase, which causes chronic progressive inflammation and thickening of the basal dura mater. We report a case of IHCP associated with superior oblique paralysis and present a review of the literature. Methods: An 8-year-old boy presented with binocular diplopia and left side head tilting. Suspecting right superior oblique muscle paralysis, an alternating prism test, head tilt test, fundus examinations, neurologic examination, and brain MRI were performed. Results: The brain MRI revealed abnormal enhancement of the right tentorium in the course of the right fourth cranial nerve, leading to a diagnosis of IHCP with paralytic strabismus and the patient was treated with systemic steroid therapy. Conclusions: We report a case of IHCP with right superior oblique paralysis. Patients with recent onset paralytic strabismus require appropriate neurolgic and neuroimaging examinations.
징병신체검사에서 의뢰된 성인 약시 환자의 무늬시유발전위의 양상
유웅선,박연정,유지명,Woong Sun Yoo,MD,Yeon Jung Park,MD,Ji Myong Yoo,MD,PhD 대한안과학회 2010 대한안과학회지 Vol.51 No.10
Purpose: To evaluate the pattern VEP in adult amblyopic patients seen in consultation for ophthalmic evaluation as a past of physical examinations for conscription. Methods: We retrospectively analyzed, 67 men, 20-year-old or older, who had pattern VEP done for the diagnosis of amblyopia from January 2004 to May 2009. P100 latency and P100 amplitude were analyzed. Results: Thirteen patients were non-amblyopic, and 54 patients had amblyopia. Binocular amblyopia and monocular amblyopia were found in 23 and 31 patients, respectively. In the binocular amblyopic patients, four patients were hyperopic, seven patients were myopic, and 12 patients were astigmatic amblyopia. In the monocular amblyopic patients, 15 patients were anisometropic, 12 patients were strabismic, and four patients had organic amblyopia. The value of P100 latency and P100 amplitude were statistically significantly different between non-amblyopic and amblyopic eyes, with check size of 32×32. However, the types of amblyopia among the patients were not different at a statistically significant level. Visual acuity and P100 amplitude were significantly positively correlated. Conclusions: VEP might be a useful tool for diagnosis of adult amblyopia, especially using a 32×32 check size. This tool may impart the ability to decide relationship between amblyopia and visual acuity by analyzing P100 latency and amplitude values. J Korean Ophthalmol Soc 2010;51(10):1392-1397