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윤도예,김주현,전현선,전희은,한상범,현준영 대한안과학회 2019 Korean Journal of Ophthalmology Vol.33 No.5
Purpose: To evaluate the protective effect of applying an ophthalmic viscosurgical device (OVD) to the ocularsurface during cataract surgery and its ability to prevent dry eye syndrome. Methods: Twenty-four patients aged 50 to 75 years who underwent cataract surgery at Seoul National UniversityBundang Hospital and agreed to participate in the study were included and divided into two groups: astudy group who underwent cataract surgery after application of an OVD to the ocular surface, and a controlgroup who underwent cataract surgery without application of an OVD. DisCoVisc was used as the OVD in thestudy group, while other factors including surgical techniques and administration of anesthetic agents wereperformed in both groups in the same manner. Indicators of dry eye syndrome including ocular staining score,tear break-up time, and tear osmolality were analyzed. Ocular surface disease index and a visual analog scalewere analyzed for dry eye symptoms, and the amount of balanced salt solution used during surface irrigationand operation time were also analyzed. Results: Significant improvement in the tear break-up time, corneal ocular staining score, and ocular surfacedisease index score in the study group compared with the control group one week after operation (by theMann-Whitney test). Use of OVD was associated with longer operating time. Conclusions: OVD applied to the ocular surface during cataract surgery had a protective effect on the ocularsurface one week after surgery.
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윤도예,박진구,김남주,정호경,곽상인 대한안과학회 2017 대한안과학회지 Vol.58 No.1
목적: 분리종은 조직학적으로 정상 조직이 비정상적인 위치에서 증식한 것을 말하며, 소안구증과 동반되어 발생하는 것은 매우 드문것으로 알려져 있다. 저자들은 소안구증에 동반된 광범위한 안구바깥 분리종 1예를 보고하고자 한다. 증례요약: 생후 9일 된 남아가 좌측 안구가 관찰되지 않아 의뢰되었다. 좌측 눈꺼풀틈새 안쪽에서 큰 각막이 피부색을 띤 막으로 덮여있는 것처럼 보여 소눈증 또는 소안구증에 동반된 각막포도종을 의심하였다. 생후 2개월째 좌안 결막낭 중앙부 조직이 돌출되어 눈꺼풀틈새 밖으로 노출되었고, 밀어 넣어도 다시 노출되는 양상을 보였다. 생후 9개월째 안와 자기공명영상에서 좌측 안구 위치에 큰지방덩이와 뒤쪽의 작은 안구 추정 구조물이 관찰되었다. 소안구증에 동반된 안구바깥 분리종으로 진단하고, 생후 12개월에 노출된 종괴만 부분절제술을 시행하였다. 병리검사에서 분리종을 확인하였고, 술 후 10개월인 현재까지 의안 착용으로 외관상 양호한 상태를 유지하고 있다. 결론: 소안구증에 동반된 광범위한 안구바깥 분리종은 시력이 없는 상태이므로 주된 치료목표는 미용 개선이며, 의안 착용이 가능한 정도의 종괴 부분절제술과 결막낭 성형술도 효과적 방법이다. Purpose: Choristomas represent congenital overgrowth of normal tissues in an abnormal location. The simultaneous presence of epibulbar choristoma and microphthalmos has rarely been reported. The authors report a case of extensive epibulbar choristoma associated with microphthalmos. Case summary: A 9-day-old boy with the left eyeball absent from birth was referred to our clinic. A large cornea-like structure covered by keratinized membrane was observed inside the eyelid aperture, therefore buphthalmos or corneal staphyloma with microphthalmos was presumed. At the age of 2 months, a large mass of central conjunctival sac protruded through the left eyelid aperture. Manual reduction could not return the tissue to its original site and the mass immediately protruded again. At the age of 9 months, orbital magnetic resonance imaging showed the small presumed ocular tissue behind the large mass of fat signal in the central anterior orbit, therefore, extensive epibulbar choristoma associated with microphthalmos was diagnosed. At 12 months of age, partial excision of the protruding portion of the mass was performed. Based on pathologic examination, the mass was determined to be a choristoma and cosmetically acceptable appearance with prosthesis was maintained for 10 months after the surgery. Conclusions: Because there is no vision in extensive choristoma associated with microphthalmos, the treatment goal is cosmetic improvement. Conjunctivoplasty following partial mass excision for prosthesis wearing is a good treatment option.
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원발쇼그렌증후군에서 눈물 오스몰 농도와 눈 및 전신질환 관련 인자의 상관관계
윤도예,김주현,전현선,위원량,현준영 대한안과학회 2017 대한안과학회지 Vol.58 No.8
Purpose: To investigate the relationships between tear osmolarity and various parameters for ocular and systemic disease in primary Sjögren's syndrome. Methods: The medical records of 53 patients with primary Sjögren's syndrome were reviewed. Tear osmolarity using a TearLab® (TearLab™ Corp., San Diego, CA, USA) osmometer as well as other dry eye parameters such as tear break-up time, ocular staining score (Sjögren's International Collaboration Clinical Alliance [SICCA] ocular staining score, SICCA score), Schirmer-I score, symptoms with Ocular Surface Disease Index (OSDI), and Visual Analog Scale (VAS) were obtained. Systemic laboratory data and medication history were also collected. The correlations between the parameters were analyzed using the Spearman's rank correlation test. Results: 53 patients with a mean age of 54.1 ± 13.2 years and female predominance (96.23%) were enrolled. The majority of patients (28.3%) were receiving systemic therapy for severe Sjögren's syndrome. The tear osmolarity in Sjögren's syndrome patients was 307 ± 13.6 (mOsm/L). Higher tear osmolarity was associated with lower tear film break-up time (BUT) scores and with higher SICCA scores. Tear osmolarity and the Schirmer test results were not significantly related. Higher tear osmolarity was paradoxically associated with lower VAS scores and lower OSDI scores. Neither current medication nor the salivary gland focus score showed significant associations with tear osmolarity. Although tear osmolarity was not associated with the SSA-Ro or SSA-LA titer, serum immunoglobulin G (IgG) level and serum erythrocyte sedimentation rate (ESR) level showed positive correlations with tear osmolarity. Conclusions: Tear osmolarity is positively correlated with the severity of dry eye and was associated with lower symptom severity. The significant associations of tear osmolarity with IgG and ESR suggest that high tear osmolarity may be correlated with autoantibody load and the systemic inflammatory state. 목적: 원발쇼그렌증후군 환자에서 눈물 오스몰 농도와 눈 및 전신질환과 관련된 인자들의 관련성에 대하여 알아보고자 하였다. 대상과 방법: 원발쇼그렌증후군으로 진단받은 환자 중 3개월 이상 경과관찰한 총 53명을 대상으로 의무기록을 후향적으로 분석하였다. TearLabⓇ (TearLab™ Corp., San Diego, CA, USA) 오스몰 농도 측정기를 이용한 눈물 오스몰 농도와, 각결막표면염색 검사, 안구표면장애 측정표(ocular surface disease index, OSDI) 및 시각통증척도(visual analogue scale, VAS)를 통한 증상점수, 눈물막파괴시간, 쉬르머검사, 그리고 자가항체 등에 대하여 확인하였다. 결과: 53명의 환자는 여성의 비율이 96.23%였으며, 28.3%의 환자에서 중증 쇼그렌증후군에 대하여 류마티스 내과에서 전신적인 약제를 처방 받아 복용 중이었다. 쇼그렌증후군 환자에서 눈물 오스몰 농도는 평균 307 ± 13.6 mOsm/L였다. 눈물 오스몰 농도가 높은 것은 눈물막 파괴시간과 음의 상관관계를 보였으나 통계적으로 유의하지 않았으며, 높은 각결막표면염색 검사 점수와 연관이 있었다. 눈물 오스몰 농도는 쉬르머검사 결과와 연관성이 없었으며 높은 눈물 오스몰 농도는 역설적으로 낮은 VAS 점수와 낮은 OSDI 점수와 관련성이 있었다. 눈물 오스몰 농도는 항 Ro (SS-A)와 항 La (SS-B) 항체 수치와는 연관성이 없었지만, 혈청 면역글로불린 G (immunoglobulin G, IgG) 수치(ρ=0.347, p=0.003)와 혈청 적혈구침강속도(erythrocyte sedimentation rate, ESR) 수치(ρ=0.277, p=0.010) 와 양의 상관 관계를 보였다. 결론: 눈물 오스몰 농도는 안구건조증의 중증도와 양의 상관 관계가 있으며, 낮은 증상 지표와 연관이 있다. 높은 눈물 오스몰 농도와 IgG, ESR 수치가 연관 있는 것은 자가항체 발현 정도와 전신적인 염증 정도와 연관 있을 것으로 생각된다.
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