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안용선,조양경 대한안과학회 2015 대한안과학회지 Vol.56 No.4
목적: 백내장 수술 전 만니톨 정맥주사를 통한 안압 하강 후 백내장 초음파 유화술을 시행하는 것이 수술 후 각막내피 손상을 감소시킬 수 있는지 알아보고자 한다. 대상과 방법: 양안 백내장 수술 환자 중 양안 모두 전방 깊이가 2.50 mm 미만인 36안(A군)과 2.50 mm 이상인 44안(B군)을 대상으로하였다. 각 군내 동일 환자에서 무작위로 한쪽 눈 수술 전에만 만니톨 정맥주사를 시행하고, 반대쪽 눈 수술 전에는 시행하지 않았다.모든 환자들은 수술 후 1일, 2주, 5주에 각막 내피세포 밀도, 세포면적 변이계수(Coefficient of variation, CV), 육각형세포 비율(Hexagonality, HA)과 각막 두께를 측정하였다. 그리고 A군과 B군 각각에서 만니톨 정맥주사를 시행한 군과 시행하지 않은 군의 수술후 시력, 각막 내피세포 그리고 각막 두께를 비교하였다. 결과: A군에서 수술 전 만니톨 정맥주사를 시행한 군이 시행하지 않은 군보다 수술 후 1일, 5주째 각막 내피세포 밀도가 유의하게 더 높았고, 1일째 각막의 두께가 유의하게 얇았으며, 최대 교정 시력도 유의하게 더 좋았다(all p<0.05). 하지만 B군에서는 만니톨 정맥주사를 시행한 군과 시행하지 않은 군 사이의 각막 내피세포 밀도, CV, HA, 각막의 두께, 최대 교정 시력은 모든 경과 관찰 시점에서 유의한 차이가 없었다. 결론: 전방의 깊이가 얕은 환자에서 백내장 초음파 유화술 전 만니톨 정맥주사에 의한 안압 하강은 수술 후 초기 각막 내피세포 보호에 효과가 있고, 초기 시력 회복에 도움이 된다. Purpose: To evaluate whether intraocular pressure reduction by intravenous injection of mannitol before phacoemulsificationcataract surgery can have a protective effect on corneal endothelium. Methods: Patients undergoing sequential bilateral cataract surgery were divided into 2 groups, 36 eyes with anterior chamber depth (ACD) ˂ 2.50 mm (group A) and 44 eyes with ACD ≥ 2.50 mm (group B). In each group, preoperative intravenous injection of mannitol was performed in 1 randomly selected eye of the patient. The specular microscopic examination including cell density(ECD), coefficient of variation (CV), hexagonality (HA) of corneal endothelium, and corneal thickness was performed on postoperative 1 day, 2 weeks, and 5 weeks. In each group, the parameters were compared between the eyes with mannitolization and the contralateral eyes without mannitolization. Results: In group A, eyes with preoperative mannitolization showed significantly higher ECD at postoperative 1 day and 5 weeks and showed a significantly thinner cornea at postoperative 1 day than those without mannitolization (all p < 0.05). However, in group B, there was no significant difference of ECD, CV, HA, and corneal thickness between the eyes with and without mannitolization. Conclusions: Preoperative intraocular pressure reduction by mannitolization before phacoemulsification can protect the corneal endothelial cells and recover the early postoperative period visual acuity in eyes with shallow anterior chamber.
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안용선,박율리,김현승 대한안과학회 2015 대한안과학회지 Vol.56 No.4
목적: 인공수정체 공막 봉합고정술 후 전방 깊이, 인공수정체의 기울어짐과 중심이탈에 따른 굴절력 변화를 알아보고자 한다. 대상과 방법: 인공수정체 공막 봉합고정술을 시행한 17안 중 6안은 무수정체안, 5안은 인공수정체 탈구, 6안은 수정체 탈구 상태였다. 12안에는 아크릴레이트 재질(MN60ACⓇ), 5안에는 PMMA 재질(CZ70BDⓇ)의 인공수정체를 모두 각막 윤부로부터 1.0 mm 뒤쪽 공막에봉합고정하였다. 그리고 후향적 의무기록 분석을 통해 이들의 수술 후 2주, 1개월, 2개월째 전방 깊이, 인공수정체의 기울어짐과 중심이탈, 현성 굴절력, 굴절오차 그리고 각막 내피세포 검사를 확인하였다. 결과: 수술 후 2주, 1개월, 2개월째 전방 깊이는 3.36 ± 0.11 mm, 3.30 ± 0.12 mm, 3.27 ± 0.13 mm로 낭내삽입술군에 비해 유의하게 더 얕았다. 인공수정체의 기울어짐은 4.61 ± 0.12o, 4.65 ± 0.14o, 4.60 ± 0.12o, 중심이탈은 0.43 ± 0.01 mm, 0.45 ± 0.01 mm, 0.45± 0.01 mm로 낭내삽입술군에 비해 유의하게 더 컸다. 굴절오차는 ‐0.55 ± 0.27D, ‐0.63 ± 0.24D, ‐0.69 ± 0.19D로 낭내삽입술군에 비해 유의하게 더 근시화되는 경향을 보였다. 결론: 본 연구의 결과로는 각막 윤부로부터 1.0 mm 뒤쪽에 인공수정체 공막 봉합고정 시 예측보다 약 0.75D 원시를 목표로 도수를 선택하면 원하는 목표 굴절력에 근접할 수 있다. 하지만 수술 후 굴절력은 절개창, 고정 위치, 봉합사 장력 등 술자 요인에도 영향을받으므로 수술 시 이를 고려하여야 할 것이다. Purpose: To evaluate the anterior chamber depth (ACD), extent of intraocular lens (IOL) tilt, and decentration and refractive error after transscleral fixation of IOL. Methods: We retrospectively reviewed the medical records of 17 cases with transscleral fixation of IOL (6 with aphakia, 5 with IOL dislocation, and 6 with lens subluxation). The acrylic IOL (MN60AC??) was fixated in 12 eyes and the polymethylmethacrylate IOL (CZ70BD??) was fixated in 5 eyes at 1.0 mm posterior from the limbus. We analyzed the ACD, extent of IOL tilt and decentration,manifest refraction, refractive error, higher order aberration, and corneal endothelium at 2 weeks, 1 month and 2 months postoperatively. Results: The mean ACD was 3.36 ± 0.11 mm, 3.30 ± 0.12 mm, and 3.27 ± 0.13 mm, the mean extent of IOL tilt was 4.61 ± 0.12°,4.65 ± 0.14°, and 4.60 ± 0.12° and the mean extent of IOL decentration was 0.43 ± 0.01 mm, 0.45 ± 0.01 mm, and 0.45 ± 0.01mm at 2 weeks, 1 month and 2 months postoperatively, respectively in eyes with transscleral fixation of IOL. The ACD was shallower and the extent of IOL tilt and decentration was greater than with IOL in-the-bag insertion patients. The mean refractive errors were -0.55 ± 0.27 D, -0.63 ± 0.24 D, and -0.69 ± 0.19 D at the same period, respectively. Conclusions: Although postoperative refractive error is influenced by surgeon factors such as incision size, distance of fixation suture from limbus, and tightness of suture material, according to our results, an IOL 0.75 D more hyperopic than predicted should be selected in transscleral fixation of IOL at 1.0 mm posterior from the limbus. Additionally, each surgeon should assess their specific results and modify the lens calculations accordingly.
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아파트 시공시 발생한 초기균열의 실태분석 및 대책에 관한 연구
안용선 嶺南大學校 工業技術硏究所 1997 工業技術硏究所論文集 Vol.25 No.1
The concrete crack is generally accepted as unavoidable one in concrete structure. As it is well known, the crack leads to the corrosion of reinforcing steel bar and finally weaks the inner structure endurance in concrete structure. Especially, the incipient crack originated from the construction of apartment houses, is often neglected as a minor problem in Korean construction sites. In case of the construction apartment houses, the occurrence place of crack is recognized well among the supervisors on sites, but the frequency number and width of crack are not known until now.The counterplan, accordingly, to prevent the crack has not been considered, because there is no reality condition such as the frequency and width of crack. Therefore, in this study, the reality of crack should be understood and the counterplan to avoid the crack in view points of design and construction is suggested. Finally, if it is difficult to find the cause of crack and its measure, the criteria of repairing should be established.
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안용선,이진아,조양경,Yong Sun Ahn,Jin A Lee,Yang Kyung Cho 대한안과학회 2014 대한안과학회지 Vol.55 No.2
Purpose: Corneal perforation from phlyctenular keratoconjunctivitis is rarely reported worldwide and no case has been reported in Korea. We report a case of corneal perforation in a patient with phlyctenular keratoconjunctivitis along with a literature review. Case summary: A 15-year-old female presented to our clinic with repetitive tears, conjunctival injection, and discomfort in her right eye for several months. Slit-lamp examination revealed oily plugs at the meibomian gland orifices with collarettes, conjunctival injection and a round, whitish elevated lesion accompanying neovascularization of the inferotemporal side of the cornea. As an initial treatment, topical antibiotic was given but no signs of improvement were observed. Hence, topical steroid was applied on suspicion of phlyctenular keratitis and the patient’s symptoms and corneal lesion improved. Two months later, the patient’s symptoms relapsed and the lesion was found progressing towards the central cornea. The treatment was restarted and the symptoms improved but the corneal lesion continuously progressed towards the center, thinning the central cornea. Seventeen months from the time of initial diagnosis, the patient revisited prior to the scheduled appointment complaining of abrupt tears in her right eye. Slit-lamp examination revealed a corneal perforation at the center of the thinned cornea. Hence, we performed an emergent tectonic corneal patch graft. After the operation, opacity remained covering the visual axis at the central cornea, thus penetrating keratoplasty was performed 10 months later. Henceforth, the patient has remained free of symptoms and visual acuity has been recovered. Conclusions: Usually phlyctenular keratoconjunctivitis responds well to treatment and does not have a significant influence on vision. However, occasionally phlyctenular keratoconjunctivitis may not respond to treatment and may spread to the central cornea causing loss of visual acuity and even corneal perforation in rare occasions. Therefore, in order to prevent such complications, prompt diagnosis and treatment are essential. J Korean Ophthalmol Soc 2014;55(2):298-303
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안용선,지동현 대한안과학회 2018 대한안과학회지 Vol.59 No.7
Purpose: The purpose of this study was to estimate the socioeconomic costs of glaucoma in Korea. It is to be used as an academic reference regarding policy making for the introduction of glaucoma screening tests in the national health check-ups. Methods: We estimated the socioeconomic costs of glaucoma from a societal perspective, which included medical, nonmedical, and productivity costs. The medical costs consisted of official and nonofficial medical costs, and the nonmedical costs consisted of transportation, time, and nursing costs. We used the National Health Insurance Service-National Sample Cohort 2002-2013 and the Korea Health Panel study. Results: The socioeconomic costs of glaucoma were estimated to be 3,000 billion Korean won (KRW) in 2013. These total costs were divided into 1,539 billion KRW (51.3%) for medical costs, 1,292 billion KRW (43.1%) for nonmedical costs, and 168 billion KRW (5.6%) for productivity costs. Conclusions: Glaucoma is a large economic burden from a societal perspective. The nonmedical and productivity costs, as well as the medical costs are especially high. Because the disease costs of glaucoma are expected to increase continuously, political support for early detection of glaucoma should be considered. 목적: 한국인에서 녹내장의 사회적 비용을 분석하여 추후 국가건강검진사업에 녹내장선별검사 도입의 학문적 근거를 제공하고자 한다. 대상과 방법: 사회적 관점에서 비용 분석을 시행하였으며, 비용 항목으로 의료비용, 비의료비용 그리고 생산성 손실비용을 분석하였다. 의료비용은 공식적 의료비용과 비공식적 의료비용으로 세분하였으며, 비의료비용은 교통비용, 시간비용, 간병비용으로 세분하였다. 자료원으로는 국민건강보험공단 표본 코호트 2002-2013년, 한국의료패널 등을 이용하였다. 결과: 2013년 녹내장의 사회적 비용은 약 2조 9,997억 원으로 추정되었다. 이 중 의료비용은 약 1조 5,393억 원(51.3%), 비의료비용은 약 1조 2,920억 원(43.1%), 그리고 생산성 손실비용은 약 1,683억 원(5.6%)이었다. 결론: 본 연구를 통해 녹내장의 사회적 비용이 상당하고, 특히 의료비용뿐만 아니라 비의료비용과 생산성 손실비용도 크다는 것을 알 수 있었다. 향후 녹내장의 질병비용은 지속적으로 늘어날 것으로 예상되므로 국가적으로 녹내장 조기 발견에 대한 정책적 뒷받침이 필요할 것이다.
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