Stargardt씨 병 1예와 Fundus Flavimaculatus 1예

온영훈 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Stargardt disease was first recognized in 1909. Stargardt's description of this disease included a juvenile onset of poor central vision with distinctive macular changes, bilaterality, slow progression, and hereditary. In 1963, Franceschetti et al drew attention to the presence of pisciform flecks in the macula and midperiphery, and named this phenotype "Fundus Flavimaculatus". The macular region can be detected in almost 50% of the fundus flavimaculatus. However, these diseases are considered one disease-category at now. We have recently seen macular dystrophy occuring in a 13-years-old boy, whose chief complaints was the severe decrease of the vision for 2 years. A dilated fundus examination was reveled a definitely atophic macular lesion("Bull's eye") surrounded by many yellow flecks in the paracentral region in the both eyes. A fluorescein angiogram demonstrated the hypofluorescence in the center and the multiple fluorescent spots with outlines. Based on these results, a diagnosis of Stargardt disease was made. In other hands, we coudln't find any specific findings in his past and family histories. But the inheritance of Stargardt disease is mostly autosomal recessive, despite some reports of dominantly-inherited or sporadic Stargardt disease. So the fact of the abscence of family history can't exclude the Stargardt disease. We experienced another case, a 45-years-old female. She visited our hospital for general work-up of body. We noticed her fundus abnormalities, but her best corrective visual acuity was 1.0 in the both eyes. A dilated fundus examination was revealed multiple yellow flecks in the midperipheral retina, but no macular lesion. A fluorescein angiogram demonstrated the multiple granular hypofluorescence spots corresponding the fundus findings. The results of the visual field test, electroretinogram, multifocal electroretinogram were normal. This case was diagnosed to fundus flavimaculatus. The purpose of this article are to report of a case of Stargardt disease and a case of fundus flavimaculatus, and to review the disease.

Multifocal Electroretinogram의 원리와 임상

온영훈 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.2

Purpose: To compare the Multi-focal electroretinogram(ERG) system to conventional Ganzfeld and focal ERGs obtained from patients with known retinal diseases in order to assess its clinical applicability. Methods: A multi-input system analysis was used to explore the field topography of ERG responses to local luminance modulaton in patients with retinitis pigmentosa, pericentral pigmentary retinal dystrophy, branch retinal arterial occlusion or idiopathic macular hole. Results: The dysfunctional areas measured by multifocal ERG were well compatible to those assumed by combined findings of Ganzfeld and focal ERGs However, the wave shapes of multi-focal ERG in the retina with arterial occlusion differed from those of conventional focal ERG, suggesting that the negative and negative and positive deflections shown in the first order kernel of multi-focal ERG may not correspond to conventional a - and b- waves of ERG. Conclusions: The multi-focal ERG system is available for electroretinographic field mapping at the clinical level.

정상안에서 Pressure Eye Patch가 외안부에 미치는 영향

김재호,온영훈,신환호,정순국 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.1

Immobilizaiton of eyelids by pressure eye patch may relieve photophobia and some ocular pain. Although many ophthalmologists prefer pressure eye patch after operation and ocular trauma, it was not considered that eye patch may induce some ocular symptoms. We therefore studied the effects of pressure eye patch in normal eyes of healthy young adults. Thirty two medical students and doctors participated in this study. The pressure eye patch in normal eyes of healthy young adults. Thirty two medical students and doctors participated in this study. The pressure eye patch was applied for 14 hours on one eye of participants. Both eyes of all participants were examined twice, before and after patching. The examination included opthalmic examination and questionnaire of subject symptoms. Each symptom and sign was graded on a scale from 0 to 3. The scores were statistically evaluated by using the the Wilcoxon signed-rank test. In group 1 (patched eyes), 30 of 32 participants had clinical symptoms and signs. In comparison between group 1 (patched eyes) and group 2 (unpatched eyes), participants in the group 1 had more symptoms and signs such as discomfort (P<0.01), itching (P<0.01), congestion (P<0.01) and irregular astigmatism (P<0.01). Thus we concluded that complicaitons of varialbe severity and shape were induced by eye patch in normal eyes. So we considered that Eye Patch ater operation and trauma may contribute the above mentioned complicaitons and we must doing this procedure cautously.

야간 응급실 당직의사의 안외상환자 처치의 적절성에 대한 고찰

신환호,온영훈,최병수 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.1

Proper management in ocular injured patients is important in prognosis of visual acuity. The authors performed census on the management and treatment of ocular injured patients by 63 doctors in emergency room of 63 hospitas and clinics at night in Seoul. The data were obtained during 2 month period from Nov. 1 1994 to Jan. 31 1995. Interns(62%) were common doctors in emergency room at night. Work period ranged from 1 to 6 months in most cases(33%). Ocular injuries were included: lid laceration(33%), periorbital contusion(24%), corneal laceration(10%), subconjunctiveal hemorrhage(8%). The common management in the emergency room was primar repair(48%). The majority of severe ocular injured patients, such as corneal laceration and scleral laceration, was referred to teh university hospitals(75%). When patients were referred, 8 doctors notified to the ophthalmologist of referred hospitals. The common time inteval between visit of emergency room and transfer of patients was within 30 minutes. These results suggest that doctors in emergency room were passive and inappropriate managements to ocular injured patients. And we think that education is needed to medical students, general physicians, interns and residents.

식욕억제제에 의한 일시적 근시와 급성폐쇄각녹내장 발생 증례보고

노규화,이우진,장지호,정진권,온영훈 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.2

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한가족에 발생한 가족성 삼출성 초자체망막증

온영훈(Young Hoon Ohn),신환호(Han Ho Shin),최병수(Byung Su Choi),박성희(Song Hee Park) 대한안과학회 1995 대한안과학회지 Vol.36 No.4

다국소 망막전위도검사의 임상적 응용

온영훈 ( Young Hoon Ohn ),안용석 ( Yong Suk Ahn ) 대한안과학회 2002 대한안과학회지 Vol.43 No.10

알코올성 간경화에서 발생한 망막출혈 2예

온영훈(Young Hoon Ohn),박태관(Tae Kwann Park),한정우(Jung Woo Han),서두리(Du Ri Seo),김영신(Young Shin Kim) 대한안과학회 2015 대한안과학회지 Vol.56 No.8

목적: 알코올성 간경화에서 발생한 빈혈과 혈소판감소증으로 망막출혈 2예를 경험하였기에 이를 보고하고자 한다. 증례요약: (증례 1) 알코올성 간경화로 소화기내과에 입원 치료 중 양안의 시력저하가 발생한 45세 여자로, 안저검사상 양안의 황반부를 포함하는 다수의 망막전출혈 및 망막하출혈이 관찰되었다. 혈액학적 검사상 심한 빈혈과 혈소판감소증이 관찰되었다. 수혈로 혈액학적 이상을 교정하였고, 증상 발생 후 1개월째 시력은 호전되고, 망막출혈은 감소되었다. (증례 2) 알코올성 간경화로 간 이식을 시행받은 후 3일 뒤 호소한 좌안 시력저하로 의뢰된 47세 남자 환자로, 안저검사상 좌안 황반부를 포함하는 다수의 망막전출혈이 양안에서 관찰되었다. 간 이식 당시 심한 빈혈과 혈소판감소증이 관찰되어 수혈로 이를 교정하였다. 증상 발생 후 3개월째 좌안 시력이 호전되었고, 망막출혈은 대부분 흡수되었다. 결론: 알코올성 간경화로 인해 발생하는 혈액학적 이상으로 망막출혈이 발생할 수 있다. 정기적인 경과관찰로 망막출혈의 감소와 시력의 회복을 확인하였다. Purpose: To report 2 cases of retinal hemorrhage due to anemia and thrombocytopenia in patients with alcoholic cirrhosis. Case summary: (Case 1) A 45-year-old female with alcoholic cirrhosis who was treated in the gastroenterology department pre-sented with reduced vision in both eyes. Fundus examination showed multiple preretinal and subretinal hemorrhages with mac-ular involvement in both eyes. Hematological findings revealed severe anemia and thrombocytopenia. One month after the transfusion treatment her visual acuity was improved and retinal hemorrhages resolved. (Case 2) A 47-year-old male presented with painless loss of vision in the left eye 3 days after orthotopic liver transplantation for the treatment of alcoholic cirrhosis. Fundus examination showed preretinal hemorrhages in both eyes with macular involvement in the left eye. During the trans-plantation, hematological findings revealed severe anemia and thrombocytopenia. Three months after the transfusion treatment his visual acuity was improved and retinal hemorrhages nearly completely resolved. Conclusions: Hematological abnormalities due to alcoholic cirrhosis can cause retinal hemorrhage. In the present cases the reti-nal hemorrhages were resorbed and the visual acuity recovered.

근시의 정도에 따른 안압, 뇌척수압 및 사상판경유압력차의 관계

나승관(Seung Kwan Nah),온영훈(Young Hoon Ohn),김찬윤(Chan Yun Kim),이시형(Si Hyung Lee) 대한안과학회 2018 대한안과학회지 Vol.59 No.6

목적: 한국인에서 근시와 안압, 뇌척수압, 사상판경유압력차 간의 관계를 알아보고자 하였다. 대상과 방법: 본 연구는 2008년부터 2012년까지 시행한 국민건강영양조사자료를 바탕으로 19세 이상의 성인 6,933안을 대상으로 젊은 연령군(19-49세, Group 1)과 고령군(≥50세, Group 2)으로 분류하였다. 추정뇌척수압은 ‘cerebrospinal fluid pressure(mmHg)=0.44×신체비만지수(kg/m2)+0.16×이완기혈압(mmHg)-0.18×나이(years)-1.91’ 공식을 사용하였다. 사상판경유압력차는 안압에서 추정뇌척수압수치를 제하여 구하였다. 결과: 전체 환자군에서, 평균추정뇌척수압은 13.7 ± 0.1 mmHg (Group 1: 14.2 ± 0.1 mmHg, Group 2: 11.5 ± 0.1, p<0.01)였고 평균 안압은 14.0 ± 0.1 mmHg (Group 1: 14.0 ± 0.1 mmHg, Group 2: 14.1 ± 0.1, p=0.724)였으며, 평균사상판경유압력차는 0.7 ± 0.1mmHg (Group 1: 0.3 ± 0.1 mmHg, Group 2: 3.0 ± 0.2, p<0.001)였다. 혼란변수를 보정한 후 시행한 다중선형회귀분석에서 근시의 정도와 추정뇌척수압 간의 양의 상관관계를 가졌으며(p<0.001; β: 0.12, spherical equivalent [SE]: 0.03), 이는 안압에서도 마찬가지였다(p<0.001; β: 0.29, SE: 0.05). 결과적으로 근시가 심할수록 높은 사상판경유압력차와 연관이 있었다(p=0.002; β: 0.18, SE: 0.06). Group 1과 Group 2로 나눠 시행한 분석에서 Group 1은 비슷한 연관성을 보였으나(추정뇌척수압: p<0.001; β: 0.12, SE: 0.03; 안압: p<0.001; β: 0.28, SE: 0.05; 사상판경유압력차: p=0.005; β: 0.17, SE: 0.06), Group 2에서는 사상판경유압력차와 근시의 정도와의 관계가 통계적으로 유의하지 않았다(p=0.274; β: 0.18, SE: 0.16). 결론: 한국인에서 공식으로 계산한 사상판경유압력차는 근시의 정도와 연관이 있으며, 이는 근시가 녹내장의 발병과 진행에 영향을 미치는 병리기전에 사상판경유압력차 증가가 기여할 수 있음을 나타낸다. Purpose: To investigate the relationships between myopia and the three parameters of intraocular pressure (IOP), estimated cerebrospinal fluid pressure (CSFP), and the trans-lamina cribrosa pressure difference (TLCPD). Methods: A total of 6,933 adults (≥19 years of age) who participated in the Korea National Health and Nutrition Examination Survey (2008–2012). These subjects were divided into two groups: young age group (19–49 years of age) and old age group (≥50 years of age). The estimated CSFP was calculated as CSFP (mmHg) = 0.44 body mass index (kg/m2) + 0.16 diastolic blood pressure (mmHg) - 0.18 age (years) - 1.91. The TLCPD was calculated by subtracting the CSFP from the IOP. Results: The mean estimated CSFP in the total population was 13.7 ± 0.1 mmHg (young, 14.2 ± 0.1 mmHg; old, 11.5 ± 0.1; p <0.01), the mean IOP in the total population was 14.0 ± 0.1 mmHg (young, 14.0 ± 0.1 mmHg; old, 14.1 ± 0.1; p = 0.724), and the mean TLCPD in the total population was 0.7 ± 0.1 mmHg (young, 0.3 ± 0.1 mmHg; old, 3.0 ± 0.2; p < 0.001). After adjusting for confounding factors, multivariate linear regression analyses revealed significant positive associations between the degree of myopia and the estimated CSFP (p < 0.001; β, 0.12; spherical equivalent [SE], 0.03), as well as IOP (p < 0.001; β, 0.29; SE, 0.05). As a result, a higher TLCPD also showed a significant association with more myopic refractive error (p=0.002; β, 0.18; SE, 0.06). In subgroup analyses, a similar association was shown only in the young age group (estimated CSFP, p < 0.001; β, 0.12; SE, 0.03; IOP, p < 0.001; β, 0.28; SE, 0.05; TLCPD, p = 0.005; β, 0.17; SE: 0.06), while the old age group did not show a significant association between TLCPD and the degree of myopia (p = 0.274; β, 0.18; SE, 0.16). Conclusions: The calculated TLCPD showed an association with high myopia. It was consistent with the potential role of high myopia in the pathogenesis of open-angle glaucoma.

Changes in Electroretinogram Parameters after Panretinal Photocoagulation in Diabetic Retinopathy

Young Keun Han,Si Hyung Lee,Chan Hee Moon,Young-Hoon Ohn 순천향대학교 순천향의학연구소 2014 Journal of Soonchunhyang Medical Science Vol.20 No.1

Objective: This study was performed to evaluate the effect of panretinal photocoagulation (PRP) on parameters of electroretinograms (ERG). Methods: Retrospective study was performed on 58 eyes of 29 patients with proliferative diabetic retinopathy (PDR) who underwent PRP. ERG was performed in each patient before and after PRP, and each ERG parameters were compared between the preand post-PRP state. Also, the results of ERG performed after PRP were compared between two groups: one group showing obvious new vessels regression and the other group showing poor regression after PRP. Results: Marked reduction in amplitude and delay in implicit time were observed in all patients (P<0.05). The results also showed larger reduction of amplitude and delay in implicit time in b-wave than a-wave (P<0.05). There were no significant differences in ERG parameter changes after PRP between the group showing obvious new vessel regression and the group showing poor new vessel regression after PRP (P>0.05). Conclusion: PRP in diabetic retinopathy patients may affect not only the outer retina but also the cells within the inner nuclear layer, causing changes in ERG parameters. However, ERG was not a good indicator for representing the amount of new vessel regression in PDR.