중간포도막염에서 평면부유리체 절제술의 임상성적

김철구(Chul Gu Kim),김시영(Si Young Kim),김종우(Jong Woo Kim) 대한안과학회 1999 대한안과학회지 Vol.40 No.11

망막혈관종성증식에서 유리체강내 라니비주맙과 애플리버셉트 주입술의 단기 임상결과 비교

김오제(Oh Jae Kim),김재휘(Jae Hui Kim),김종우(Jong Woo Kim),이태곤(Tae Gon Lee),조성원(Sung Won Cho),이동원(Dong Won Lee),한정일(Jung Il Han),김철구(Chul Gu Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

목적: 망막혈관종성증식에서 유리체강내 라니비주맙과 애플리버셉트 주입술을 이용하여 치료한 6개월의 임상 결과를 보고하고자 한다. 대상과 방법: 망막혈관종성증식으로 진단 후 유리체강내 라니비주맙 혹은 애플리버셉트 주입술로 치료 받은 31안(28명)을 대상으로 후향적 의무기록 분석을 시행하였다. 진단 후 1개월 간격으로 3회의 주사 후, 이후에는 재발하는 경우 추가 치료를 시행하였다. 치료전 및 첫 번째 주사 후 3, 6개월에 최대교정시력 및 중심망막두께를 측정하여 비교하였다. 결과: 라니비주맙군은 16안, 애플리버셉트군은 15안이었다. 치료 전 및 치료 후 3개월, 6개월에 측정된 평균 최대교정시력(logMAR)은 라니비주맙군에서 0.78 ± 0.50, 0.47 ± 0.30, 0.59 ± 0.41, 애플리버셉트군에서 0.96 ± 0.52, 0.83 ± 0.52, 0.74 ± 0.56이고, 평균 중심망막두께는 라니비주맙군에서 315.75 ± 115.44, 188.38 ± 57.33, 218.50 ± 96.49 μm, 애플리버셉트군에서 249.00 ± 74.88, 143.73 ± 32.73, 196.73 ± 94.08 μm였다. 두 군 모두에서 진단 후 6개월에 측정된 최대교정시력은 진단 당시와 비교하여 유의하게 호전되었으며(p<0.05), 중심망막두께 역시 유의하게 감소하였다(p<0.05). 두 군 사이에 시력(p=0.770) 및 중심망막두께 (p=0.470)의 감소 정도는 유의한 차이가 없었다. 결론: 유리체강내 라니비주맙 혹은 애플리버셉트 주입술은 망막혈관종성증식 환자에서 시력을 호전시키고 황반두께를 정상화시키는데 효과적인 방법으로 생각된다. Purpose: To evaluate the 6-month outcomes of intravitreal ranibizumab and aflibercept treatment for patients with retinal angiomatous proliferation (RAP). Methods: A retrospective review of medical records of 28 patients (31 eyes) diagnosed with RAP was performed. All patients were initially treated with 3 consecutive intravitreal ranibizumab or aflibercept injections after diagnosis. Additional treatment was performed when exudation recurred. The best-corrected visual acuity (BCVA) and central foveal thickness were measured before the first injection and 3 and 6 months after the first injection. The values measured before the treatment were compared with those after treatment. Results: Sixteen eyes were treated with ranibizumab and 15 eyes with aflibercept. The logarithm of minimal angle of resolution (log MAR) values of BCVA before the first injection and 3 and 6 months after the first injection were 0.78 ± 0.50, 0.47 ± 0.30 and 0.59 ± 0.41 in the ranibizumab group and 0.96 ± 0.52, 0.83 ± 0.52 and 0.74 ± 0.56 in the aflibercept group, respectively. Central foveal thickness was 315.75 ± 115.44, 188.38 ± 57.33 and 218.50 ± 96.49 μm in the ranibizumab group and 249.00 ± 74.88, 143.73 ± 32.73 and 196.73 ± 94.08 μm in the aflibercept group, respectively. BCVA was significantly improved and central foveal thickness was significantly reduced at 6 months (p < 0.05) compared to measurements before the first injection in both groups. However, BCVA improvement and central foveal thickness were not significantly different between the 2 groups. Conclusions: Both intravitreal ranibizumab and aflibercept treatments were beneficial for both normalizing macular thickness and improving visual acuity in patients with RAP. The efficacy of the 2 drugs was not noticeably different.

백내장수술 후 발생한 스테노트로포모나스말토필리아 안내염: 임상양상, 항생제 감수성과 예후

김재민(Jae Min Kim),조한주(Han Joo Cho),김형석(Hyung Suk Kim),한정일(Jung Il Han),이동원(Dong Won Lee),김철구(Chul Gu Kim),김종우(Jong Woo Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.6

Purpose: To describe the clinical manifestations, treatment results, and antibiotic susceptibility in 6 cases of Stenotrophomonas maltophilia endophthalmitis. Methods: We retrospectively reviewed 6 eyes of 6 patients who were diagnosed with Stenotrophomonas maltophilia endophthalmitis. Specifically, we considered each patient s age, sex, past history, visual acuity, hypopyon, treatment, and prognosis. Results: For our study, we considered patients treated during the period of January 2008 to December 2015. Stenotrophomonas maltophilia (6 eyes) was the second most common gram-negative bacteria cause of total bacterial endophthalmitis while Pseudomonas aeruginosa (14 eyes) was the most common gram-negative bacteria cause during the same period. Visual disturbance was the dominant symptom being found in all 6 patients. Other symptoms include ocular pain and hypopyon. The initial visual acuity was light perception (1 patient), hand motion (3 patients), finger count (1 patient), and 0.02 (1 patient). Excluding the 1 patient with light perception, the mean initial visual acuity was logMAR 1.72 (Snellen equivalent; 20/1,049). Overall, 5 patients underwent vitrectomy and intravitreal antibiotics injection, while, the remaining other patient was treated with intravitreal antibiotics injection, followed by vitrectomy. All 6 patients showed sensitivity to Ceftazidime and Levofloxacin and 2 patients showed sensitivity to Trimethoprim/Sulfamethoxazole. Conclusions: Stenotrophomonas maltophilia endophthalmitis was the second most common gram negative organism to cause endophthalmitis after cataract surgery. All 6 of the tested isolates were found to be sensitive to ceftazidime and levofloxacin. Urgent treatment outcomes were similar to previous reports. J Korean Ophthalmol Soc 2017;58(6):663-669 목적: 백내장수술 후 발생한 Stenotrophomonas maltophilia 안내염의 임상 경과와 항생제 감수성, 그리고 치료 결과에 대해서 보고하 고자 한다. 대상과 방법: 2008년 1월과 2015년 12월 사이에 본원으로 안내염으로 의뢰되어 치료받은 환자 중 세균배양검사에서 Stenotrophomonas maltophilia 안내염이 확진된 환자 6명의 의무기록을 후향적으로 분석하였다. 결과: Stenotrophomonas maltophilia는 연구 기간 동안 확진된 그람 음성균 관련 안내염 중(총 23안)에서 Pseudomonas aeruginosa (14안) 다음으로 두 번째로 흔한 원인균(6안)이었다. 대상안들의 초진 시력은 light perception부터 0.02까지였다(평균 logMAR 1.72 [snellen equivalent; 20/1,049]). 초기 치료로서 모든 환자에서 vancomycin과 ceftazidime을 병합한 intravitreal antibiotics injections가 시행되었는데 5명에서는 일차적으로 유리체 절제술이 병행되었고, 1명에서는 일차적 항생제 주입 후 유리체 절제술이 추후에 추가적으로 시행되었다. 항생제 감수성 검사에서는 대상안 6안 모두 Ceftazidime과 Levofloxacin에 감수성을 보였고 Trimethoprim/Sulfamethoxazole 에는 2안에서 감수성을 보였다. 치료 후 6명의 대상안 중 5안에서 0.1 이상의 최종시력을 보였으며, 치료 후 초진시력에 비해 나쁜 시력을 보인 환자는 없었다. 결론: Stenotrophomonas maltophilia 그람 음성균 관련 안내염의 두 번째로 흔한 원인 균주였으며, 대상안 모두 ceftazidime과 Levofloxacin에 감수성을 보였다. 즉각적인 치료는 기존에 보고되었던 안내염의 치료 결과와 유사하였다.

라니비주맙 치료에 반응이 제한적인 습성황반변성에서 3회 애플리버셉트 주입술의 효과

김경민(Kyung Min Kim),김재휘(Jae Hui Kim),장영석(Young Suk Chang),김종우(Jong Woo Kim),김철구(Chul Gu Kim),이동원(Dong Won Lee) 대한안과학회 2017 대한안과학회지 Vol.58 No.1

Purpose: To evaluate the efficacy of 3 bimonthly aflibercept injections for neovascular age-related macular degeneration (AMD) that showed limited response to 3 initial ranibizumab injections. Methods: Three bimonthly aflibercept injections were performed for 21 eyes with neovascular AMD that was refractory to 3 monthly ranibizumab injections. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured at diagnosis, 1 month after 3 ranibizumab injections, and 1 month after 3 aflibercept injections, and these values were compared. Results: The mean logarithm of minimal angle of resolution (logMAR) BCVA at diagnosis, after ranibizumab therapy, and after aflibercept therapy was 0.62 ± 0.29, 0.73 ± 0.31, and 0.65 ± 0.28, respectively. The CRT at the aforementioned times was 427.0± 98.7 μm, 409.5 ± 78.7 μm, and 315.9 ± 98.2 μm, respectively. When compared with the value measured after ranibizumab therapy, CRT was significantly decreased after aflibercept therapy (p < 0.001), whereas there was no significant difference in BCVA(p = 0.092) between the two times. Improved BCVA was noted in 8 eyes (38.1%) after aflibercept therapy and BCVA was unchanged in 11 eyes (52.4%). Decreased CRT was noted in 18 eyes (85.7%) after aflibercept therapy. Conclusions: Three bimonthly aflibercept injections were found to be useful in terms of improving or maintaining visual acuity, as well as reducing retinal thickness in neovascular AMD that showed limited response to 3 initial ranibizumab injections. 목적: 최초 3회 라니비주맙 주입술에 반응이 제한적인 습성황반변성을 대상으로 한 2개월 간격 3회 애플리버셉트 주입술의 임상 결과를 알아보고자 한다. 대상과 방법: 습성황반변성으로 진단된 후 1개월 간격으로 3회 라니비주맙 주입술을 시행 받았으나 반응이 없어 2개월 간격으로 3회 애플리버셉트 주입술을 추가로 시행 받은 21명의 환자를 대상으로 후향적 의무기록 분석을 시행하였다. 진단 시, 라니비주맙 치료후 1개월 및 애플리버셉트 치료 후 1개월에 측정된 시력과 중심망막두께를 서로 비교하였다. 결과: 최초 진단 시, 라니비주맙 치료 후, 및 애플리버셉트 치료 후 측정된 평균 logarithm of minimal angle of resolution (logMAR) 시력은 각각 0.62 ± 0.29, 0.73 ± 0.31 및 0.65 ± 0.28이었으며, 중심망막두께는 각각 427.0 ± 98.7 μm, 409.5 ± 78.7 μm 및 315.9 ± 98.2 μm였다. 라니비주맙 주입술 후와 비교하였을 때 애플리버셉트 주입술 후 유의한 중심망막두께의 감소가 나타났으나(p<0.001) 시력은 차이가 없었다(p=0.092). 애플리버셉트 주입술 후 시력이 호전된 경우는 8안(38.1%)이었으며, 11안(52.4%)의 경우 시력의 변화가 없었다. 애플리버셉트 주입술 후 18안(85.7%)에서 중심망막두께가 감소하였다. 결론: 최초 3회 라니비주맙 주입술에 반응이 제한적인 환자를 대상으로 한 2개월 간격 3회 애플리버셉트 주입술은 시력을 유지시키거나 호전시키고 망막 두께를 감소시키는 데 유용한 치료 방법으로 생각된다.

습성 나이관련황반변성으로 진단된 90세 이상 초고령 환자의 특성

이윤곤(Youn Gon Lee),한상윤(Sang Yun Han),한재욱(Jae Wook Han),김종우(Jong Woo Kim),김철구(Jong Woo Kim),이동원(Youn Gon Lee),김재휘(Jae Hui Kim) 대한안과학회 2018 대한안과학회지 Vol.59 No.5

Purpose: To evaluate the characteristics of patients aged ≥ 90 years who were diagnosed with neovascular age-related macular degeneration (AMD). Methods: A retrospective review of medical records was performed for 44 patients aged ≥ 90 years diagnosed with neovascular AMD. History of cerebrovascular or cardiovascular disorder and visual acuity at diagnosis were assessed. Fellow eye visual acuity data were also collected. When the fellow eye visual acuity was worse than 0.5, the primary reason for the visual deterioration was identified. Results: The mean patient age was 91.5 ± 1.5 years (range: 90–95 years). Ten (22.7%) patients had histories of cerebrovascular or cardiovascular disorders. The mean logarithm of the minimal angle of resolution (logMAR) of visual acuity was 1.11 ± 0.51 and the visual acuity was worse than 0.1 in 20 eyes (45.5%). The fellow eye visual acuity was worse than 0.5 in 26 eyes (59.1%). The primary reason was neovascular or atrophic AMD in 23 eyes (88.5%). Conclusions: The incidence of cerebrovascular or cardiovascular disorders was relatively high in patients aged ≥ 90 years. Patients also had poor visual acuity at diagnosis and a high incidence of fellow eye visual deterioration. These systemic conditions should be considered when treating these patients. Additionally, a regular ophthalmic examination is recommended for the early detection of these disorders. J Korean Ophthalmol Soc 2018;59(5):444-450

증식당뇨망막병증 환자의 유리체절제술의 임상 분석

김철구(Chul Gu Kim),정연철(Yeon Chul Jung),김종우(Jong Woo Kim) 대한안과학회 1998 대한안과학회지 Vol.39 No.1

분지망막정맥폐쇄에 동반된 황반부종 환자에서 덱사메타손 유리체강내 삽입물의 단기임상결과

강선아,김종우,김철구,이태곤,유영주,김재휘,Sun Ah Kang,Jong Woo Kim,Chul Gu Kim,Tae Gon Lee,Young Ju Lew,Jae Hui Kim 대한안과학회 2015 대한안과학회지 Vol.56 No.1

Purpose: To evaluate short-term outcomes of intavitreal dexamethasone implant in macular edema secondary to branch retinal vein occlusion (BRVO). Methods: A retrospective review of medical records was performed for 24 patients (24 eyes) who were diagnosed with macular edema secondary to BRVO. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured before the injection and at 1 and 3 months after the injection. The values measured before and after the treatment were compared. In addition, the association between duration of symptoms and 3-month changes in BCVA was evaluated. Results: In 24 eyes, the logarithm of minimal angle of resolution BCVA before the injection and 1 and 3 months after the injection was 0.56 ± 0.25, 0.42 ± 0.26 and 0.45 ± 0.27, respectively. The CFT was 550.2 ± 116.5 μm, 270.3 ± 101.5 μm, and 356.6 ± 173.7 μm, respectively. When compared with the baseline values, the BCVA at 3 months was significantly improved (p = 0.018) and the CFT was significantly decreased (p < 0.001). There was a significant negative association between the duration of symptoms and 3-month changes in BCVA (p = 0.032, r = -0.375). Elevated intraocular pressure was observed in 3 eyes (12.5%). Conclusions: Intravitreal dexamethasone implant was found effective in treating macular edema secondary to BRVO. However, rebound macular edema and deterioration in visual acuity after 1 month suggest further studies with longer follow-ups are necessary. J Korean Ophthalmol Soc 2015;56(1):39-46

23게이지와 20게이지를 병합한 경결막 무봉합 유리체절제술

진선영,최문정,김철구,김종우,Sun Young Jin,Moon Jeong Choi,Chul Gu Kim,Jong Woo Kim 대한안과학회 2008 대한안과학회지 Vol.49 No.1

`Purpose: To describe the clinical experience and safety profile of a combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy (TSV) Methods: Thirty-seven eyes of thirty-seven consecutive patients who underwent 23-gauge combined with 20-gauge transconjunctival vitrectomy surgery by a single surgeon from August 2006 through December 2006 were reviewed retrospectively for surgical indications, wound problems, and postoperative complications. Results: Thirty-seven eyes, including eyes with proliferative diabetic retinopathy (n=24), macular hole (n=3), epiretinal membrane (n=3), vitreous hemorrhage due to branch retinal vein occlusion and choroidal neovascular membrane (n=3), vitreous opacity secondary to uveitis (n=1), rhegmatogenous retinal detachment (n=1), and vitreoretinal traction syndrome (n=1), underwent operation. Seven eyes at 23-gauge sclerotomy sites and 15 eyes at 20-gauge sclerotomy sites had subconjunctival hemorrhage. Three eyes required sutures at 20-gauge sclerotomy sites intraoperatively due to wound leakage. One wound hemorrhage occurred at a 23-guage sclerotomy site. Vitreous hemorrhage (4 eyes), hyphema (2 eyes), and vitreous hemorrhage with hyphema (1 eye) occurred postoperatively. Postoperative hypotony, retinal detachment, and other complications did not occur. Conclusions: A combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy which was created by modifying transconjunctival sutureless vitrectomy systems published previously guarded against sclerotomy wounds and a variety of vitreoretinal surgical indications.`

당뇨황반부종 환자에서 이미지 압축이 빛간섭단층촬영 결과 해석에 미치는 영향

강선아,장영석,김종우,김철구,이태곤,김재휘,Sunah Kang,Young Suk Chang,Jong Woo Kim,Chul Gu Kim,Tae Gon Lee,Jae Hui Kim 대한안과학회 2014 대한안과학회지 Vol.55 No.9

Purpose: To evaluate the influence of image compression on optical coherence tomography (OCT) images in eyes with diabetic macular edema (DME).Methods: Twenty eyes of 30 patients diagnosed with DME were included in this retrospective observational case series. Horizontal OCT scans centered at the center of the fovea were conducted using spectral-domain OCT (Spectral OCT/SLO<SUP>Ⓡ). The images were exported to Tag Image File Format (TIFF) and then transformed to 10, 5, and 1 quality of Joint Photographic Experts Group (JPEG) format using Photoshop. OCT images were taken before and after intravitreal bevacizumab injection. The presence of intraretinal fluid, foveolar detachment, and photoreceptor inner segment/outer segment (IS/OS) disruption were evaluated in each image. Results: The mean (+/- standard deviation) size of TIFF images and 10, 5 and 1 quality JPEG images were 1712.0, 183.3 ± 6.8, 90.9 ± 4.3, 42.8 ± 1.4 kilobytes (KB), respectively, before the injection and 1712.0, 189.5 ± 9.1, 94.9 ± 5.6, 43.4 ± 1.8 KB, respectively, after the injection. The presence of intraretinal fluid, foveolar detachment, and photoreceptor IS/OS disruption identified in TIFF images was also identified in the compressed JPEG images. Conclusions: Quality of retinal OCT image did not influence the estimation of DME despite the JPEG image being compressed to approximately 1/40 of the original TIFF image size. J Korean Ophthalmol Soc 2014;55(9):1320-1326

황반원공 수술 후 중심와 주변 미세구조 변화의 장기 결과

정성헌,김재휘,김종우,김철구,이태곤,조성원,Seong Hun Jeong,MD,Jae Hui Kim,MD,Jong Woo Kim,MD,Chul Gu Kim,MD,Tae Gon Lee,MD,Sung Won Cho,MD 대한안과학회 2013 대한안과학회지 Vol.54 No.11

Purpose: To evaluate long-term outcome of foveal tissue elongation after macular hole (MH) surgery. Methods: This retrospective, observational case series was performed on patients who underwent MH surgery and were followed-up more than 12 months. Distance between the parafoveal edge of the outer plexiform layer (OPL) was defined as the inter-OPL distance and measured using optical coherence tomography images at 5 to 8 months postoperatively and at the last follow-up. The horizontal and vertical inter-OPL distances were compared between the 2 defined time points. In addition, further elongation of the foveal tissue in certain directions was defined as asymmetric elongation and was compared between the defined time points. Results: The early and late postoperative examination was performed at 6.3 ± 1.1 (mean ± standard deviation) months and 22.7 ± 7.8 months, respectively. The horizontal inter-OPL distance was 552.3 ± 130.5 μm and 502.8 ± 139.3 μm at the defined time points, respectively and the vertical inter-OPL distance was 478.9 ± 107.2 μm and 447.5 ± 107.1 μm, respectively. Both horizontal and vertical inter-OPL distances were significantly shortened at the last postoperative examination (p < 0.001, p = 0.002, respectively). The degree of asymmetric elongation was 10.8 ± 6.5% and 11.8 ± 7.9% at the defined time points, respectively, and was not different between the defined time points (p = 0.426). Conclusions: The long-term shortening of foveal tissue after MH surgery without progression of asymmetry may partially contribute to the long-term recovery of visual function after MH surgery. J Korean Ophthalmol Soc 2013;54(11):1731-1736