제 1형 신경섬유종증 환자에서 발생한 절반-망막중심정맥폐쇄

이연희,김경남,신경섭,김정열,Yeon Hee Lee,MD,Kyoung Nam Kim,MD,Kyoung Sup Shin,MD,Jung Yeul Kim,MD 대한안과학회 2010 대한안과학회지 Vol.51 No.1

Purpose: We report on a case of hemi-central retinal vein occlusion (Hemi-CRVO) which occurred in a patient with Type 1 neurofibromatosis. Case summary: A 31-year-old woman presented with a chief complaint of a one-month history of decreased visual acuity in the left eye. The patient had Type 1 neurofibromatosis but had no other systemic diseases. The best corrected visual acuity (BCVA) was 0.8 in the right eye and 0.05 in the left eye. Multiple Lisch nodules were present in the irises of both eyes on slit lamp examination. Fundus examination revealed a hemi-central retinal artery occlusion in the left eye. Optical coherence tomograms showed that the central macular thickness was 192 microns in the right eye and 732 microns in the left eye. There was cystoid macular edema in the left eye. A fluorescein angiogram showed delayed filling in the superior branch retinal vein of the left eye. There was an extensive area of non-perfusion of the retinal capillary in the corresponding area, including the perifoveal area. Blood tests for hyper-coagulability, autoimmune disorders, connective tissue disorders and other tests for the brain and carotid artery and coronary artery disease showed no abnormal findings. The clinical course was monitored following an intravitreal injection of bevacizumab (AvastinⓇ). Eight months later, the BCVA had improved to 0.2. Conclusions: Although it is rare, hemi-CRVO occurring in younger patients who have no underlying diseases could be related to neurofibromatosis. J Korean Ophthalmol Soc 2010;51(1):150-154

섬모체망막동맥폐쇄가 첫 임상 증후로 나타난 안매독 환자 1예

이연희,남기엽,김정열,Yeon Hee Lee,Kiyup Nam,Jung Yeul Kim 대한안과학회 2011 대한안과학회지 Vol.52 No.10

Purpose: To report a case of a neurosyphilis patient with cilioretinal artery occlusion as the first manifestation. Case summary: A 58-year old man presented with a visual impairment which developed 5 days earlier in his right eye. During initial evaluation, the visual acuity in the right eye was 0.02. On fundus examination, a whitening adjacent to the macula was observed and fluorescein angiography showed filling delay and late leakage of the cilioretinal arteries. The patient was diagnosed with cilioretinal artery occlusion. Two weeks after his initial visit, visual acuity in the patient’s right eye improved to 0.7 and retinal whitening was decreased on fundus examination. Three months later, a visual decrease in the right eye reoccurred and the visual acuity was 0.01. Anterior chamber cell reaction with hypopyon was observed on slit lamp examination and vitreal opacity was noted during fundus examination. Among the numerous tests performed in order to determine the cause of uveitis, RPR antibody and treponemal antibody were found positive. The patient was diagnosed with neurosyphylis and 2 weeks after intravenous administration of penicillin, visual acuity improved to 0.7 and anterior chamber cell reaction as well as vitreal opacity decreased. Conclusions: The authors reported a case of cilioretinal artery occlusion suspected secondary to neurosyphilis. J Korean Ophthalmol Soc 2011;52(10):1254-1258

갑상샘눈병증과 관련된 사시의 자연경과

이연희,황정민,오세열,Yeon Hee Lee,M,D,Jeong Min Hwang,M,D,Sei Yeul Oh,M,D 대한안과학회 2006 대한안과학회지 Vol.47 No.12

Purpose: This study investigated the natural course of strabismus associated with thyroid ophthalmopathy. Methods: A retrospective review was performed on the medical records of 31 patients with strabismus associated with thyroid ophthalmopathy who had been followed up for more than 6 months and had not received surgery. For the purpose of this study, a significant change of deviation angle was defined as more than 10 prism diopters in the primary position. Results: Forty-two percent of patients showed a significant change in deviation angle during the observation period of 23.8±17.7 months. The direction of the change was vertical in 32%, horizontal in 3%, and vertical and horizontal in 6% of patients. A significant change of deviation angle developed in 30% of patients within 6 months from the initial ophthalmologic examination, in 24% between 6 and 12 months, and in 13% of patients between 12 and 18 months from the initial examination. Conclusions: Although the deviation angle of strabismus associated with thyroid ophthalmopathy tended to stabilize with time, it nonetheless was susceptible to change even 12 months after the initial ophthalmologic examination. In addition, a vertical change in the deviation angle was more frequent than a horizontal change

갑상샘눈병증에서 심한 사시각변화를 보인 1예

이연희,왕선진,황정민,Yeon-Hee Lee,Seon Jin Wang,Jeong-Min Hwang 대한안과학회 2008 대한안과학회지 Vol.49 No.8

Purpose: We report a patient with strabismus associated with thyroid ophthalmopathy whose condition changed remarkably for 6 years of a natural course. Case summary: A 69-year-old woman with Graves' disease presented with diplopia in April 1999. On examination, she showed left hypotropia of 50 prism diopters (Δ) accompanied by supraduction limitation and lid lag in the left eye. She was diagnosed with strabismus associated with thyroid ophthalmopathy and was observed without any intervention. In October 2000, her left hypotropia decreased to 16Δ, and esotropia of 14Δ developed. Both eyes showed limitation of supraduction, and the left eye showed limitation of abduction. In December 2003, the esotropia increased to 35Δ, and the direction of vertical strabismus changed to 40Δ of right hypotropia. Supraduction limitation of the right eye and abduction restriction of both eyes increased, and infraduction limitation of the left eye developed. In April 2005, esotropia increased to 75Δ, and the amount of right hypotropia was 35Δ. The abduction limitation of both eyes increased. Conclusion: The natural course of strabismus associated with thyroid ophthalmopathy can show continuous and remarkable changes. J Korean Ophthalmol Soc 49(8):1350-1355, 2008

특발성 비대경수막염에 동반된 급성 양안 시력 소실

이연희,김정열,남기엽,Yeon-Hee Lee,MD,Jung Yeul Kim,MD,Ki Yup Nam,MD 대한안과학회 2011 대한안과학회지 Vol.52 No.7

Purpose: To report a case of bilateral optic neuropathy related with idiopathic hypertropic pachymeningitis. Case summary: A 66-year old woman presented with acute visual loss that developed 6 days previously in the right eye and 3 days prior in the left eye. During the initial evaluation, her visual acuity was light perception in the right eye and counting fingers at 30 cm in the left eye. A relative afferent papillary defect (RAPD) was noted in the patient’s right eye. On brain MRI, the duramater was thickened and enhanced by contrast. The erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) level were increased and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) as positive. Other neurological and medical abnormalities were not found. Under the suspicion of bilateral optic neuropathy due to idiopathic hypertrophic pachymeningitis, the patient was treated with methylprednisolone pulse therapy. Two days after the treatment, the visual acuity was hand movements at 20 cm in the right eye and 0.6 in the left eye. Three months after the treatment, the visual acuity was counting fingers at 20 cm in the right eye, and 0.7 in the left eye. The right eye showed optic disc pallor and diffuse retinal nerve fiber layer (RNFL) defect. The left eye showed a suspicious RNFL defect, and was otherwise normal. Conclusions: The authors report a rare case of optic neuropathy related with idiopathic hypertrophic pachymeningitis. Idiopathic hypertrophic pachymeningitis should be considered as one of the various causes of optic neuropathy. J Korean Ophthalmol Soc 2011;52(7):893-896

Ciprofloxacin , HK - 3140 , Norfloxacin , Ofloxacin 에 대한 Escherichia coli 저항균주의 특성

이연희,김경순,편희은,박원봉,박명환,김완주 ( Yeon Hee Lee,Kyung Soon Kim,Hee En Pyun,Woon Boong Park,Myung Hwan Park,Wan Joo Kim ) 생화학분자생물학회 1992 BMB Reports Vol.25 No.2

Resistant strains of Escherichia coli were obtained against ciprofloxacin, ofloxacin, norfloxacin and HK-3140. Each resistant strain showed cross-resistance to other quinolones and peniciline-G. To find out the resistant mechanism, lipid and outer membrane proteins of the cells were separated and analyzed with gas chromatography and SDS denaturing gel electrophoresis. Lipid profiles from sensitive and resistant cells showed no big differences while outer membrane protein profiles showed a large variation. Sensitive cells showed better uptake of quinolone than resistant cells suggesting that the resistance against quinolone was resulted from the change in permeability through the outer membrane proteins.

개방성 안구손상 환자의 시력 예후 인자와 안외상점수의 예측도

이연희,곽주영,이성복,Yeon Hee Lee,MD,Joo Young Kwag,MD,Sung Bok Lee,MD,PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.6

Purpose: To determine the prognostic factors of visual outcome in open globe injury and to assess the possibility of an ocular trauma score (OTS) model of predictive value in open globe injuries in Koreans. Methods: The medical records of 242 patients with open globe injury from 2000 to 2010 were retrospectively reviewed. Prognostic factors of visual outcome, positive predictive rate, and negative predictive rate were surveyed. Results: In the multivariate analysis, old age, relative afferent pupillary defect, impaired initial visual acuity and retinal detachment were the worst predictive factors of vision survival. In OTS categories 1 and 2, worse final visual acuity was acquired, and positive predictive rate and negative predictive rate for assessment of final visual acuity less than 0.02 were 70.1% and 89.8%, respectively. Conclusions: The prognostic factors of open globe injury associated with impaired final visual acuity were old age, relative afferent pupillary defect, worse initial visual acuity, retinal detachment and OTS categories 1 and 2. The OTS may have prognostic value in open globe injuries in Korean patients. However, identified prognostic factors of the present study did not entirely coincide with those of other Koreans or previous studies. Therefore, additional studies on the modified open globe injury as a prognostic model in Korean patients are needed. J Korean Ophthalmol Soc 2012;53(6):825-832

양방 항암치료와 병행하여 산삼약침과 봉약침 치료를 받은 전립선암 환자들의 PSA 수치 변화 관찰 보고

이연희,김채원,이광호,Lee, Yeon-Hee,Kim, Chae-Won,Lee, Kwang-Ho 대한약침학회 2011 Journal of pharmacopuncture Vol.14 No.4

Objectives: The purpose of this report is to find out how Mountain Ginseng Pharmacopuncture(MGP) and Sweet Bee Venom(SBV) treatments are effective on prostate cancer patients by monitoring Prostate specific antigen(PSA) values. Methods: We treated two prostate cancer patients with MGP and SBV from October 2008 to April 2011. One patient had localized prostate cancer, the other was in the terminal stage of prostate cancer with lung and bone metastasis and both had been receiving western anticancer therapy. We had monitored the changes of PSA value. Results: In case 1, MGP and SBV treatments seemed to be helpful in preventing the recurrence of localized prostate cancer. In case 2, PSA value was decreased by MGP treatment. Conclusions: It is conceivable that MGP and SBV are effective treatments for patients with prostate cancer.

갑상샘기능저하증이 동반된 패리-롬버그 증후군 1예

이연희(Yeon Hee Lee),이성은(Seong Eun Lee),김정열(Jung Yeul Kim),김경남(Kyoung Nam Kim),이성복(Sung Bok Lee) 대한안과학회 2017 대한안과학회지 Vol.58 No.7

목적: 우측 안구함몰 및 하사시, 상전장애가 있는 갑상샘기능저하증 환자에서 칼자국상과 국소형 피부경화증의 기왕력, 탈모 소견을 통해 패리-롬버그 증후군을 진단하여 이를 보고하고자 한다. 증례요약: 41세 여자가 5년 전부터 서서히 진행하는 우측 안구함몰을 주소로 내원하였다. 안구돌출측정법에서 우안 10 mm, 좌안 13mm로 우측 안구함몰과 안구주위조직 위축소견이 있었고, 안면부 전산화단층촬영에서 우측 안와부의 연부조직 위축 및 안구함몰이 관찰되었으며 뼈의 이상소견은 보이지 않았다. 제일눈위치에서 우안에 4프리즘디옵터(prism diopter)의 하사시 및 양안에 상전장애(-2)가 있었다. 시력은 정상이었고 전안부검사에서 특이소견은 없었다. 20년 전 우측 반흔성 탈모가 있어 시행한 조직검사에서 국소형 피부경화증(morphea)으로 진단받은 기왕력이 있었고, 우측 이마쪽과 모발선 상부로 특징적인 칼자국상이 관찰되었다. 혈액검사에서 antinuclear antibody 검사 양성 소견, 하시모토 갑상샘염에 의한 갑상샘기능저하 소견이 있어, 갑상샘기능저하증이 동반된 패리-롬버그 증후군(Parry-Romberg syndrome)으로 진단하였다. 결론: 안구함몰 및 상전장애 등의 안구 이상이 있는 환자에서 칼자국상과 국소형 피부경화증의 기왕력, 탈모 소견 등의 피부증상이 동반될 때, 드문 질환인 패리-롬버그 증후군을 고려해야 할 것으로 생각된다. <대한안과학회지 2017;58(7):857-861> Purpose: We report a case of Parry-Romberg syndrome associated with right enophthalmos, hypotropia, up-gaze limitation, en coup the sabre, morphea, and hypothyroidism. Case summary: A 41-year-old woman presented with slowly progressive right enophthalmos that started 5 years previous. With a Hertel exophthalmometer, the right eye measured 10 mm, and the left eye 13 mm. Right enophthalmos and atrophy of subcutaneous tissues of right side orbit were observed. Axial scan of computerized tomography shows atrophy of right side orbital subcutaneous tissues without bony abnormality. At primary gaze, 4 prism diopter hypotropia was observed in the right eye. Up-gaze was limited in both eyes. Visual acuity was 1.0 in both eyes. No specific sign was found in her anterior segment. The patient had experienced right side alopecia 20 years prior and had undergone biopsy, which proved morphea. Linear en coup de sabre morphea was found on the right forehead and scalp. Hypothyroidism due to Hashimoto’s thyroiditis was diagnosed based on a blood test, which also showed positive antinuclear antibody. Thus, the patient was diagnosed with Parry-Romberg syndrome associated with hypothyroidism. Conclusions: Clinicians need to consider the rare disease Parry-Romberg syndrome when a patient with ophthalmologic symptoms such as enopthlamos or eye movement disorders is accompanied by dermatologic symptoms such as linear en coup de sabre morphea or alopecia. J Korean Ophthalmol Soc 2017;58(7):857-861

하시모토 갑상샘염 환자에서 구후마취 후 발생한 수직 사시

이연희(Yeon Hee Lee),이은경(Eun Kyoung Lee),남기엽(Ki Yup Nam),김정열(Jung Yeul Kim) 대한검안학회 2009 Annals of optometry and contact lens Vol.8 No.2

목적: 구후마취하에 안내 수술을 시행받은 후 수직사시가 발생한 환자에서 하시모토 갑상샘염을 진단하고 수직사시의 단계적인 진행과정을 관찰하여 이를 보고하고자 한다. 대상과 방법: 33세 남자환자가 양안에 구후마취하에 안내 수술을 시행받은 후 발생한 복시로 내원하였다. 과거력에서 특이소견은 없었다. 프리즘 검사를 포함한 안과검사와 안와 전산화 단층촬영, 갑상샘 기능검사, 갑상샘 자가항체 검사를 시행하였다. 결과: 처음 내원 시 원거리 정면주시 시 우안 상사시와 하전제한을 보였고, 이후 정위가 되었다가 2개월 후 우안 하사시를 나타내었다. 안와 전산화 단층촬영에서 우안 하직근의 비대가 관찰되었다. 갑상샘 기능검사는 정상이었으나, 갑상샘 자가항체 검사에서 anti-Thyroglobulin Ab, anti-thyroid microsomal peroxidase Ab (anti-TPO Ab)가 비정상적으로 증가한 소견을 보여 내과로 의뢰되었고, 하시모토갑상선염으로 진단받았다. 환자는 초기에 하직근 마비의 양상을 보이다가 하직근 제한을 나타내었고, 이후 기능항진이 동반되는 양상을 나타내었다. 결론: 구후마취하에 안내 수술을 시행받은 후 수직사시가 발생한 환자에서 하시모토 갑상샘염도 기저질환으로 고려하여야 하며, 갑상샘 기능검사 외에도 갑상샘 자가항체 검사를 시행하는 것이 필요할 것으로 생각한다. Purpose: We report a case of vertical strabismus after retrobulbar anesthesia. We diagnosed the patient as Hashimoto s thyroiditis and observed the progression of vertical strabismus. Methods: A 33-year-old man with no history of strabismus underwent intraocular surgery under retrobulbar anesthesia in both eyes. Ocular exam including a prism test, orbital CT, thyroid function test and thyroid autoantibodies testwere performed. Results: At first visit, vertical diplopia and right hypertropia in the primary position with underaction of left inferior rectus muscle was noted. It changed to orthotropia in the primary position, and progressed to right hypotropia 2 months later. Orbital CT demonstrated a thickening of the right inferior rectus muscle belly. Thyroid function testwas normal, but thyroid autoantibodies test demonstrated very high titer of antithyroglobulin and anti-TPO Ab. He was consulted to endocrinologic department and diagnosed to Hashimoto s thyroiditis. Initially, He showed paretic feature of the inferior rectus muscle. The feature reversed and became restrictive, and then it became restrictive and overactive. Conclusions: In the case of vertical strabismus after retrobulbar anesthesia, Hashimoto s thyroiditis should be considered as causative factor. Thyroid autoantibodies test as well as thyroid function test may require to confirm Hashimoto s tjyroiditis.