유리체절제술 중 발생한 발살바현상 관련 맥락막상강출혈

임한웅,고병우,송유미,이병로,Han Woong Lim,Byung Woo Ko,Yumi Song,Byung Ro Lee 대한안과학회 2008 대한안과학회지 Vol.49 No.6

Purpose: To report a suprachoroidal hemorrhage by Valsalva maneuver during vitrectomy under general anesthesia. Case summary: A healthy 26-year-old man had vitrectomy under general anesthesia due to rhegmatogenous retinal detachment in his right eye. During scleral indentation and endolaser photocoagulation, he took a sudden and severe bucking reflex because the effect of general anesthesia was insufficient. After the bucking reflex, suprachoroidal hemorrhage occurred in his right eye. Immediate IOP elevation and hyperfluorocarbon tamponade was performed to remove the suprachoroidal hemorrhage and reattach the retina and choroid. The patient’s corrected visual acuity was 20/50 and slender crescent‐shaped choroidal rupture remained around the temporal area of the macula, unlike traumatic choroidal rupture. Following fluorescein angiography, staining was evident at the choroidal rupture site; no fluorescein leakage was evident. Conclusions: We report a case of acute suprachoroidal hemorrhage which we investigated by fundus examination and fluorescein angiography. J Korean Ophthalmol Soc 49(6):1022-1027, 2008

외상성 앞방 출혈과 동반된 섬유주 파열에서 안압 변동

임한웅,고명규,Han Woong Lim,Myung Kyoo Ko 대한안과학회 2008 대한안과학회지 Vol.49 No.9

Purpose: To report the relationship between the extent of rupture of the trabecular meshwork and intraocular pressure changes in traumatic hyphema patients. Methods: Ninety-five trabecular meshwork rupture patients were selected from a group of traumatic hyphema patients. Identification and measurement of the rupture of the trabecular meshwork were performed by gonioscopy, and intraocular pressure was measured by Goldmann applanation tonometry until 3 months after the trauma. Results: There were statistically significant differences of IOP between the traumatic eyes and the contralateral eyes at day 2, 3, 5, and 1 month (p=0.000, 0.018, 0.001, 0.040, respectively). IOP was highest at the 2nd day post-trauma, and dropped by the 5th day, after which it rose slightly. The relationship between the extent of trabecular meshwork rupture and the difference of IOP was positive at the 2nd day post-trauma (r=0.259) and negative at the 6th day post-trauma (r=-0.296); these differences are statistically significant (p=0.020, p=0.041, respectively). Conclusions: A rupture of the trabecular meshwork can be measured using gonioscopy, and the change of IOP in a trabecular meshwork rupture increases as the extent of the rupture of the trabecular meshwork increases. J Korean Ophthalmol Soc 2008;49(9):1501-1506

여러 가지 트리암시놀론제재의 유리체강내 투명기름방울모양 잔존물 발생 양상의 비교

임한웅,고병우,송유미,박영숙,이병로,Han Woong Lim,M,D,Byung Woo Ko,M,D,Yumi Song,M,D,Young Sook Park,M,D,Byung Ro Lee,M,D 대한안과학회 2008 대한안과학회지 Vol.49 No.7

Purpose: To investigate the characteristics of the clear oil-drop residue observed in the vitreous cavity after intravitreal injection of different brands of triamcinolone acetonide (TA), and to compare this ingredient’s effects in those products. Methods: Intravitreal injections of four different brands of triamcinolone acetonide (4 mg/0.1 mL), which are commercially available in Korea, were given to 40 eyes for the treatment of macular edema due to a variety of causes from October 2005 through February 2006. Regular slit-lamp biomicroscopy of fundus had been performed periodically with digital image acquisition equipment after injection of TA for at least two months. We analyzed the characteristics of this residue and compared the number and size of this residue in each product. Results: Four TA products commercially available in Korea were used, with vehicles composed of preservatives and suspending agents. There were differences between products in respect to ingredients and content, as well as the characteristics of the intravitreal clear oil droplet-like residue. Conclusions: Each TA product has a variable frequency and variable amounts of clear oil droplet-like residue, which seems to be a component of the vehicle. This variation could generate differences in efficacy, side effects, and retaining duration. It should be verified whether commercial TA products are consistently safe and effective. J Korean Ophthalmol Soc 49(7):1087-1093, 2008

백내장수술 전 구후마취 직후 발생한 망막중심동맥과 중심정맥의 폐쇄 1예

임한웅,고병우,송유미,박영숙,이병로,Han Woong Lim,M,D,Byung Woo Ko,M,D,Yumi Song,M,D,Young Sook Park,M,D,Byung Ro Lee,M,D 대한안과학회 2008 대한안과학회지 Vol.49 No.6

Purpose: To report central retinal vein and artery occlusion after retrobulbar anesthesia for a cataract operation. Case summary: A 65-year-old woman was transferred to our facility 4 days after she had undergone cataract extraction with IOL implantation. She could count fingers and had a relative afferent papillary defect in her left eye. As seen upon fundus examination, dot-shaped, circular-shaped irregular, and partially linear-shaped retinal hemorrhages were evident. Fluorescein angiography revealed that branch arteries around the nasal and temporal areas were not filled, and that the filling of veins was delayed. After two weeks, the patient was only able to recognize hand motion, and her intraocular pressure was 10 mmHg. According to a fundus examination, the size and quantity of retinal hemorrhages increased, and a pale, macular edema was observed. Following fluorescein angiography, the filling defect of branch vessels on the nasal and temporal areas was still evident, and the blocked fluorescence of capillaries on the fundus was prominent. After two months, she could still only recognize hand motion, and her intraocular pressure had increased to 35 mmHg; we therefore diagnosed a neovascular glaucoma. Conclusions: A patient experienced a serious central retinal vessel occlusion after retrobulbar anesthesia for cataract extraction. Retrobulbar injections should therefore be administered with great caution to prevent this outcome. J Korean Ophthalmol Soc 49(6):1013-1017, 2008

광간섭단층촬영기로 구한 시신경 및 망막신경섬유층 측정치들에 영향을 미치는 요인

한정일,임한웅,송유미,엄기방,Jung-Il Han,M,D,Han-Woong Lim,M,D,Yoo-Mi Song,M,D,Ki Bang Uhm,M,D 대한안과학회 2007 대한안과학회지 Vol.48 No.8

Purpose: To determine the factors influence retinal nerve fiber layer (RNFL) and optic nerve head (ONH) parameters measured by Stratus optical coherence tomography (OCT). Methods: Topographic RNFL thickness and optic disc parameters of 129 healthy Korean subjects of aged 14 to 87 were measured using the fast retinal nerve fiber layer thickness and fast optic disk algorithms of Stratus OCT. One eye of each subject was randomly selected for statistical analysis. Using multiple linear regression, the effect of optic disc area, age, refractive error, and zone beta on each parameter was analyzed. Results: Large discs had large horizontal integrated rim width (HIRW), cup area, rim area, C/D area ratio, and vertical C/D ratio. The thickness of average, superior, inferior, and nasal quadrant RNFL increased significantly with an increase in optic disc area. Average and superior quadrant RNFL thickness, and HIRW decreased with age. Refractive error showed a correlation with the vertical integrated rim area, horizontal C/D ratio, and temporal quadrant RNFL thickness. Gender and zone beta had no statistically significant influence on ONH and RNFL parameters. Conclusions: This study shows that optic disc size affects most RNFL thickness and ONH parameters. Because of the relationships revealed in this study, optic disc area in addition to age should be considered when the Stratus OCT RNFL thickness and ONH parameters are interpreted.

특발성 망막전막에서 유리체절제술 전후 미세시야계를 이용한 구조와 기능의 상관관계 분석

서샘,임한웅,신용운,강민호,성민철,조희윤.Sam Seo. MD. Han Woong Lim. MD. Yong Un Shin. MD. Min Ho Kang. MD.Min Cheol Seong. MD. Hee Yoon Cho. MD 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: To investigate the relationship between photoreceptor inner/outer segment (IS/OS) integrity and macular sensitivity after epiretinal membrane (ERM) surgery using spectral-domain optical coherence tomography combined with microperimetry. Methods: 20 eyes of 20 patients with idiopathic ERM who underwent pars plana vitrectomy for ERM removal were prospectively reviewed. The IS/OS defect diameter, BCVA, macular sensitivity, and fixation stability were measured using spectral-domain optical coherence tomography combined with microperimetry. The correlation of these factors was analyzed. Results: The macular sensitivity improved after successful ERM surgery (p < 0.001), but the IS/OS defect diameter has not improved. The preoperative and postoperative macular sensitivity were negatively correlated with preoperative IS/OS defect diameter (p = 0.035, p = 0.006). The fixation stability was not correlated with preoperative IS/OS defect diameter. Conclusions: Macular sensitivity showed significant correlation with IS/OS defect diameter. Macular sensitivity is vital functional parameter allows subjective quantification of the retinal function and reflects morphologic changes.

접안렌즈를 이용한 범망막광응고술 후 발생한 눈꺼풀처짐에 대한 전향적 연구

김유정,임한웅,강민호,성민철,조희윤,Yu Jeong Kim,Han Woong Lim,Min Ho Kang,Min Cheol Seong,Hee Yoon Cho 대한안과학회 2013 대한안과학회지 Vol.54 No.7

Purpose: To investigate the possibility of blepharoptosis as a complication after panretinal photocoagulation using ophthalmoscopic contact lens. Methods: We prospectively evaluated patients who were diagnosed with diabetic retinopathy and scheduled to be treated with panretinal photocoagulation. Margin reflex distance 1 (MRD1), levator function, palpebral fissure height and width, and tarsal plate height were measured at the day of photocoagulation and 3 months after treatment. Results: MRD1 was decreased in 8 eyes (25.8%), levator function was decreased in 5 eyes (16.1%), and palpebral fissure height was decreased in 6 eyes (19.4%). The decrement of MRD1 and palpebral fissure height after photocoagulation were significant (p = 0.008, p = 0.031, respectively). There was a significant negative correlation between MRD1 decrement and tarsal plate height (p = 0.045). Conclusions: We identified blepharoptosis after panretinal photocoagulation using contact ophthalmoscopic lens, which was related with low tarsal plate height.

유리체절제술과 백내장병합수술 후 앞방 깊이와 안구 길이 및 굴절력의 변화 측정

서샘,성민철,임한웅,강민호,조희윤,Sam Seo,MD,Min Cheol Seong,MD,Han Woong Lim,MD,Min Ho Kang,MD,Hee Yoon Cho,MD 대한안과학회 2013 대한안과학회지 Vol.54 No.7

Purpose: To evaluate the changes of anterior chamber depth (ACD), Axial length (AXL) after combined vitrectomy and cataract surgery and to analyze the association with refractive errors. Methods: In 22 eyes who underwent combined vitrectomy and cataract surgery (PPV-Phaco group), 20 eyes who underwent vitrectomy-only (PPV-only group) and 28 eyes who underwent uncomplicated cataract surgery (Phaco-only group), ACD and AXL were measured with IOL master (Carl Zeiss Jena, Germany) preoperatively and 3 months postoperatively. We compared the preoperative desired refraction and postoperative 3 months refraction. Results: ACD were increased in PPV-Phaco group and Phaco-only group (all, p < 0.001) and this change was more prominent in PPV-Phaco group (p = 0.030). In PPV only group, ACD was decreased (p < 0.001). The AXL after surgery was not significant different from the preoperative AXL in PPV-Phaco and PPV only groups (p = 0.612, p = 0.090). But the AXL was decreased in Phaco-only group (p = 0.022). Hyperopic shifting were noticed in PPV-Phaco and phaco-only groups, but myopic shifting was noticed in PPV-only group. However, these changes were not statistically significant (p = 0.292, p = 0.251, p = 0.068). Conclusions: ACD was increased after combined vitrectomy and cataract surgery. AXL was not changed. The hyperopic shifting was noticed after combined vitrectomy and cataract surgery, but was not statistically significant.

성인 코우츠병에서 유리체강내 베바시주맙 주입술 2예

박영숙,손준홍,임한웅,이병로.Young Sook Park. MD. PhD. Jun Hong Sohn. MD. PhD. Han Woong Lim. MD. Byung Ro Lee. MD. PhD 대한안과학회 2009 대한안과학회지 Vol.50 No.4

Purpose: To report the efficacy of intravitreal bevacizumab injection in adult patients with Coats’disease. Case summary: Vascular telangiectasia, microaneurysms, circinate hard exudates, and macular edema were shown in the macula of two patients. Vascular abnormality was limited to≤6 clock hours in both cases. In case 1, the temporal retina demonstrates filigree-like vessels and capillary nonperfusion. In case 2, the nasal retina demonstrates aneurysmal dilatation and multiple microaneurysms. Intravitreal bevacizumab injection was administered in both cases. After 1 month, macular edema decreased. Laser photocoagulation was performed for vascular telangiectasia, microaneurysms, and capillary nonperfusion area. Then an additional decrease of macular edema was observed. Fluorescein leakage decreased, as well. After 1 month (case 1) and 2 months (case 2), macular edema increased. The second and third intravitreal reinjections were administered to each patient. Macular edema decreased. Conclusions: We report two rare cases of Coats’disease in adult patients. Intravitreal bevacizumab injection in patients with Coats’disease can result in a rapid decrease of macular edema, which will then lead to rapid visual recovery and an opportunity for effective laser photocoagulation. We recommend that intraviteal bevacizumab injection be used in combination with laser photocoagulation for the treatment of Coats’disease. J Korean Ophthalmol Soc 2009;50(4):630-634

정상인의 안구 운동 범위와 연령과의 연관성

김지홍(Ji Hong Kim),임한웅(Han Woong Lim) 대한안과학회 2017 대한안과학회지 Vol.58 No.6

목적: 정상인의 안구 운동 범위를 측정하고 연령이 안구 운동 범위에 미치는 영향에 대해 알아보고자 하였다. 대상과 방법: 5세부터 91세까지의 연령으로 구성된 85명을 대상으로 전향적 관찰 연구를 시행하였다. 기본주시안위에서의 사진을 얻은 뒤 이미지 분석 소프트웨어(Photoshop 6.0 [Adobe, San Jose, CA, USA])를 이용하여 처리하였다. 안구 운동 범위를 측정하기 위해 전처리된 이미지를 Image J 프로그램을 이용하여 분석하였다. 안구 운동 범위를 각막 윤부 분석법을 통해 각도로 정량화하였다. 내전, 외전, 상전, 그리고 하전에서의 안구 운동 범위를 측정하였다. 결과: 안구 운동의 정상 범위는 내전에서 44.4 ± 6.9 o , 외전에서 44.8 ± 5.5 o , 상전에서 27.7 ± 7.6 o , 그리고 하전에서 46.7 ± 8.4 o 로측정되었다. 내전, 외전 및 상전과 연령은 유의미한 음의 상관관계를 보였다(R 2 =0.220 in adduction, R 2 =0.126 in abduction, and R 2 =0.304 in elevation, all p<0.001). 그러나, 하전은 연령과 유의미한 상관관계를 보이지 않았다(R 2 =0.030, p=0.113). 결론: 모든 연령에서 수평 방향의 정상 안구 운동 범위는 대칭적인 반면, 수직 방향의 정상 안구 운동 범위는 상전이 하전보다 작았다. 연령이 증가하면서 하전 이외의 모든 방향에서는 안구 운동 범위의 감소가 나타났으나, 하전은 연령이 증가해도 감소하지 않았다. 안구 운동을 평가할 때, 운동 방향에 따른 안구 운동 범위의 차이와 연령에 따른 안구 운동 범위의 변화를 고려해야 할 것이다. Purpose: The purpose of this study is to measure the range of normal eye movement and to evaluate the effect of age on the range of ocular movement in a normal population. Methods: We conducted a prospective observational study of 85 subjects aged between 5 and 91 years. Photographs were taken of the cardinal position, and these images were analyzed using an image analysis software (Adobe Photoshop 6.0, Adobe, San Jose, CA, USA). To measure the range of eye movement, the preprocessed images were analyzed using the Image J program. The range of movement of the eyeball was quantitatively measured using corneal limbal analysis. Specifically, the ranges of ocular movement according to adduction, abduction, elevation, and depression were measured. Results: The normal movement ranges were 44.4 ± 6.9° in adduction, 44.8 ± 5.5° in abduction, 27.7 ± 7.6° in elevation, and 46.7 ± 8.4° in depression. Adduction, abduction, and elevation were negatively correlated with age (R 2 = 0.220, R 2 = 0.126, and R 2 = 0.304, respectively, all p < 0.001). However, there was no significant correlation between age and depression (R 2 = 0.030, p = 0.113). Conclusions: For all ages, the range of normal ocular movement in the horizontal direction was symmetric, while the range of ocular movement in elevation was smaller than that of depression. As age increased, the range of ocular movement decreased in all directions except depression, but depression did not decrease with age. When assessing eye movement, it is necessary to consider the range of ocular movements relative to both the movement direction and changes in the ocular movement range according to age.