비특이성안와염에서 고용량 부신피질호르몬 주사요법의 효과

정승아,윤진숙,이상열.Seung Ah Chung. MD. Jin SooK Yoon. MD. Sang Yeul Lee. MD 대한안과학회 2010 대한안과학회지 Vol.51 No.10

Purpose: To evaluate the efficacy of intravenous methylprednisolone pulse therapy in patients with idiopathic orbital inflammation. Methods: Fifty-two patients who received three-day pulse methylprednisolone for acute severe swelling, loss of visual acuity, limitation of eye movement, diplopia, or pain were included in the present study. The lesions were divided into five subtypes using computed tomography or magnetic resonance imaging; anterior, lacrimal, myositic, diffuse and apical. A case diagnosed as sclerotic type was excluded. The response rate, recurrence rate and cure rate were assessed. Results: The total response rate to intravenous methylprednisolone from all groups was 84.6%, with 100% in the anterior subtype and 71.4% in the diffuse subtype. During the mean follow-up period of 10.5 months, 15.9% of patients experienced a recurrence after a mean of 5.7 months. Overall, the cure rate was 71.2%. Recurrence was more common in the younger patients, and three of the seven patients with recurrence had myositic inflammation. Conclusions: Intravenous methylprednisolone was effective in patients with severe idiopathic orbital inflammation. However, combining other treatment modalities in patients with diffuse or myositic subtypes and in younger patients who show relatively low response or high recurrence is recommended. J Korean Ophthalmol Soc 2010;51(10):1299-1304

건성각결막염 환자에서 스테로이드 점안 후 눈물 신경성장인자의 변화

정승아,이형근,서경률,홍순원,김현창,김응권,Seung Ah Chung,Hyung Keun Lee,Kyoung Yul Seo Soon Won Hong,Hyung Chang Kim,Eung Kweon Kim 대한안과학회 2006 대한안과학회지 Vol.47 No.11

Purpose: To compare nerve growth factor (NGF) levels in tears and on the ocular surface of normal controls with those of non-Sjogren type keratoconjunctivitis sicca (KCS) subjects, and investigate the effect of 0.1% prednisolone eye drops on NGF levels in KCS patients. Methods: Baseline tear NGF levels were measured in 41 KCS patients and 23 healthy control subjects using enzyme-linked immunosorbent assays (ELISA). KCS patients received 0.1% prednisolone drops in one eye, and 0.1% hyaluronic acid drops in the other eye, three times daily for 28 days. Impression cytology (IC) and immunostaining for NGF on conjunctival epithelium was performed for both groups. Results: KCS patients were found to have higher baseline tear NGF concentrations compared to age- and sex- matched healthy control subjects (65.9±14.5 vs. 122.1±45.3, p<0.0001). In KCS patients, prednisolone treatment for 28 days resulted in a decrease in tear NGF levels, symptom scores and IC scores, whereas hyaluronic acid treatment had no such effect (68.2±25.0 pg/μg vs. 108.0±43.4 pg/μg, p<0.0001 for tear NGF/TP ratio; 2.16±1.01 vs. 3.39±1.50, p=0.0014 for symptom scale; 1.05±0.67 vs. 1.61±0.86, p=0.0317 for IC). Measurements taken at both 14 and 28 days indicate that neither prednisolone nor hyaluronic acid treatment affected BUT or Schirmer values. Conclusions: KCS patients showed elevated levels of tear NGF, which were decreased by treatment with 0.1% prednisolone. These data suggest that the ocular surface NGF may play an important role in ocular surface inflammation processes associated with dry eyes.

최초 발견자 차이와 관련된 간헐외사시 특징

김청운(Chung Woon Kim),김승우(Seung Woo Kim),유재은(Jaeeun Yu),정승아(Seung Ah Chung) 대한안과학회 2022 대한안과학회지 Vol.63 No.11

목적: 수술이 필요한 정도의 간헐외사시를 처음 발견한 사람이 안과의사인 군과 부모를 비롯한 비전문가인 군에서 간헐외사시 특징이다른지 알아보고자 하였다. 대상과 방법: 평균 5.9 ± 1.4세에 20프리즘디옵터(prism diopters, PD) 이상의 간헐외사시로 진단받은 환아 218명의 의무기록을 후향적으로 조사하였다. 간헐외사시 최초 발견자가 안과의사인 군과 비전문가인 군으로 나누어, 프리즘교대가림검사로 측정한 실제사시각과 반투명가리개로 가리고 촬영한 사진을 바탕으로 전문의 2명이 평가한 사진사시각, 간헐외사시 분류, 융합조절, 입체시, 억제, 구면렌즈대응치를 비교하였다. 결과: 평균 원거리사시각이 25.8 ± 6.8 PD인 간헐외사시를 41명(18.8%)은 안과의사가, 177명(81.2%)은 비전문가가 처음 발견하였다. 사시안의 구면렌즈대응치가 안과의사군에서 비전문가군에 비해 근시인 것(-0.77 ± 1.59 디옵터[diopters, D] vs. -0.19 ± 1.48 D, p=0.03)을 제외하고는 두 군 간 차이가 없었다. 두 군에서 나이와 사시안의 구면렌즈대응치를 짝지은 39쌍을 비교하면, 안과의사군에서 원거리, 근거리 실제사시각이 비전문가군에 비해 작았지만(24.0 ± 6.8 PD vs. 28.5 ± 6.4 PD, 26.9 ± 6.6 PD vs. 31.0 ± 6.4 PD, p<0.01), 사진사시각을 비롯한 다른 특징은 차이가 없었다. 결론: 수술이 필요한 정도의 간헐외사시라도 사시각이 작거나 근시가 동반된 경우 안과의사가 검진을 통해 처음 발견하는 경우가 많았다. Purpose: To determine whether the clinical features of intermittent exotropia (IXT) needing muscle surgery were different in the ophthalmologist-detected and non-specialist-detected groups (including parents). Methods: Medical records of 218 children (mean age: 5.9 ± 1.4 years) with IXT of ≥ 20 prism diopters (PD) were reviewed retrospectively. The angles of deviation were measured using the prism and alternate cover test and assessed by two ophthalmologists using photographs with a translucent occluder (photographic angle). The IXT subtype, fusional control, stereopsis, suppression, and spherical equivalent (SE) were compared between the ophthalmologist-detected and non-specialist-detected groups. Results: Mean 25.8 ± 6.8 PD of distant angle of IXT was first detected by the ophthalmologist in 41 patients (18.8%) and the non-specialists in 177 patients (81.2%). The deviated eye was more myopic in the ophthalmologist-detected than non-specialist- detected group (-0.77 ± 1.59 diopters [D] vs. -0.19 ± 1.48 D, p = 0.03). There were no other differences between the two groups. A comparison of 39 age- and non-dominant eye SE-matched pairs demonstrated that the measured angles for distant and near fixation were smaller in the ophthalmologist-detected than non-specialist-detected group (24.0 ± 6.8 PD vs. 28.5 ± 6.4 PD and 26.9 ± 6.6 PD vs. 31.0 ± 6.4 PD, respectively, p < 0.01), while the remaining characteristics, including the photographic angle, were similar. Conclusions: In cases with small angles of deviation or myopia, IXT with angles requiring surgical correction were commonly first detected by ophthalmologists during examinations.

간헐외사시에서 근시 진행과 수술 후 외편위 재발과의 상관관계

김민호,정승아,최아영,이종복,Min Ho Kim,Seung Ah Chung,Ah Young Choi,Jong Bok Lee 대한안과학회 2012 대한안과학회지 Vol.53 No.11

Purpose: To investigate the relationship between myopic progression and exodrift after surgery in patients with intermittent exotropia (X[T]). Methods: Eighty-five patients who underwent bilateral lateral rectus recession for X(T) and had a follow-up of more than 1 year were recruited for the present study. Progression of myopia was determined by measuring the difference in spherical equivalent of both eyes between the initial and final refraction divided by the total follow-up time per patient. Postoperative exodrift was calculated by subtracting the deviation at postoperative 6 weeks from the deviation at the last follow-up, and the deviation at postoperative day 1 from the deviation at postoperative 6 weeks. Linear regression was conducted to determine the relationship between postoperative exodrift and myopic progression. The risk factors for recurrence, defined as exodeviation of 10 prism diopters or more at the final examination, were also analyzed. Results: Sixty-eight (80.0%) subjects showed myopic progression of -0.50 diopters or more, and 47 (55.3%) had recurrence of exotropia during the mean follow-up period of 37.9 months. Patients with myopic progression showed more exotropic drift after postoperative 6 weeks than the patients without myopic progression (p < 0.01). Immediate postoperative overcorrection, oblique dysfunction, and a short follow-up period were associated with a low recurrence, whereas preoperative angle of exodeviation, sensory status, and age at the time of surgery were not. Conclusions: In patients who underwent bilateral lateral rectus recession for X(T), a greater myopic progression was related with greater postoperative exodrift. As the development of myopia was observed to be axial in nature, the results from the present study raises the possibility that ocular elongation may reduce the effect of recession.

근시 성인에서 조절마비 전후와 조절마비제에 따른 굴절 변화 비교

신규민,정승아,이종복,Kyu Min Shin,Seung Ah Chung,Jong Bok Lee 대한안과학회 2011 대한안과학회지 Vol.52 No.2

Purpose: To evaluate the efficacy of 3 cycloplegic regimens in adults with myopia. Methods: Refraction, accommodation amplitude, residual accommodation and biometric findings were assessed before and after instillation of regimen I (tropicamide 0.5% and phenylephrine 0.5%), regimen II (cyclopentolate 1.0%), and regimen III (combination of regimen I and II). Results: In myopic adults aged 22 to 26 years, cycloplegic refraction revealed less myopia than manifested refraction. Although there was no difference in residual accommodation among the 3 regimens, regimen II and III were more effective in reducing myopia, accommodation, and axial length. The difference in cycloplegic refraction between regimen I and II was more prominent in patients who had larger amplitude of accommodation and residual accommodation with regimen I. Conclusions: Cycloplegic refraction should be used even in adult myopes. For patients with stronger accommodation and larger residual accommodation with tropicamide, cycloplegic refraction with cyclopentolate may be used to ensure relaxation. J Korean Ophthalmol Soc 2011;52(2):141-146

약시 가림치료가 안구정렬에 미치는 영향

김승우(Seung Woo Kim),정승아(Seung Ah Chung) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

목적: 한눈 약시에서 가림치료가 안구정렬에 미치는 영향을 알아보고자 하였다. 대상과 방법: 가림치료를 처음 시행한 한눈 약시 환아를 대상으로, 가림치료 전, 두 눈 시력이 같아진 시점, 가림치료 후에 안구편위를 측정하여 비교하고, 약시 종류와 정도, 편위 종류와 정도, 굴절이상 종류, 가림치료 시작 나이에 따른 차이가 있는지 살펴보았다. 수평 사시각은 8프리즘디옵터(prism diopter, PD) 이상, 수직 사시각은 2PD 이상의 차이가 있으면 의미 있는 변화로 정하였다. 결과: 총 209명은 굴절부등약시 135명, 사시약시 50명, 혼합약시 19명, 시각차단약시 5명이었다. 가림치료 후 원거리 안구편위는 177명(84.7%)에서 변화가 없었으나, 23명(11.0%)에서 감소, 9명(4.3%)에서 증가하였다. 굴절부등약시의 7.4%, 사시약시의 20.0%, 혼합약시의 10.5%, 시각차단약시의 20.0%에서 편위각이 감소하였고, 굴절부등약시의 4.4%, 혼합약시의 5.3%, 시각차단약시의 40.0%에서 편위각이 증가하였다. 외편위의 24.2%, 내편위의 21.6%에서 편위각이 감소하였으나, 수직편위는 변하지 않았다. 8PD가 넘는 편위가 있었던 환아의 31.9%에서 편위각이 감소하였다. 약시 정도, 굴절이상 종류, 나이에 따른 편위 변화의 차이는 없었다. 가림치료에 성공한 경우, 편위각 감소는 두 눈 시력이 같아질 때까지, 증가는 가림치료를 감량하는 동안 많이 나타났다. 결론: 일부 약시 환아에서 가림치료 전후 안구정렬에 변화가 생길 수 있으며, 8PD가 넘는 수평사시를 동반한 경우에 상대적으로 흔하였다. Purpose: To evaluate the effect of patching on ocular alignment in children with unilateral amblyopia. Methods: We evaluated the change in ocular alignment during and after patching in patients who had started amblyopia treatment with patching, and analyzed the aspects of change according to the cause and severity of amblyopia, type and magnitude of deviation, type of refractive error, and age at initiation. A change of eight prism diopters (PD) or more in horizontal deviation, or two PD or more in vertical deviation was considered significant. Results: A total of 209 patients were enrolled; 135 had amblyopia associated with anisometropia, 50 with strabismus, 19 with combined cause, and 5 with deprivation. After patching, there was no change in distant deviation in 177 patients (84.7%), while a decrease was noted in 23 patients (11.0%) and an increase in nine patients (4.3%). The angle of deviation decreased in 7.4% of anisometropic amblyopia, 20.0% of strabismic amblyopia, 10.5% of combined amblyopia, and 20.0% of deprivation amblyopia. The angle of deviation increased in 4.4% of anisometropic amblyopia, 5.3% of combined amblyopia, and 40.0% of deprivation amblyopia. The angle of deviation decreased in 24.2% of exodeviation, and 21.6% of esodeviation, but there was no change in vertical deviation among the studied patients. The angle of deviation decreased in 31.9% of patients with deviation greater than 8 PD. The change did not differ according to severity of amblyopia, type of refractive error, or age. Among the successes, decrease in deviation was more common until they achieved equal visual acuity between both eyes, while the increase during tapering of patching. Conclusions: Change in ocular alignment may occur after patching in some patients with amblyopia, and seems to be more frequent in cases associated with horizontal deviation greater than 8 PD.

삼차신경통에 대한 경피적 신경차단술 후 발생한 외향신경마비 1예

최아영,정승아,윤일석,Ah Young Choi,Seung Ah Chung,Il Suk Yun 대한안과학회 2013 대한안과학회지 Vol.54 No.3

Purpose: To report a case of abducens nerve palsy after a percutaneous nerve blocking procedure for trigeminal neuralgia. Case summary: A 35-year-old female complaining of stabbing pain in the right maxillary area 4 months in duration was diagnosed with trigeminal neuralgia at a pain clinic. The patient underwent a percutaneous trigeminal nerve blocking procedure using alcohol at the right maxillary nerve. After the procedure, the patient was referred to an ophthalmologic service for horizontal diplopia and abduction defect of her right eye. Her corrected visual acuity, intraocular pressure, pupillary response, anterior segment and fundus were normal bilaterally. The patient had right esotropia of 38 prism diopters in primary gaze (70 prism diopters in right gaze, 20 prism diopters in left gaze) with limited abduction of -3 in the right eye. She was diagnosed with abducens nerve palsy of the right eye. Three months after initial presentation, the patient had intermittent esotropia of 4 prism diopters at right gaze and orthophoria at the other diagnostic gazes; she presented no diplopia. Conclusions: In the present case study, abducens nerve palsy following a percutaneous trigeminal nerve blocking procedure resolved over 3 months. Because the abducens nerve is adjacent to the trigeminal nerve near the foramen ovale based on anatomical structure, when performing a percutaneous trigeminal blocking procedure, the surgeon should be aware that deep needle puncture could cause abducens nerve palsy.

반복적인 시신경 침범으로 재발한 급성백혈병

이승엽(Seung Yeop Lee),윤지현(Ji Hyun Yoon),정승아(Seung Ah Chung) 대한안과학회 2020 대한안과학회지 Vol.61 No.3

목적: 급성백혈병이 반복적인 시신경 침범으로 재발한 2예를 보고하고자 한다. 증례요약: 8세 남아가 급성림프모구백혈병으로 유지 요법 중 우안 시력저하로 의뢰되었다. 우안 시신경유두부종이 있어 고용량스테로이드 치료 후 시력과 안저 소견이 호전되었다. 2달 후 재발하여 시행한 뇌/안와 자기공명영상에서 우측 시신경에서 시신경교차까지 고신호강도를 보였고, 고용량스테로이드 치료 후 우안 시력이 회복되었다. 한 달 후 재발하였고 뇌척수액검사에서 림프모구세포가 관찰되어 경막내 항암화학 치료를 시작하였다. 3주 후 우안 시력은 회복되었으나 시신경유두창백이 발생하였다. 급성골수성백혈병으로 동종말초혈액줄기세포이식을 시행 받은 45세 남자 환자가 좌안 시력저하로 내원하였다. 좌안 시신경유두부종이 있어 고용량스테로이드 치료 후 시력과 안저 소견이 호전되었으나, 3주 후 재발하여 감량 중이던 스테로이드를 고용량 정맥주사로 변경하였다. 뇌자기공명영상에서 좌측 시신경을 압박하는 골수성육종이 의심되어 국소 방사선치료를 시작하였으나, 한 달 후 좌안 시력은 무광각으로 소실되었다. 결론: 급성백혈병에서 반복적인 시신경 침범이 있을 경우 스테로이드 치료에 반응이 있더라도 중추신경계 재발을 고려하여야 하겠다. Purpose: To report two cases with recurrent involvement of the optic nerve as the initial sign of acute leukemic relapse. Case summary: An 8-year-old male with acute lymphoblastic leukemia on the maintenance chemotherapy was referred for a decrease in visual acuity in the right eye. The visual acuity and optic disc swelling were completely resolved with high-dose steroid therapy. Two months after the initial presentation, the symptoms recurred and brain/orbit magnetic resonance imaging (MRI) showed high intensity along the right optic nerve from the retrobulbar area to the optic chiasm. The visual acuity was restored after high-dose steroid therapy. One month after the second attack, the symptoms recurred and the cerebrospinal fluid cytology was positive for lymphoblasts. Three weeks after the intrathecal chemotherapy, the visual acuity improved fully, but optic disc atrophy developed. A 45-year-old male, who received allogenic peripheral blood stem cell transplantation for acute myeloid leukemia, presented with a decrease in visual acuity in the left eye. The left optic disc swelling improved with high-dose steroid therapy, but the medication was restarted due to the recurrence of symptoms 3 weeks later. Brain MRI showed a mass lesion compressing the left optic nerve, presumed to be a myeloid sarcoma. One month after local irradiation, the visual acuity was no light perception in the left eye. Conclusions: In patients with a prior history of acute leukemia, the recurrent involvement of the optic nerve should be considered as a central nerve system relapse, regardless of improvement with steroid treatment.

한 눈 상전장애로 나타난 전신홍반루푸스 1예

김승우(Seung Woo Kim),김용현(Yong Hyun Kim),정승아(Seung Ah Chung) 대한안과학회 2016 대한안과학회지 Vol.57 No.1

Purpose: To report a case of monocular elevation deficiency as the presenting manifestation of systemic lupus erythematosus(SLE). Case summary: A 23-year-old, otherwise healthy female presented with a 3-day history of vertical diplopia and headache. She had a left hypotropia, which worsened in adduction and supra-duction and a profound inferior oblique underaction (-3). Magnetic resonance imaging showed an enhancement around the left superior oblique muscle and multiple infarctions in the left midbrain. On repetitive serological tests, anemia, lymphopenia, and anti-phospholipid antibody were positive. A presumptive diagnosis was a myositis of left superior oblique muscle and hyper-coagulation related with anti-phospholipid antibody. Two months after high-dose steroid treatment, the vertical diplopia was resolved. Five months later, the left hypotropia recurred as a more severe form with the inability to elevate the left eye in all directions. In addition, the infarction associated with vasculitis recurred in the left midbrain. As the treatment with high-dose steroid failed to relieve her ocular symptoms, recession of the left inferior rectus was performed 8 months later. One month after the surgery, she developed multiple lesions of erythematous nodosa with tenderness. Skin biopsy of the lesion in the fingers showed the histological findings consistent with lupus. Conclusions: Eye movement abnormality can be an initial manifestation of SLE, which should be considered as a differential diagnosis especially in young female patients.

선택적 경부 절제술 후 발생한 비동맥염성 앞허혈시신경병증 1예

박수연,노승수,정승아.Suyoun Park. MD. Seungsoo Rho. MD. Seung Ah Chung. MD 대한안과학회 2012 대한안과학회지 Vol.53 No.1

Purpose: To report a case of non-arteritic anterior ischemic optic neuropathy after bilateral selective neck dissection. Case summury: A 48-year-old man presented with a visual field defect in his right eye 11 days after bilateral selective neck dissection. His corrected visual acuity in the right eye was 20/20; fundus photographs revealed a segmental optic disc swelling in the superior half of the right eye, and the Humphrey visual field test showed an inferior altitudinal defect in the right eye, corresponding to the disc swelling. The fluorescein angiography revealed a delayed filling on the superior half of the optic disc in the right eye. The diagnosis was non-arteritic anterior ischemic optic neuropathy. Orbital and brain MRIs showed an increase in caliber of the right optic nerve, but no other mass or enhanced lesion was noted. After 3 months, the patient’s visual acuity and visual field were maintained, but segmental atrophy developed on the superior half of the right optic disc. Conclusions: With the risk factors of ischemic optic neuropathy, the possibility of postoperative visual impairment or field defect should be considered after a selective head and neck surgery. J Korean Ophthalmol Soc 2012;53(1):180-185