거대열공 망막박리에서 과불화탄소액을 사용한 유리체절제술 단독수술과 공막두르기 병합수술 비교

이동현(Dong Hyun Lee),김경호(Kyong Ho Kim),박성후(Sung Who Park),변익수(Ik Soo Byon),이지은(Ji Eun Lee) 대한안과학회 2015 대한안과학회지 Vol.56 No.12

목적: 증식유리체망막병증이 동반되지 않은 거대열공에 의한 망막박리에서 과불화탄소액을 사용하여 유리체절제술을 시행할 경우 추가적인 공막두르기술의 임상적 유용성에 대해서 알아보고자 하였다. 대상과 방법: 거대열공에 의한 망막박리로 수술 받은 환자 중에서 과불화탄소액을 이용하여 유리체절제술만 시행한 단독수술군과 공막두르기술을 함께 시행한 병합수술군으로 나누어 두 군의 일차수술성공률, 최종수술성공률, 최종교정시력을 비교하였다. 수술 전 최대교정시력, 안압, 수정체 상태, 눈수술의 기왕력, 고도근시, 외상병력, 증상이 발생한 날짜부터 수술일까지의 기간, 거대망막열공의 위치 및 크기, 망막박리의 범위와 중심와 침범을 조사하였다. 결과: 총 29명 29안 중에서 단독수술군은 8안, 병합수술군은 21안이었다. 열공의 위치 및 크기, 망막박리의 범위와 중심와 침범, 안압, 눈수술의 기왕력, 수정체상태, 고도근시, 외상병력, 증상이 발생한 날짜부터 수술일까지의 기간 모두 두 군 사이에 차이가 없었다. 일차수술성공률은 단독수술군 87.5%, 병합수술군 85.7%였으며, 최종수술성공률은 각각 100.0%, 95.2%로 두 군 사이에 유의한 차이가 없었다. 최종교정시력(logMAR)은 각각 0.80, 0.92로 차이가 없었다. 결론: 증식유리체망막병증이 동반되지 않은 거대열공에 의한 망막박리에서는 과불화탄소액을 이용하여 유리체절제술을 시행하는 경우에 추가적인 공막두르기술로 인한 수술성공률과 시력에 차이가 없었다. 철저한 주변부 유리체의 제거가 성공적인 망막유착을 달성할 수 있는 것으로 생각된다. Purpose: To evaluate the clinical usefulness of additional encircling in patients treated for retinal detachment with giant retinal tear and without proliferative vitreoretinopathy, compared to single vitrectomy using perfluorocarbon liquid. Methods: Patients who underwent surgery for retinal detachment with giant retinal tear were divided into either the vitrectomy alone group or combined vitrectomy and encircling group. We reviewed the primary anatomical success rate, final anatomical success rate and best corrected visual acuity (BCVA) at the last follow-up (log MAR). Additionally, BCVA at the first visit, intraocular pressure, lens status, history of intraocular surgery, high myopia, trauma history, time from symptom onset to surgery, location and size of the giant retinal tear, extent of retinal detachment and foveal detachment were reviewed. Results: Among a total of 29 eyes, the vitrectomy alone group included 8 eyes and the combined group 21 eyes. Location and size of the giant retinal tear, extent of retinal detachment and foveal detachment, intraocular pressure, history of intraocular surgery, lens status, high myopia, trauma history and time from symptom onset to surgery were not different between the 2 groups. The primary success rate was 87.5% in the vitrectomy group and 85.7% in the combined group; the final surgery success rate was 100.0% and 95.2%, respectively. There was no significant difference in the anatomical success rate between the 2 groups. The postoperative BCVA was similar in both groups (0.80 vs. 0.92). Conclusions: When vitrectomy using perfluorocarbon liquid was performed for the treatment of giant retinal tear without proliferative vitreoretinopathy, an encircling provided no additional benefit for the anatomical success rate and visual recovery. Only intensive vitrectomy of peripheral retina was considered capable of achieving a successful retinal attachment in patients without proliferative vitreoretinopathy.

큰 황반원공에서 시행한 내경계막 자가이식술

김경호(Kyong Ho Kim),정재우(Jae Woo Jung),박성후(Sung Who Park),변익수(Ik Soo Byon),이지은(Ji Eun Lee) 대한안과학회 2015 대한안과학회지 Vol.56 No.12

목적: 크기가 큰 황반원공의 수술적 치료로서 내경계막 자가이식술을 시행한 환자 5명의 수술방법과 결과를 알아보고자 한다. 대상과 방법: 크기가 400 μm 이상인 큰 황반원공 환자를 대상으로 유리체절제술을 시행하고 0.025% Briliant blue G로 내경계막을 염색하였다. 원공 주변의 내경계막을 약 2.5 유두직경의 크기로 벗겨낸 뒤, 원공 속에 내경계막 절편을 이식하고, 추가적으로 약 1.5 유두직경 정도의 내경계막을 더 제거하였다. 액체공기교환을 하고 가스를 충전하였다. 수술 후 빛간섭단층영상으로 원공 폐쇄를 조사하였다. 결과: 5안의 평균 나이는 65.0 ± 11.8 (52-77)세였다. 평균 수술 전 교정시력(logMAR)은 0.80 ± 0.27이었고, 평균 구면대응 굴절값은 -2.0 ± 2.2디옵터였다. 원공 크기는 평균 수평직경 701.4 ± 129.4 μm, 수직 직경 630.2 ± 202.8 μm였다. 기저부는 1,043.4 ± 225.0 μm, 높이는 464.4 ± 218.9 μm였다. 4안은 수술 후 1일째, 1안은 수술 후 4-7일 사이에 원공이 완전히 폐쇄되었다. 경과관찰기간 동안 중심와의 해부학적 모양은 더욱 개선되었다. 2안에서는 시력호전이 되었으나, 3안은 술 전과 차이가 없었다. 결론: 내경계막 자가이식술을 통해 수술 후 빠른 기간에 성공적인 원공의 폐쇄를 얻을 수 있었다. 크기가 큰 황반원공에서 시행해 볼 만한 유용한 수술 술기라고 생각한다 Purpose: To evaluate the surgical outcome of autologous transplantation of internal limiting membrane (ILM) for the treatment of large macular hole. Methods: Twenty-five gauge pars plana vitrectomy was performed for the treatment of patients with full thickness macular hole larger than 400 μm. ILM was stained using 0.025% brilliant blue G. ILM around the hole was circumferentially peeled as large as 2.5 disc diameter (DD) in size and then transplanted inside the hole. ILM was peeled out additionally approximately 1.5 DD in size. Fluid-air exchange and gas injection were performed. After surgery, the hole was scanned using spectral domain optical coherence tomography. Results: A total of 5 eyes were included in the present study. The mean age was 65.0 ± 11.8 years (52-77) and mean best corrected visual acuity (log MAR) was 0.80 ± 0.27. The mean refractive error was -2.0 ± 2.2 diopter, mean horizontal size of hole was 701.4 ± 129.4 μm, mean vertical size was 630.2 ± 202.8 μm, mean hole base size was 1,043.4 ± 225.0 μm and hole height was 464.4 ± 218.9 μm. At the first day after surgery, transplanted ILM was detected inside the hole in all 5 eyes and complete closure of the hole occurred in 4 eyes. One hole was closed between postoperative days 4 and 7. Foveal contour improved gradually but photoreceptor integrity did not during the follow-up period. Two eyes showed visual improvement but 3 did not after surgery. Conclusions: Macular hole was closed successfully and quickly using the autologous ILM transplantation technique. Based on our results, the autologous ILM should be considered the treatment of choice for large macular holes.

자연분리 후 재발된 특발성 망막앞막

권정민(Jeong Min Kwon),이종헌(Jong Heon Lee),김경호(Kyong Ho Kim),박성후(Sung Who Park),이지은(Ji Eun Lee),변익수(Ik Soo Byon) 대한안과학회 2016 대한안과학회지 Vol.57 No.4

목적: 특발성 망막앞막으로 경과관찰 중 막의 자연분리가 일어나 시력의 개선이 있었으나 이후 막이 재증식하여 시력저하를 유발한 증례를 보고하고자 한다. 증례요약: 62세 환자가 좌안 시력저하로 내원하였다. 교정 시력은 0.8이었다. 안저검사에서 뒤유리체박리가 동반된 망막앞막이 관찰되었다. 빛간섭단층촬영영상에서 두꺼워진 황반부가 확인되었다. 망막열공, 염증성질환 및 망막혈관질환 등의 소견이 없어 특발성 망막앞막으로 진단하였다. 7개월째 황반부 아랫부분에서 막의 분리가 일어났으며, 12개월째에는 중심부까지 분리가 일어났다. 시력은 1.0으로 상승하였다. 17개월째에는 망막앞막이 재증식하여 황반부 전체를 덮고 있었으며, 교정시력도 0.7로 다시 저하되었다. 21개월째에는 더욱 진행하여 수술적 치료가 필요하게 되었다. 결론: 특발성 망막앞막의 자연분리는 드문 현상이며, 시력의 회복을 동반하기도 한다. 하지만 이러한 환자에서도 막이 재증식하여 시력감소와 변형시를 일으킬 수 있으므로 정기적인 검진이 필요하다. Purpose: To report the reproliferation of membrane after a spontaneous separation in a patient with idiopathic epiretinal membrane(ERM). Case summary: A 62-year-old woman complained of metamorphopsia in the left eye. Her vision without correction was 0.8. On fundus examination, the epiretinal membrane was covering the fovea with posterior vitreous detachment. Optical coherence tomography (OCT) showed the ERM and thickened macula. Retinal break, intraocular inflammatory disease, and retinal vascular disease were not noted. We diagnosed her with idiopathic ERM and followed up regularly. At month 7, a partial separation of the membrane from the retinal surface was noted. At month 12, complete spontaneous separation of the ERM from the macula except that in the temporal area was accompanied by improvement of vision to 1.0. OCT, showing recovery of the fovea contour. However, her corrected vision decreased to 0.7 at month 17, and the ERM was again observed to cover the macula. Thickening of the ERM progressed further, and her corrected vision decreased to 0.5 at month 21. Conclusions: Spontaneous separation of membrane is a rare phenomenon in idiopathic ERM. Reproliferation of membrane can develop and induce visual impairment. Therefore, regular examination is recommended in patients with spontaneous separation of membrane.

난소임신 4 예

박병도,황진석,정후곤,허정수,정봉진,이기수,박연진,주경란 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.9

Primary ovarian pregnancy is a rare form of ectopic pregnancy, and the prevalence rate is reported to be between 1/7,000 and 1/40,000 pregnancies. Ovarian pegnancy occurs within the ovary and on the corpus luteum, usually with rupture and massive bleeding. It is frequently misdiagnosed as a ruptured corpus luteum and the differentiation may be made only by micoroscopic examination of a tissue specimen. We have experienced four cases of ovarian pegnancy, which are presented with a brief review in the literature.

Migrational Behavior of Human Melanoma towards Polymeric Chemoattractants

( Kyu Nam Park ),( Han Joon Kim ),( Jung Hee Wee ),( Who Kyong Lee ),( Heung Jae Chun ),( Ju Woong Jang ),( Richard B Beard ) 한국조직공학·재생의학회 2008 조직공학과 재생의학 Vol.5 No.4

In order to understand the molecular mechanisms of chemotaxes through reactive oxygen species(ROS), the polymeric chemoattractants with free radical generating compounds were prepared, and the migrational behavior of melanoma cells towards the samples was investigated using a Boyden chamber assay. The samples with quinoid compounds had an enhanced melanoma cells migration than control. The migrational abilities of cells were further increased when the free radicals on the surface of samples were activated with blood plasma.

In Vitro and In Vivo Biocompatibility of r-ray Crosslinked Gelatin-Poly(vinyl Alcohol) Hydrogels

( Kyoung Hee Seo ),( Su Jung You ),( Heung Jae Chun ),( Chun Ho Kim ),( Who Kyong Lee ),( Yoon Mook Lim ),( Young Chang Nho ),( Ju Woong Jang ) 한국조직공학·재생의학회 2009 조직공학과 재생의학 Vol.6 No.4

Previously cross-linked hydrogels for three dimensional scaffold were made from a mixture of poly(vinyl alcohol)(PVA) and gelatin using a 60Co r-ray irradiation technique. These hydrogels exhibited desirable physical properties as the 3D constructs for diploid cell cultures. The cell adhesion in the hydrogels increased upon increasing the gelatin content. In addition, the cells cultured in gelatin containing hydrogels showed the improved spreading ability and growth ratio. As a continuation study, biocompatibility profiles of gelatin-poly(vinyl alcohol) hydrogels were investigated in vitro and in vivo, in accordance with the ISO 10993-5. Test results were cpmapred to polyurethane(PU) as a positive control and low-density poly ethylene(LDPE) as a negative control.Although the results have small differences with respect to the gelatin contents, all samples showed negligible toxicity to the cells and tissues.

난소의 낭성 기형종에서 발생한 편평상피세포암 1 예

박병도 ( Byung Do Park ),황진석 ( Jin Seok Hwang ),정후곤 ( Who Kon Jeung ),허정수 ( Jeong Soo Heo ),정봉진 ( Bong Jin Jeung ),이기수 ( Kee Soo Lee ),박연진 ( Yeun Jin Park ),주경란 ( Kyong Ran Zoo ) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7

Mature cystic teratoma of the ovary is the most common ovarian germ cell neoplasm comprising (10-20%) of all ovarian tumors and almost always benign, but it can be developed into malignancy rarely. We have recently experienced one case of squamous cell carcinoma arising in mature cystic teratoma of the right ovary in 67-year-old postmenopausal woman. The ovarian tumor was measured 17 X 12.5 X 8 cm in size and had not intact capsule, and the peritoneal washing cytology was positive. The survival rate with cancerous dernoid is very poor. Neither of two forms of postoperative treatment (radiotherapy and chemotherapy) has any significant influence on survival. We report above case with a brief review of literature.

Polymorphonuclear Leukocytes Adhesion onto Polymeric Charge Carriers

( Hae Kwan Park ),( Chong Won Park ),( Su Jung You ),( Heung Jae Chun ),( Chun Ho Kim ),( Who Kyong Lee ),( Ju Woong Jang ),( Young Bock Shim ) 한국조직공학·재생의학회 2009 조직공학과 재생의학 Vol.6 No.4

A series of PP-g-AAc-AAm of different charge levels were prepared as the polymeric charge carrier, and the adhesion of PMNs to the prepared surface as well as the effects of serum proteins on PMNs adhesion were studied systematically. The samples enhanced PMNs adhesion in the order of PP-g-AAc1-AAm4, PP-g-AAc2-AAm3, PP-g-AAc3-AAm2, and PP-g-AAc4-AAm1, eg., PMNs adhesion increased with increase in the positive charge of the substrates. From this, the charge interaction between the PMNs and the substrates seems to be the dominantfactor in the PMNs adhesion. However, the results from SDS-PAGE and the immuno-blotting showed that the adsorption of proteins, especially immune proteins, also increasedwith increase in the positive charge of the samples. In addition, PMNs adhered to the samples show the spreading behavior which is uncommon phenomenon for the cells tightly adhered by strong charge interaction. Therefore, it is concluded that the immune proteins bound to the samples enhances PMNs adhesion by increasing PMNs chemotaxis.

Human Melanoma Cells Adhesion on the Surface of Polymeric Chemoattractants

( Heung Jae Chun ),( Ju Woong Jang ),( Han Joon Kim ),( Kyu Nam Park ),( Jung Hee Wee ),( Who Kyong Lee ),( Anthony Addison ),( Richard B. Beard ) 한국조직공학·재생의학회 2008 조직공학과 재생의학 Vol.5 No.4

Two dimensional(2-D) polymeric matrices with free radical generating quinoid compounds, hydroquinone- grafted-polypropylene(HQ-g-PP) and vitamin-K1-grafted-polypropylene(VK1-g-PP), were prepared by a liquid phase photo-grafting technique, and the adhesion of primary(WM 793) and metastatic(WM 1205) human melanoma cells to prepared surfaces was investigated. Grafting of polar groups in VK1and HQ increased surface tension of PP matrices from 27 dyne/cm to 39 dyne/cm, resulting in decreased protein adsorption. In addition, electron paramagnetic resonance(EPR) spectra showed that the matrices generated free radicals at the interface when in contact with serum. Both WM 793 and WM 1205 cells showed an enhanced adhesion to the prepared samples compared to the control PP. The adhesion of metastatic melanoma cells onto the polymeric matrices was more pronounced than that of primary melanoma cells. VK1-g-PP with twice as many free radical generating groups in a unit graft yield as HQ-g-PP had a greater cell adhesion. The number of cells adhered to the surface of the polymeric chemoattractants increases with increase in the content of free radicals at the interface.