코곁굴 암종 환자의 안과적 임상양상에 대한 고찰

강일봉,태경,이윤정 대한안과학회 2009 대한안과학회지 Vol.50 No.10

Purpose: To investigate ocular complications that occur after orbital preservation surgery for paranasal malignancies and to identify the early clinical features of ophthalmic manifestations in paranasal malignancy patients. Methods: We reviewed the clinical charts of patients following ophthalmic consultation after orbital preservation surgery for paranasal malignancies. We also investigated the early clinical features of ophthalmic manifestations in patients with paranasal malignancies. Results: In our study, 54 patients had paranasal malignancies. Among them, 41 had undergone orbital preservation surgery, and 19 patients sought an ophthalmology consultation. There were seven patients who presented with eye symptoms caused by paranasal malignancies before the diagnosis. Paranasal malignancies included squamouscell carcinoma (13 cases), adenocarcinoma (3 cases), plasmocytoma (1 case), malignant schwannoma (1 case), and undifferentiated carcinoma (1 case). The locations of the origin of the tumor included the maxillary sinus (16 cases) and the ethmoid sinus (3 cases). The most common eye symptoms after orbital preservation surgery were enophthalmos, lid retraction, tearing, strabismus, inflammation, dry eyes, and cataracts, in order of frequency. Patients who visited the ophthalmic clinic due to paranasal malignancies had eye symptoms such as proptosis, nonspecific ocular pain, strabismus, tearing, eyelid swelling, and relative afferent pupillary defects, in order of frequency. Conclusions: Ocular complications were more common if the paranasal malignancy had invaded the orbital bone. However, many of the patients with disease invasion of the periosteum had no nasal or ocular symptoms upon presentation. Therefore, these patients should be managed carefully since symptoms may initially be vague and nonspecific. 목적: 코곁굴 암종의 절제술 시 남아있는 안구 및 안와의 합병증을 조사하고 안증상을 초기 주소로 내원 시 임상적 특징에 대해 알아보았다. 대상과 방법: 코곁굴 암종으로 안구보존종양절제술을 시행 받은 환자들 가운데 안과 협진을 받았거나 안증상을 초기 증상으로 내원한 환자들에 대해 의무기록을 후향적 분석하였다. 결과: 코곁굴 암종으로 진단 받은 54명 중 안구보존종양절제술을 받은 환자는 총 41명이고 이중 안과 협진을 받은 환자는 19명, 안과를 초기 증상으로 내원한 환자는 7명이었다. 암종의 종류는 편평세포암 13예, 선암종 3예, 형질세포종 1예, 악성신경초종 1예, 미분화암종 1예였고 원발부위는 위턱굴이 16예, 벌집굴이 3예였다. 이비인후과 수술 후 안증상으로 안과 협진을 받은 환자의 주증상은 안구함몰, 눈꺼풀이상, 눈물흘림, 염증, 건조증, 사시, 백내장 등이고 안증상을 초기 증상으로 내원한 경우의 주증상은 안구돌출, 안구통증, 사시, 눈물흘림, 눈꺼풀 부음, 구심성 동공장애 등이었다. 결론: 코곁굴 암종은 안와골을 침범할수록 안과적 합병증 발생 확률이 높았으며 코 증상 없이 안과 증상으로 내원 시 증상이 비특이적이라서 각별한 주의가 요구된다.

사체를 이용한 아래눈꺼풀지방의 해부학적 연구

이윤정,강일봉,신선영,백두진,Yoon Jung Lee,M,D,Il Bong Kang,M,D,Sun Young Shin,M,D,Doo Jin Paik,M,D 대한안과학회 2007 대한안과학회지 Vol.48 No.7

Purpose: This study investigated the anatomy of infraorbital fat and the relationship between surrounding structures and infraorbital fat. Methods: Forty-one orbits from adult Korean cadavers were dissected. Among them 20 orbits were male and 21 orbits were female. The cadavers were perfused and embalmed in formalin solution. The skin and orbicularis oculi muscle were dissected to expose the arrangement and compartments of infraorbital fat. A punctal probe was used to find a deeper fat compartment lying under the another compartment. The width of each compartment and the distances from the inferior orbital rim and from the lower lid margin to the topmost point of each compartment were measured using a digital caliper. The distance from the top of the medial compartment and lower lid margin to the first appearance of the inferior oblique muscle, located between the medial and the central fat compartments, were measured, respectively. Results: The width of the medial compartment was 11.49±2.54 mm, the central compartment was 21.78±5.69 mm, and the lateral compartment was 17.94±4.99 mm. The distance from the inferior orbital rim to the medial compartment was 8.13±2.72 mm, to the central compartment was 9.91±3.44 mm, to the lateral compartment was 9.58±3.76 mm. The distance from the lower lid margin to the medial compartment was 5.55±1.22 mm, to the central compartment was 7.09±3.22 mm, and to the lateral compartment was 5.41±3.07 mm. The distance from the inferior oblique muscle to the medial compartment was 9.09±2.63 mm, and to the lower lid margin was 13.60±2.27 mm. Conclusions: Our study evaluates the normal anatomy of the infraorbital fat compartments in Korean patients and suggests a useful index for lower blepharoplasty and lower orbital surgery.

백내장수술 후 시력예측을 위한 조명식 근거리 카드의 예측도

강성민,강일봉,김준현,Sung Min Kang,Il Bong Kang,Joon Hyun Kim 대한안과학회 2006 대한안과학회지 Vol.47 No.10

Purpose: To determine the accuracy of predicting potential visual acuity in cataract using the illuminated near card (INC). Methods: Thirty-nine eyes (34 patients) having cataract were studied prospectively by comparing the postoperative distance Snellen acuity to the visual acuity (VA) obtained preoperatively using the INC viewed through a pinhole. Results: The INC predicted postoperative acuity within two Snellen lines in 20 of 39. The accuracy between predicted and achieved acuities was follows: 61.5% in patients with a preoperative acuity of better than 0.3, 53.8% of better than 0.1, 50.0% of better than 0.05 and 28.6% of worse than 0.05. The disparity between INC results and postoperative VA was 3.89 lines (cortical opacity, nucleosclerosis, subcapsular opacity), 2.48 lines (cortical and subcapsular opacity), 2.08 lines (cortical opacity, nucleosclerosis), 1.8 lines (nucleosclerosis only), 3.3 lines (nucleosclerosis, subcapsular opacity), 1.6 lines (subcapsular opacity) and 3.0 lines (the others). Conclusions: The INC is easy to use and is a fast and accurate measurement instrument for predicting postoperative VA after cataract operation.

비안와두부형 뮤코르진균증의 임상양상 3예

송유미,강일봉,신선영,Yoo Mi Song Il Bong Kang,Sun Young Shin 대한안과학회 2007 대한안과학회지 Vol.48 No.4

Purpose: To report upon several cases of rhino-orbito-cerebral mucormycosis with variable clinical manifestations including ocular symptoms. Methods: We documented three patients with rhino-orbital-cerebral mucormycosis and uncontrolled diabetes. Results: The patients presented variable ophthalmic symptoms including blepharoptosis, ophthalmoplegia, visual disturbance, visual field defect and ocular pain. Despite administration of an antifungal agent within two days, all of the patients died. Conclusions: We reported the cases of three patients with rhino-orbito-cerebral mucormycosis presenting ophthalmic symptoms with a literature review. Variable initial symptoms were emphasized in making diagnosis of rhino-orbito-cerebral mucormycosis.

위눈꺼풀 성형술 후 눈꺼풀계측치의 변화

이윤정,강일봉,김준현,Yoon Jung Lee,Il Bong Kang,Joon Hyun Kim 대한안과학회 2007 대한안과학회지 Vol.48 No.3

Purpose: To evaluate the morphological changes in the external eyes after upper blepharoplasty. Methods: Twenty-six eyes of 13 patients undergoing upper blepharoplasty from May 2002 to May 2003 were selected. All surgeries were performed by one surgeon. MRD1, MRD2, interpalpebral fissure height, and levator function test were each measured twice, and the averages were calculated. Likewise, significant changes were checked before and after the operation. The subjects were divided into two groups. For group A (n=12), a double line suture was stitched at the levator aponeurosis, which was directly superior to the tarsal plate. In group B (n=14) the suture was stitched at a levator aponeurosis 3 mm superior to tarsal plate. The delta levator function (postoperative mean levator function minus preoperative mean levator function) measurements were calculated and compared between the two groups. Results: The MRD1 was 2.04±0.75 (mean±SD) before the operation, and 2.0±0.81 after the operation. MRD2 was 5.23±0.75 before the operation, 5.35±0.54 after operation. Interpalpebral fissure height was 7.27±0.38 before the operation and 7.35±0.63 after the operation. There were no statistically significant factors before and after the operation in MRD1, MRD2 and interpalpebral fissure height. The levator function was 14.04±1.80 before versus 16.19±1.58 after. This increase was statistically significant (p<0.01, Wilcoxon signed ranks test). The delta levator function was 1.58±0.90 for group A and 1.96±1.36 for group B. Conclusions: After upper blepharoplasty, the measurement of levator function increased significantly.