결막하 림프관의 관찰과 그 의미

김지택,김재훈,김재찬,Jee Taek Kim,Jae Hoon Kim,Jae Chan Kim 대한안과학회 2008 대한안과학회지 Vol.49 No.8

Purpose: To observe and characterize subconjunctival lymphatics in patients with subconjunctival hemorrhages. Methods: Patients who visited our clinic with subconjunctival hemorrhage resulting from ocular trauma, or subconjunctival injection of gentamicin and betamethasone during a cataract operation, were included in this study. Subconjunctival hemorrhages and subconjunctival lymphatics were observed using slit lamp biomicroscopy. Results: Apparent dilated lymphatics were found in one patient with subconjunctival hemorrhage after rubbing of the eye; thin lymphatics were found in 10 patients with traumatic subconjunctival hemorrhages; and apparent dilated lymphatics were found in 10 patients after subconjunctival injection. Slit lamp biomicroscopy using a green filter allowed easy visualization of subconjunctival lymphatics. Conclusions: Subconjunctival lymphatics, which are not visible in normal ocular conditions, are evident on subconjunctival hemorrhages, especially after subconjunctival drug injection. J Korean Ophthalmol Soc 49(8):1215-1219, 2008

저시력 환자의 삶의 질에 관한 연구

김지택,문남주,Jee Taek Kim,Nam Ju Moon 대한안과학회 2007 대한안과학회지 Vol.48 No.9

Purpose: To Carry out a low vision quality of life questionnaire and to evaluate subjective quality of life of low-vision patients. Methods: The subject were 250 patients whose visual acuity was between hand motion and 0.3 among the patients at our clinic. The normal control group included 60 patients. After a review of the literature, we selected a useful questionnaire to assess quality of life in low vision patients and translated the questionnaire into Korean. The questionnaire used had 25 items concerning low vision and each question was multiple-choice, and the sum of the total points was used to assess of the quality of life. Results: The range of scores was from 0 to 125 points (the higher the score, the higher the quality of life). Fifty-one patients among 250 patients in the low vision group replied to our questionnaire. Fifty patients among 60 patients in the control group replied. The average low vision quality of life (LVQOL) score for patients with low vision (67.3±26.7) was significantly lower than the average score of those with normal vision (114±9.72). There was no statistically significant difference between the average score of patients questioned by mail versus telephone Conclusions: The score of low vision patients was significantly lower than that of the control group, so this questionnaire can be applied to low vision patients specifically to evaluate quality of life. Optimally, the the questionnaire shoud be administered before and after the low vision consultation. The comparision of prerehabilitation score with postrehabilitation score might be helpful to evaluate the quality of life in a post rehabilitation state.

백내장 수술후 발생한 엔테로코코스 페칼리스 안내염 증례보고 1예

김지택,이정규,문남주,조호균.Jee Taek Kim. M.D.. Jeong Kyu Lee. M.D.. Nam Ju Moon. M.D.. Ho Kyun Cho. M.D. 대한안과학회 2006 대한안과학회지 Vol.47 No.11

Purpose: To report a case of Enterococcus faecalis endophthalmitis which occurred two days after phacoemulsification and posterior chamber intraocular lens implantation. A vitrectomy performed during the early stage of infection showed retinal and vitreous presentation. We report the clinical manifestation, operative findings, and treatment of this pathogen. Methods: A healthy, 71-year-old female, presented with a sudden loss of vision and eyeball pain two days after phacoemulsification and intraocular lens implantation. As inflammation of the anterior chamber and vitreous cavity progressed rapidly, we performed intravitreal antibiotics injection (Amikacin, 0.4 mg/0.1 ml, Vancomycin, 1 mg/0.1 ml). Since this was ineffective, pars plana vitrectomy, silicone oil tamponade, and intravitreal antibiotics injection (Vancomycin, 1 mg/0.1 ml) were performed. During the procedure, we noted that the vitreous humor was cloudy and apparently filled with pus. We also noted an edematous retina with hemorrhages and necrotic changes. Enterococcus faecalis was identified on vitreous and aqueous fluid culture. Results: Twelve weeks after vitrectomy, her corrected visual acuity was hand motion and there was no evidence of recurrence.

당뇨환자에서 빛간섭단층촬영을 이용한 시신경 유두 및 망막신경섬유층의 형태학적 분석

김지택,이정규,문남주,조호균,Jee Taek Kim,Jeong Kyu Lee,Nam Ju Moon,Ho Kyun Cho 대한안과학회 2008 대한안과학회지 Vol.49 No.6

Purpose: Retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) in diabetic patients with normal tension were analyzed using optical coherence tomography (OCT), which revealed that diabetes induce morphologic changes in optic disc and RNFL thickness. Methods: A total of 192 patients with type 2 diabetes were analyzed with fundus examination and classified as having normal retina, mild - moderate, severe nonproliferative retinopathy (NPDR), or proliferative retinopathy (PDR). These patients were evaluated with OCT and compared with normal control group. Results: The mean average thickness and nasal average thickness of RNFL in mild-moderate, and severe NPDR groups decreased compared with those of the other groups. There was an increase in the temporal average thickness of RNFL in the PDR group. As the duration of diabetes increased, the mean average and nasal average of RNFL thickness also decreased. The severity of diabetic retinopathy didn’t show statistically significant differences in a topographic analysis of the optic nerve head. Conclusions: The mean average thickness and nasal average of RNFL decreased in NPDR groups. Diabetic changes should be considered when diabetes patients are diagnosed with glaucoma or glaucoma progression. J Korean Ophthalmol Soc 49(6):935-941, 2008

비강과 구강점막 자가이식을 이용한 외안부재건술 1예

이석현,김재훈,김지택,전연숙,김재찬,Seok Hyun Lee,Jae Hoon Kim,Jee Taek Kim,Yeoun Sook Chun,Jae Chan Kim 대한안과학회 2008 대한안과학회지 Vol.49 No.7

Purpose: To report a case of ocular surface reconstruction using nasal and oral mucosa auto grafts on a man whose ocular surface was deformed by a chemical burn. Case summary: A 48-year-old man was injured when his right eye was exposed to alkali solution. He underwent fifteen operations, including amniotic membrane auto grafts and fornix reconstructions. However, his right eye still suffered from symble pharon, drying, corneal neovascularization, and erosion. We performed ocular surface reconstruction with free autologous nasal and oral mucosal transplantation and amniotic membrane graft. By one month after surgery, his eye showed no evidence of symble pharon or fibrovascularization recurrence on the cornea or conjunctiva. By six months after surgery, his ocular surface had stabilized. Conclusions: Ocular surface reconstruction with free autologous nasal and oral mucosal transplantation is a useful method on eyes that are injured by chemical burns. J Korean Ophthalmol Soc 49(7):1177-1182, 2008

대동맥판막치환술 후 발생한 푸르처 유사 망막병증

이승현(Seung Hyeun Lee),김지택(Jee Taek Kim) 대한안과학회 2021 대한안과학회지 Vol.62 No.3

목적: 맥락망막염이 동반된 세균성 심내막염 환자에서 대동맥판막치환술 시행 후 푸르처 유사 망막병증 소견을 보인 증례에 대해 보고하고자 한다. 증례요약: 균혈증 및 감염성 심내막염이 의심되는 52세 남자 환자가 로트반점 등의 안과적 소견 확인을 위해 의뢰되었다. 환자는 양안 전방 1단계의 염증, 안저의 침윤성 병변 및 로트반점을 동반한 맥락망막염 소견을 보였으며, 감염성 심내막염 확진되어 흉부외과에서 전신마취하 대동맥판막치환술을 시행받았다. 수술 후 시행한 안과 검진에서 양안 전방의 염증은 사라졌으며 안저의 침윤성 병변은 경계가 분명해지고 로트반점은 소실되어 맥락망막염은 호전된 것으로 판단하였다. 그러나 양안 시신경유두 주변 표층망막에 경계가 불분명한 다발성의 면화반 및 지연성 망막출혈, 시야검사상 중심암점이 새로 발견되었으며, 이는 푸르처 유사 망막병증의 소견에 합당하였다. 특이 치료 없이 경과 관찰하였으며 4개월 후 망막의 이상 소견은 소실되었다. 결론: 심장판막수술 후 푸르처 유사 망막병증과 같은 망막의 혈관 이상과 시야장애가 드물게 동반될 수 있음을 인지하여야 하며, 정확한 원인과 예후에 대해서는 추가적인 연구가 필요할 것으로 생각된다. Purpose: We report a case of Purtscher-like retinopathy after aortic valve replacement surgery. Case summary: A 52-year-old male with bacteremia suspicious of infectious endocarditis was referred to our department for ophthalmic examination. Inflammatory reaction was evident in both anterior chambers. Fundus examination revealed infiltrative lesions with a Roth spot, and the patient was diagnosed with chorioretinitis. After 3 days, aortic valve replacement surgery was performed in the cardiac surgery department using cardioplegic solutions. Ophthalmologic exams were repeated after the valve surgery. The Roth spot had disappeared and infiltrated, leaving a clear margin. An anterior chamber cell was not noted. However, there were newly developed peripapillary superficial cotton-wool spots and delayed hemorrhagic lesions. Based on the medical history and specific pathognomonic fundus findings, the patient was diagnosed with Purtscher-like retinopathy. Four months later, all characteristic funduscopic features of Purtscher-like retinopathy had disappeared, leaving a remaining retinal nerve fiber defect and central visual field defect without any ophthalmologic treatment. Conclusions: Although rare, doctors should be aware of the possibility of Purtscher-like retinopathy after valve replacement surgery. Further studies are needed to understand the unknown pathophysiology of Purtscher-like retinopathy.

급성 폐쇄각녹내장을 동반한 비전형적인 보그트-고야나기-하라다병 1예

최민규(Min Gyu Choi),전연숙(Yeoun Sook Chun),김지택(Jee Taek Kim) 대한안과학회 2018 대한안과학회지 Vol.59 No.10

목적: 급성 폐쇄각녹내장이 선행한 비전형적인 보그트-고야나기-하라다병 1예를 보고하고자 한다. 증례요약: 48세 여자가 4일 전부터 시작된 두통 및 안통을 동반한 양안 시력저하를 주소로 내원하였다. 환자는 10년간 경구용 피임약복용의 과거력 이외에 특이사항은 없었다. 타 병원에서 처방받은 안압하강제 사용 후 안압은 정상화되었으나 양안 전방의 깊이는 여전히 얕았고, 홍채-수정체 가로막이 전방으로 전위되어 있어 본원으로 진료 의뢰되었다. 본원에서 레이저홍채절개술 시행 후 전방의 깊이는 불완전하게 회복되었으나, 여전히 시력은 회복되지 않았으며 안구 초음파 검사에서 맥락막 삼출 소견을 확인하였다. 양안의 전안부 염증과 빛간섭단층촬영에서 황반부에 막구조물로 구획화된 장액망막박리가 관찰되었으나, 전형적인 보그트-고야나기-하라다병과는 달리 형광안저혈관조영술에서는 이와 일치하는 다발성의 형광 누출 소견은 보이지 않았다. 비전형적인 보그트-고야나기- 하라다병으로 진단하고 점안치료와 더불어 고용량 부신피질호르몬 요법 후 부신피질호르몬과 면역억제제를 경구 투여하였다. 1개월 뒤 장액망막박리는 소실되었고 3개월 뒤 시력은 호전되었으며 현재까지 재발 없이 경과관찰 중이다. 결론: 본 증례를 통하여 비전형적인 보그트-고야나기-하라다병의 초기 소견으로 급성 폐쇄각녹내장이 선행해서 나타날 수 있음을 경험하였다. 따라서 레이저홍채절개술을 비롯한 폐쇄각녹내장의 치료 시행 후에도 호전되지 않을 경우 보그트-고야나기-하라다병을 포함한 다른 질환의 동반 가능성을 반드시 염두에 두고, 추적관찰을 해야할 것이다. Purpose: To report a case of atypical Vogt-Koyanagi-Harada disease that occurred after an acute angle closure glaucoma attack. Case summary: A 48-year-old female presented with bilateral visual disturbance accompanied by headache and ocular pain. The patient had no specific past medical or family history except taking oral contraceptives for 10 years. Despite the normalization of intraocular pressure in a local clinic, a shallow-depth anterior chamber and forward displacement of the iris-lens diaphragm remained unresolved. The depth of the anterior chamber had increased in both eyes after laser therapy but without recovery of her visual acuity. B-scans showed ciliochoroidal effusion. Anterior chamber inflammation was observed in both eyes. Optical coherence tomography showed lobulated and serous retinal detachment involving the macula of both eyes. However, fluorescence angiography findings showed no multiple hyperfluorescence, which is unusual for typical cases of Vogt-Koyanagi- Harada disease. The patient was diagnosed with atypical Vogt-Koyanagi-Harada disease and was treated with eyedrops and intravenous steroid pulse therapy, after which she was converted to oral medications with immunosuppressants. After 1 month, no serous retinal detachment was detected. After 3 months, best corrected visual acuity (logMAR) was 0.0 in both eyes, and there has been no recurrence on follow-up. Conclusions: Atypical Vogt-Koyanagi-Harada disease at presentation can mimic acute attacks of angle closure glaucoma. Therefore, if there is no improvement after treatment for angle closure glaucoma including laser iridotomy, other diseases including Vogt-Koyanagi-Harada disease must be considered and the patient should be closely monitored.

미숙아에서 내안구염과 심내막염을 동반하여 급격히 진행된 MRSA 패혈증 1례

이정민 ( Jeong Min Lee ),황지혜 ( Ji Hye Hwang ),이대용 ( Dae Yong Yi ),이나미 ( Na Mi Lee ),김혜리 ( Hye Ry Kim ),윤신원 ( Sin Weon Yun ),채수안 ( Soo Ahn Chae ),임인석 ( In Seok Lim ),최응상 ( Eung Sang Choi ),김지택 ( Jee Taek 대한주산의학회 2015 Perinatology Vol.26 No.4

메티실린 내성 황색포도알균(Methicillin-resistant Staphylococcus aureus, MRSA)은 신생아중환자실에 중요한 감염의 원인 중 하나이다. MRSA 감염의 빠른 진단과 조기 치료는 예후에 큰 영향을 미친다. 또한 MRSA 패혈증은 항생제의 치료에도 불구하고 전신에 파종될 수 있으므로, 감염의 범위를 정확하게 평가해야 한다. 본 증례는 미숙아에서 빠른 항생제 치료에도 불구하고 급속도로 진행하여 내안구염과 심내막염의 합병증을 동반한 MRSA 패혈증 1예를 경험하여 이를 보고하는 바이다. Methicillin-resistant Staphylococcus aureus (MRSA) is a critical source of infections in neonatal intensive care units. Early diagnosis and treatment are important due to the significant morbidity of MRSA infection. MRSA sepsis can be disseminated despite antibiotics, therefore the extent of the infection should be evaluated. Common complications of MRSA sepsis include infective endocarditis, pneumonia, osteomyelitis, meningitis, septic shock.Urgent evaluation of other possible suppurative complications in neoate are necessary. Therefore echocardiogram, chest X-ray, ophthalmic examination, brain sonography and spinal tapping are needed. In this study, we present a case of MRSA sepsis in a preterm infant, accompanied by endophthalmitis and endocarditisin spite of the early diagnosis and treatment.