간헐외사시에서 외직근 후전 후의 속발내사시

나경익,이주연,Kyeong Ik Na,Joo Yeon Lee 대한안과학회 2012 대한안과학회지 Vol.53 No.9

Purpose: To evaluate the progress and outcome of consecutive esotropia after surgery for intermittent exotropia. Methods: The authors investigated the risk factors, changes in the angle of esodeviation and treatment outcome in consecutive esotropia after lateral rectus muscle recession for intermittent exotropia in 196 patients. Results: Consecutive esotropia occurred in 25 patients (12.8%). The patients underwent more frequent combined muscle surgeries on vertical and oblique muscles (p = 0.001) and had a greater amount of immediate postoperative overcorrection than subjects without consecutive esotropia. There was no significant difference with the incidence of overcorrection greater than 17 PD between the 2 groups with and without consecutive esotropia. There was no difference with the immediate postoperative overcorrection between the 6 cases that required surgery for their consecutive esotropia and the cases that recovered from their consecutive esotropia with conservative treatment. The former showed increasing esodeviation and maximum angle at average postoperative month 29.5. In the latter, esodeviation tended to decrease and showed maximum angle at average postoperative month 4.3. Finally, esotropia disappeared and good stereoacuity was obtained in both cases. Conclusions: Although subjects with consecutive esotropia had a greater immediate postoperative overcorrection than subjects without consecutive esotropia, the progress and outcome of consecutive esotropia following the initial overcorrection were not predictable. Consecutive esotropia after surgery for intermittent exotropia showed good overall outcome and well‐preserved stereoacuity after treatment. J Korean Ophthalmol Soc 2012;53(9):1318-1323

특발성 망막전막의 유리체 절제술 후 시력과 망막두께의 장기변화 관찰

황덕진,나경익,권순일,박인원,Duck Jin Hwang,MD,Kyeong Ik Na,MD,Soon Il Kwon,MD,In Won Park,MD,PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.3

Purpose: To evaluate the clinical outcomes of visual acuity and foveal thickness after vitrectomy for an idiopathic epiretinal membrane (ERM). Methods: We retrospectively reviewed the records of 62 patients (62 eyes) with ERM who had been treated with vitrectomy between 2004 and 2009. Visual acuity and central macular thickness from optical coherence tomography imaging were obtained preoperatively and at every postoperative follow-up visit. Results: Mean preoperative visual acuity and central macular thickness were 0.495 ± 0.292 log MAR and 414.645 ± 95.528 μm, respectively. Mean visual acuity and central macular thickness 1 month after surgery were 0.389 ± 0.373 log MAR and 341.484 ± 73.676 μm, respectively. Visual acuity improved within 9 months and central macular thickness significantly decreased 12 months after surgery. Most of the changes in visual acuity and central macular thickness took place during the first 3 months. The only parameter which was significantly correlated with final visual acuity was preoperative visual acuity (0.635) (p < 0.001). Conclusions: Visual acuity and central macular thickness improved 12 months months after vitrectomy in patients with idiopathic ERM. Preoperative visual acuity had a significant correlation with final visual acuity. J Korean Ophthalmol Soc 2012;53(3):434-439

전신마취 후 발생한 양안 급성폐쇄각녹내장에 동반한 비동맥염 앞허혈시신경병증

박동희(Donghee Park),나경익(Kyeong Ik Na) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.4

Purpose: To report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) following acute angle closure glaucoma (AACG) after general anesthesia. Case summary: A 65-year-old woman, who had had open reduction and internal fixation under general anesthesia for her right femur fracture, presented with a 2-day history of visual loss in both eyes. Best corrected visual acuity was finger count and intraocular pressure (IOP) was 40 mmHg in her both eyes. There were diffuse corneal edema and shallow peripheral anterior chamber under slit lamp examination, and fundus examination revealed a swollen optic disc in both eyes. With no lesion found in emergent brain magnetic resonance imaging, optical coherence tomography (OCT) showed diffuse retinal nerve fiber layer (RNFL) thickening. She started glaucoma medications for lowering IOP and laser iridotomy was performed in her both eyes. Two months later, optic disc swelling was improved but OCT showed diffuse RNFL thinning in both eyes and peripheral visual field defects remained in the visual field test. Conclusions: Either stress by general anesthesia or several drugs given after the operation can be attributed to bilateral AACG. Acute rises in IOP may lead to bilateral NAION by decreasing optic nerve head perfusion pressure, which results in ischemia of the optic disc.

원시에서 연령에 따른 소아안과적 임상소견의 비교

임지원(Ji Won Lim),최정훈(Jeong Hoon Choi),나경익(Kyeong Ik Na),이주연(Joo Yeon Lee) 대한검안학회 2012 Annals of optometry and contact lens Vol.11 No.1

목적: 원시에 의해 나타나는 안과적 소견들이 연령대별로 어떠한 차이가 있는지 알아보고자 하였다. 대상과 방법: 만 4∼20세 사이의 원시 환자 144명의 임상 기록지를 통해 총 296회의 검사결과 자료를 검사연령에 따라 4세, 6세, 9세, 12세의 네 군으로 분류하였다. 그리고 이들에서 원시 정도, 부등시, 사시 및 약시유무, 입체시력 등의 소견을 분석하였다. 결과: 군별 원시 정도 및 사시 유병률은 차이가 없었다. 사시 종류는 조절내사시가 가장 많았으나 연령대가 높을수록 조절내사시 비율이 줄고 외사시와 미세사시가 많았다(p=0.047). 높은 연령대일수록 약시와 입체시 저하를 보이는 비율은 감소하였다(p=0.016, p=0.001). 저연령군(4세, 6세)에서는 사시유병률이 약시유병률의 관련 인자였으나(p=0.03), 고연령군(9세, 12세)에서는 사시유무가 아니라 사시의 종류가 약시 및 입체시 저하에 경계성의 또는 유의한 연관 인자였다(p=0.053, p=0.033). 약시환자와 입체시가 낮은 환자에서 다른 환자들에 비해 조절내사시 비율은 줄고 외사시나 한눈주시증후군의 비율은 증가하였다(p=0.053, p=0.001). 결론: 고연령 원시환자에서도 평균 원시정도는 저연령에 비해 낮지 않았다. 고연령 원시환자에서 약시와 입체시력은 많이 개선되지만 남아있는 약시와 입체시 저하는 특히 외사시 및 미세사시(한눈주시증후군)와 연관되었다. Purpose: To evaluate the clinical features in children with hyperopia according to age difference. Methods: Clinical datas from 296 visits in 144 patients with hyperopia were obtained retrospectively. We divided the datas into four groups; 4 years, 6 years, 9 years and 12 years. The degree of hyperopia, the prevalence of anisometropia and amblyopia, the prevalence and type of strabismus and stereopsis were analyzed. Results: In the degree of hyperopia and the prevalence of strabismus there were no differences between the four groups. The proportion of accommodative esotropia that was the most common type of strabismus decreased and the proportion of exotropia and microtropia increased in older groups (p=0.047). The prevalence of amblyopia and poor stereopsis fell in older groups (p=0.016, p=0.001). The prevalence of strabismus amblyopia is associated with the prevalence of amblyopia in the groups of 4 and 6 years (p=0.03). The type of strabismus showed borderline or significant association with the prevalence of amblyopia and poor stereoacuity (p=0.053, p=0.033) in the groups of 9 and 12 years, but the prevalence of strabismus didn’t. The proportion of accommodative esotropia was lower and that of exotropia and microtropia was higher in patients with amblyopia (p=0.053) or poor stereoacuity (p=0.001) than in the rest of patients. Conclusions: Mean degree of hyperopia in older children was not different from younger children under 8 years old. Amid improvement of the ambryopia and streoacuity, persistent amblyopia and poor stereoacuity tended to be associated with exotropia and microtropia (monofixation syndrome) in older children.

백내장수술을 받은 만성 신부전 환자의 혈액투석 전후 심한 안압 변동 1예

주찬웅(Chan Woong Joo),박성표(Sung Pyo Park),나경익(Kyeong Ik Na) 대한검안학회 2021 Annals of optometry and contact lens Vol.20 No.4

목적: 백내장수술 시행 후 혈액투석 전후로 심한 안압 변동을 보인 만성 신부전 환자 1예를 보고하고자 한다. 증례요약: 만성 신부전으로 혈액투석 중인 51세 여자 환자가 양안 증식당뇨망막병증 및 우안 백내장으로 경과 관찰을 하던 중 우안시력저하를 주소로 내원하였다. 우안 백내장에 대해 수정체유화술 시행 중 섬모체소대 해리와 후낭파열이 발생하였고, 섬모체고랑인공수정체삽입술을 시행하였다. 수술 후 3일째 혈액투석 후 환자는 두통을 동반한 우측 안통을 호소하였고, 우안 안압이 44 mmHg 로 상승하였으며 안구전방 내 경도의 염증과 하측 전방각의 수정체 잔류물이 확인되었다. 안압하강제 투여, 전방천자 및 전방세척으로 환자의 주관적 증상 호전과 함께 안압은 낮아졌으나, 이후에도 혈액투석 후 위와 같은 증상을 동반한 심한 안압상승이 재차 발생하였다. 백내장수술 후 1개월까지 혈액투석 전후로 안압 변동이 반복되어 안압하강수술을 고려하였으나 이후 안압이 안정되어 경과 관찰하였다. 결론: 만성 신부전으로 혈액투석을 받는 환자의 백내장수술 후 수정체 잔류물 및 잔여 점탄물질로 인한 염증과 방수유출능의 감소가 혈액투석 전후의 심한 안압 변동의 원인이 될 수 있다. Purpose: To report a case of severe intraocular pressure fluctuation following hemodialysis after cataract surgery in a patient with chronic renal failure. Case summary: A 51-year-old female patient on hemodialysis for chronic renal failure, who was seen regularly by our retina clinic for proliferative diabetic retinopathy and right eye cataract, presented with decreased visual acuity in her right eye. During phacoemulsification under the diagnosis of right eye cataract, zonular dialysis and posterior capsule rupture occurred and intraocular lens ciliary sulcus insertion was performed. Following hemodialysis 3 days after the surgery, the patient complained of headache and right eye pain. The intraocular pressure of the right eye had increased to 44 mmHg. Mild inflammation in the anterior chamber was found with remnant lens material present at the inferior anterior angle. The use of glaucoma eye drops, anterior chamber paracentesis, and anterior chamber irrigation reduced the intraocular pressure and improved the patient’s symptoms. However, a severe increase in intraocular pressure recurred with the above symptoms, again following hemodialysis. Intraocular pressure fluctuation was repetitively present after serial hemodialysis treatments for 1 month, at which point cataract and glaucoma surgeries were considered. However, the intraocular pressure stabilized afterwards; thus, the patient remained under observation and was treated with glaucoma eye drops. Conclusions: Inflammation and a decrease in the aqueous outflow facility due to remnant lens material and the use of an ophthalmic viscoelastic device in cataract surgery may cause severe intraocular pressure fluctuations in patients undergoing hemodialysis for chronic renal failure

녹내장과 비동맥염 앞허혈시신경병증의 진단에서 망막신경섬유층유두비의 유용성

박동희(Donghee Park),최연주(Youn Joo Choi),박성표(Sung Pyo Park),나경익(Kyeong Ik Na) 대한안과학회 2022 대한안과학회지 Vol.63 No.2

목적: 개방각녹내장과 비동맥염 앞허혈시신경병증의 감별진단에서 망막신경섬유층 두께, 브루크막 개방 최소 시신경유두테 폭, 브루크막 개방 최소 시신경유두테 넓이, 망막신경섬유층유두비의 진단력을 비교하였다. 대상과 방법: 시신경유두 크기와 평균 망막신경섬유층 두께를 일치시킨 개방각녹내장과 비동맥염 앞허혈시신경병증 각 23안과 시신경유두 크기를 일치시킨 정상안 23안을 후향적으로 분석하였다. 망막신경섬유층 두께, 브루크막 개방 최소 시신경유두테 폭, 브루크막 개방 최소 시신경유두테 넓이, 망막신경섬유층유두비를 분석하였으며 area under receiver operating characteristic curve (AUC)로 진단력을 비교하였다. 결과: 평균 브루크막 개방 최소 시신경유두테 폭과 총 브루크막 개방 최소 시신경유두테 넓이는 개방각녹내장군이 다른 두 군에 비해 유의하게 작았다(모두 p<0.001). 망막신경섬유층유두비는 개방각녹내장군, 정상안군, 비동맥염 앞허혈시신경병증군 순으로 큰 값을 가졌다(p<0.001). 개방각녹내장과 비동맥염 앞허혈시신경병증을 감별하기 위한 AUC는 하이측 브루크막 개방 최소 시신경유두테 폭이 0.987, 총 브루크막 개방 최소 시신경유두테 넓이가 0.996, 망막신경섬유층 유두비가 1.000으로 하이측 망막신경섬유층 두께의 0.811에 비해 유의하게 컸다(각 p=0.005, p=0.006, p=0.006). 결론: 망막신경섬유층유두비는 개방각녹내장과 비동맥염 앞허혈시신경병증의 진단에서 기존 지표들과 함께 유용하게 이용될 수 있다. Purpose: To evaluate the diagnostic value of retinal nerve fiber layer-to-disc ratio (RDR) compared to established parameters including retinal nerve fiber layer thickness (RNFLT), Bruch membrane opening-minimum rim width (BMO-MRW), and Bruch membrane opening-minimum rim area (BMO-MRA) for differentiating between open angle glaucoma (OAG) and nonarteritic anterior ischemic optic neuropathy (NAION). Methods: This retrospective study included 23 optic disc size-matched normal control eyes and 23 OAG and NAION eyes matched according to global RNFLT. The RDR, RNFLT, BMO-MRW, and BMO-MRA were analyzed; the diagnostic capabilities of these parameters were compared using the area under the receiver operating characteristic curve (AUC). Results: The global BMO-MRW and total BMO-MRA were lower in the OAG group than in the other two groups (all p < 0.001). RDR was greatest in the OAG group, followed by the healthy and NAION groups (p < 0.001). Between the OAG and NAION groups, the AUCs for temporal inferior BMO-MRW, total BMO-MRA, and RDR were 0.987, 0.996, and 1.000, respectively; these were greater than the temporal inferior RNFLT (0.811; p = 0.005, p = 0.006, and p = 0.006, respectively). Conclusions: RDR could be one of the useful parameters for differential diagnosis in OAG and NAION.